Abstract: Background: Reliable intraoperative tools for donor liver assessment are needed, particularly in the context of steatotic and extended-criteria grafts. While histology remains the reference standard, it is limited by sampling variability and logistical constraints. Preservation fluid may provide a complementary, whole-organ source of biochemical information. Methods: In this single-center prospective exploratory pilot study, liver tissue and preservation fluid were collected from 30 donation-after-brain-death grafts during the back-table procedure. Biochemical parameters, including arginase activity, β-hydroxybutyrate (βHB), acetoacetate, and total protein, were measured using standard assays. Associations with histological steatosis on wedge biopsy were assessed using nonparametric correlation analyses, and paired preservation-fluid samples were compared. Results: Most grafts demonstrated absent or mild steatosis; only two exhibited moderate steatosis, and none were severely steatotic. No preservation-fluid biomarker showed a statistically significant association with histological steatosis. Weak, non-significant positive correlations were observed for βHB and arginase activity (Spearman r ≈ 0.33–0.35). Protein concentration and arginase activity decreased between start and end samples, whereas ketone body levels remained relatively stable. Conclusions: Preservation-fluid biomarker measurement during routine graft preparation is feasible. Although no significant associations with histological steatosis were identified, the observed weak correlations suggest possible associations requiring validation in larger studies. Larger, adequately powered studies including a broader spectrum of steatosis and clinically relevant outcomes are required to determine potential clinical applicability.

Abstract: Background: Pregnancy-related transient osteoporosis of the hip (PR-TOH) is a rare and often underdiagnosed condition presenting with acute hip pain in late pregnancy or postpartum. Due to its nonspecific clinical presentation, it is frequently misinterpreted as common musculoskeletal or pelvic girdle pain, leading to delayed diagnosis and suboptimal management. Case Presentation: We report a rare case of bilateral PR-TOH in a 35-year-old primigravida diagnosed at 31+6 weeks of gestation. The patient presented with progressively worsening hip pain leading to severe mobility impairment. Initial investigations, including ultrasound and laboratory testing, were inconclusive. Definitive diagnosis was established by magnetic resonance imaging (MRI), demonstrating characteristic bone marrow oedema in both femoral heads. The patient was managed conservatively with analgesia, restricted weight bearing, and multidisciplinary care involving obstetrics, endocrinology, and orthopaedics. Pregnancy was successfully prolonged until 37+4 weeks, when caesarean section was performed due to clinical deterioration. Postpartum management included calcium and vitamin D supplementation and rehabilitation. Follow-up demonstrated significant improvement in bone mineral density on DEXA and complete clinical recovery at 12 months. Conclusions: PR-TOH should be considered in pregnant or postpartum women presenting with persistent hip pain and progressive functional limitation. Early use of MRI is essential for accurate diagnosis and differentiation from more common pregnancy-related conditions. Prompt recognition and multidisciplinary management are crucial to prevent complications and optimize maternal and obstetric outcomes.

Abstract: This study characterized standard biochars produced at 300, 400, and 500 °C alongside a locally made biochar (LBC, drum kiln method with newly devised method of Bababe) to assess fertilizer value and toxicity against IBI thresholds. Pyrolysis temperature strongly influenced properties: electrical conductivity and salt content increased with tempera-ture (BC300 and BC500 highest; LBC lowest). All standard biochars were highly alkaline (pH 10.26–10.57), while LBC was near-neutral (7.84). Maximum carbon content occurred at 300–400 °C (56.8–56.9 %). At 10 kg ha⁻¹, standard biochars supplied 308–331 kg ha⁻¹ K, with BC400 providing the highest Ca and Mg. LBC had the highest volatile micronu-trients (B, Cu, Fe, Mn), which decreased with rising temperature. It can be particularly well suited to fertilizer coating or blending systems, especially for salt-sensitive soils where application rates are kept low (< 10 t ha⁻¹), thereby limiting agronomic risks such as Mo contaminant loading. Nevertheless, molybdenum levels in all biochars were 5–8 times above IBI safe limits (5–75 mg kg⁻¹), posing toxicity risk at 10 t ha⁻¹ application. Cd was undetectable, reduced Pb by 90 % at 400–500 °C, and kept Ni and Pd within limits. SEM revealed BC400 had optimal honeycomb porosity and homogeneous mineral dis-tribution. BC400 is most suitable for agricultural fertilizer value, BC500 for carbon se-questration, BC300 for potassium supply, and LBC as a low-cost, low-salinity material. However, excessive molybdenum across all biochars relates feedstock composition as the paramount safety factor. The weakness and limitation of this studies lies in the resource constraints from use of one feedstock, absence of direct measurement of surface area and phosphorus, and absence of measurement of biochar stability.

Abstract: The number of human genetic variants cataloged in dbSNP has plateaued since 2021, with over ~1.1 billion variants housed. Since the human pangenome reference has enabled the precise identification of even structurally complex variants, capturing the entire spectrum of human genetic variants is almost achievable. However, the clinical impacts of most genetic variants still remain elusive. This is due to limitations in genome-wide association study (GWAS), the standard framework for variant interpretation, which relies solely on statistical assumptions. GWAS cannot interpret low‐frequency alleles and capture molecular interactions between variants, hindering its ability to explain complex traits and diseases. Recently, large language models (LLMs) enabled accurate inference of human genetic variants’ pathogenicity even without requiring a large sample size or prior annotations by modeling the biological principles encoded within the genome. For instance, Evolutionary Scale Modeling (ESM1b) successfully predicted missense variants in ClinVar, achieving an auROC of up to 0.905. In addition, Evo 2 classified non-coding pathogenic variants in ClinVar with an auROC of 0.987 for single nucleotide variants (SNVs) and 0.971 for non-SNVs. These results suggest that although yet limited to pathogenicity prediction, integrating multiomic and clinical data through LLM will enable the complete clinical interpretation of human genetic variants.

Abstract: Ammonia-oxidizing bacteria (AOB) are vital for the nitrogen cycle and wastewater treatment, yet their recalcitrance to isolation and cultivation hampers industrial application. To isolate an efficient strain and optimize its culture conditions for high-ammonia wastewater treatment, we collected water samples from a polluted river in Zhongshan City. After enrichment, a strain was isolated via gradient dilution and silica gel plating, identified by scanning electron microscopy and 16S rDNA sequencing as Nitrosomonas europaea W4 (99.93% similarity to the type strain). Single-factor medium optimization examined CaCO₃ and Fe²⁺/Fe³⁺, while temperature and initial ammonia nitrogen effects were tested, and landfill leachate was used for verification. CaCO₃ shortened the lag phase without affecting maximum specific growth rate; replacing Fe³⁺ with Fe²⁺ further reduced lag and enhanced the ammonia oxidation rate. Optimal growth occurred at 25–30 °C and an initial ammonia nitrogen concentration of ~2000 mg/L. In landfill leachate, the strain increased the ammonia degradation rate 6.3-fold. Overall, N. europaea W4 exhibits high ammonia oxidation efficiency, and the optimized medium and conditions improve its proliferation and metabolic stability, providing a basis for cultivation and application in treating high-strength ammonia nitrogen wastewater.

Abstract: Large language models (LLMs) increasingly require robust evaluation under realistic instruction-following conditions, particularly for fine-tuned task-specific adapters operating in multilingual environments. This study proposes a scenario-adaptive evaluation framework for assessing the reliability of fine-tuned text models across two application regimes: misinformation detection (disinfo) and knowledge-grounded factual biography generation (heroes). The framework integrates automated generation of balanced risk-oriented scenarios, bilingual evaluation in English and Ukrainian, the LLM-as-a-Judge paradigm, and multidimensional robustness analysis through the Alignment Robustness Index (ARI). Six LoRA-adapted models based on Qwen2.5-3B-Instruct, SmolLM2-1.7B-Instruct, and TinyLlama-1.1B-Chat-v1.0 were evaluated. The implemented pipeline generated 2052 scenarios and 6156 model responses, producing a final bilingual analytical subset of 4104 judged records. Experimental results show that task-specific adaptation produces task-dependent robustness profiles. In the disinfo case, Qwen2.5-3B achieved the strongest overall performance, combining the highest safety and classification accuracy. In contrast, the heroes case revealed a more compressed and multidimensional vulnerability space without a single dominant model. The results further demonstrate the importance of multilingual evaluation, as weaker adapters exhibited substantially larger cross-lingual safety gaps. Overall, the proposed framework provides a reproducible and practically applicable methodology for auditing fine-tuned language models under imperfect instructions.

Abstract: This research answers the knowledge gap regarding the explanation of the quantum jump of the electron. This scientific paper aims to complete Einstein’s research regarding general relativity and attempt to link general relativity to quantum laws.

Abstract: International communication scholarship has undergone a paradigmatic reorientation since 2000, yet the field's conceptual repertoire has expanded more rapidly than it has been theoretically integrated. This systematic literature review interrogates that fragmentation by mapping the trajectory of the field across the period 2000–2026 and assessing the extent to which its proliferating frameworks—cultural imperialism, hybridization, network society, platform imperialism, data colonialism, computational propaganda, sharp power, and algorithmic governance—constitute cumulative theoretical advancement or analytically incommensurable parallel vocabularies. Following PRISMA 2020 procedures (Page et al., 2021) and a thematic synthesis design (Thomas & Harden, 2008), the review consolidates peer-reviewed scholarship across seven major communication databases into seven thematic clusters: cultural globalization and media flows; comparative journalism and cross-national media systems; de-Westernization and decolonial currents; phantomization, digital sovereignty, and media infrastructures; disinformation, computational propaganda, and information disorder; soft power, public diplomacy, and affective strategic communication; and the integration of generative artificial intelligence into transnational communication. Three theoretical findings emerge. First, the apparent succession of paradigms from broadcast-era to platform-era frameworks is better understood as conceptual layering, in which power-asymmetric models persist in modified form rather than being displaced by network-based alternatives. Second, the field's longstanding tension between structural and agentic accounts has been reconfigured—but not resolved—by the platform turn, with infrastructural analysis emerging as a potential synthesizing register (Parks & Starosielski, 2015; Plantin & Punathambekar, 2019). Third, the persistent disjuncture between the field's de-Westernization commitments and its bibliometric realities (Demeter, 2020) is theoretically consequential, indicating that epistemic asymmetries function not as residual artifacts but as constitutive features of contemporary international communication knowledge production. A seventh identified gap—the under-theorization of affective dimensions of international communication—extends the review's analytic horizon to include emergent comparative work on emotion, civilizational rhetoric, and cross-border public engagement (Çelik, 2025; Hameleers & Garnier Ortiz, 2024; Wahl-Jorgensen, 2019). The review proposes a future research agenda centered on epistemic pluralism, methodological diversification, infrastructural and material analysis, and sustained engagement with planetary-scale technological change.

Abstract: This research examines how climate change intensifies urban heat stress, particularly in public spaces where mechanical cooling is impractical. A climate-driven, systems-level numerical model is developed to evaluate the pre-installation feasibility of portable, solar-powered misting canopies. Hourly Typical Meteorological Year data (TMYx, 2009–2023) are analyzed for each city to estimate photovoltaic (PV) energy yield, electrical load, potential misting duration, water demand, and PV-to-load autonomy under summer daytime conditions. Misting operation is governed by an adaptive, rule-based control strategy based on air temperature, relative humidity, and solar radiation. To enable systematic comparison, K-means clustering is applied to classify the cities into six archetypal summer climate zones. Results indicate that evaporative cooling feasibility is driven more by ambient humidity than by air temperature. Hot-dry interior cities achieve the longest average misting duration (502.65 hours) and highest water consumption (30,486 L per module), but exhibit the lowest PV-to-load autonomy ratio (1.53) due to high energy demand for pumping. In contrast, humid Black Sea cities show minimal misting duration (13.11 hours) and water use (478 L) yet achieve the highest autonomy (40.91) because of limited system operation. It is important to note that the autonomy ratio reflects a seasonal energy balance rather than continuous off-grid capability. Overall, the adaptive control approach effectively aligns water and energy use with climatic suitability across all clusters. The proposed framework offers a scalable and quantitative screening tool to inform the design and deployment of PV-powered outdoor cooling systems across diverse urban environments.

Abstract: The ambitious roadmap for a sustainable transport system adopted by the European Commission (EC) by 2050 includes the deployment of an extensive Electric Vehicle Charging Stations (EVCSs) infrastructure, which introduces significant challenges for distribution power grids. High power demand, particularly from fast-charging systems, may lead to network overloading and voltage unbalance. In addition, recent measurement campaigns highlight substantial changes in grid impedance and the emergence of resonance phenomena, together with the injection and propagation of high-frequency conducted disturbances. These effects extend over a wide frequency range, up to several hundreds of kHz, causing degradation, aging and malfunction of network assets, in particular Power Line Communications. This paper provides a comprehensive and updated review of the impact of EVCSs on electrical grids, covering power flow, power quality, stability, and impedance-related interactions. Particular attention is given to the role of power-electronic converters, high-frequency emissions, and the associated challenges in measurement and standardization. The analysis highlights that EVCS integration fundamentally alters the nature of electrical loads, requiring new approaches for grid planning, monitoring, and regulation. The study identifies key research gaps and outlines future directions to ensure the reliable and sustainable integration of electromobility into modern power systems.

Abstract: We propose a generalized definition of rest energy in which mc^2 is interpreted not as an immutable intrinsic quantity, but as a latent kinetic form. Within this framework, any kinetic contribution—Fermi, Coulomb, or relativistic gravitational—that assumes a rest-like structure becomes energetically dormant unless a non-arbitrary infinitesimal deficit is introduced. We show that such a deficit leads naturally to an alternative relativistic solution characterized by extreme excitation and particle-number amplification, while preserving total energy conservation. This mechanism gives rise to a bound, atom-like gravitational configuration at macroscopic scales, referred to here as a giant atom, governed by a precise orbital condition linking de Broglie coherence to gravitational binding. A scalar field condensate is introduced not as a new source of energy, but as a geometrical and dynamical mediator: it traps the configuration, screens the enormous Coulomb self-energy, and enables migration through its gradient structure and intrinsic frequency. Importantly, the model does not rely on a phase transition or energy injection. Instead, the dynamics become effective only when cosmological damping falls below the intrinsic frequencies of the trapped system. We argue that the initial closed configuration can be established at very early times (∼〖10〗^(-5) s before BB) and remain dynamically frozen, protected by the scalar field, until plasma dilution around T∼0.1MeV allows the latent kinetic structure to express a minute energetic imbalance. This marks the onset of gravitational potential deposition and the emergence of large-scale ordered motion. The framework offers a pathway toward the formation of atom-like gravitational systems, with potential implications for early-universe dynamics and the origin of planetary system.

Abstract: A serious problem facing power systems today is the deterioration of power quality (PQ), driven mainly by the widespread use of non-linear loads, such as power electronic converters and adjustable-speed drives. These loads inject harmonic currents into the network, resulting in voltage distortion, increased losses, overheating, and reduced system efficiency. Therefore, harmonic mitigation and reactive power compensation are necessary to ensure stable and reliable operation. This paper presents the development of a Shunt Active Power Filter (SAPF) to become an intelligent Shunt Active Power Filter Conditioner (SAPFC) that operates under different loading conditions (linear, non-linear, or mixed). As a result, a conventional PI controller is upgraded with a Fuzzy Gain Scheduling (FGS) technique optimized by the Whale Optimization Algorithm (WOA) in order to keep the DC-link capacitor voltage stable. In addition, an adaptive instantaneous dq theory is used to produce accurate reference currents. The proposed intelligent SAPFC is implemented and validated in MATLAB-Simulink, where simulation results show maximizing the SAPFC's effectiveness in minimizing harmonic distortion to less than 0.7% and achieving a near-unity power factor under different operating conditions. The integrated SAPFC, with its intelligent control, offers a robust and adaptive solution for improving power quality in modern electrical systems, thereby increasing efficiency and reducing power losses.

Abstract: Dietary fibre (DF) and bioactive compounds (BC) are essential components of a healthy diet and are abundant in plant‑rich dietary patterns. Increasing evidence demonstrates that their combined and synergistic actions significantly influence human health, largely through their effects on the gut microbiota. This review highlights the need for more precise terminology regarding DF and BC, as inconsistent use of these terms can create confusion among both consumers and researchers. The DF complex encompasses all non-digestible food components that have a positive effect on human health, together with the BC associated with them, recognising that DF often serves as a carrier for these compounds throughout the digestive tract. Although recommended intakes for BC have not been established, intake levels observed in populations adhering to healthy dietary patterns may serve as useful reference points. Updated data on the intake and estimated bioavailability of polyphenolic compounds in the contemporary Spanish diet are presented.

Abstract: Prompt injection attacks represent a fundamental and unresolved threat to the safe deployment of large language models (LLMs) in agentic and multi-turn settings. Existing defences rely predominantly on pattern-matching classifiers trained on known attack templates; they fail systematically against adaptive, obfuscated, and semantically camouflaged adversarial inputs. We propose KA-PROMPT, a thermodynamic framework that reconceptualises prompt injection not as a syntactic anomaly to be detected by surface features, but as an entropic phase transition within a non-equilibrium conversational information system. Drawing on the Karimov–Alakbarli (KA) model of thermodynamic early warning signals, we formalise the prompt state space Pt = (It, Ct, Rt, Mt), define a conditional entropy drift operator ∆St, and derive a suite of precursor statistics — variance inflation, autocorrelation rise, and entropy acceleration — that are theoretically guaranteed to surface before the adversarial attractor is reached. We construct a formal threat model covering eight attack classes (A1–A8), characterise each by its entropic signature across all four state dimensions, and demonstrate via agent-based simulation that k= 5.11 turns prior to successful injection KA-PROMPT achieves a mean precursor detection offset of across all attack classes, with a mean AUROC of 0.937 — a +17.2 percentage-point improvement over the next-best baseline. KA-PROMPT is explicitly positioned not as a universal prompt-attack detector, but as a dynamical-systems framework for precursor analysis of conversational state transitions that complements, rather than replaces, existing guardrail systems.

Abstract: Business Process Management (BPM) models represent routing behavior through control-flow constructs but do not provide a quantitative mechanism for evaluating uncertainty at decision points. This study introduces the Information Entropy Performance Indicator (IEPI) as a deterministic analytics artifact that maps BPMN 2.0 routing structures and externally specified probability assignments to uncertainty-based diagnostics. The IEPI engine takes as input a BPMN 2.0 process representation, a routing-probability map, and predefined viability thresholds, and computes (i) construct-level quantities based on normalized entropy and responsiveness, (ii) block-level propagated uncertainty measures using fixed composition rules, and (iii) a bounded process-level reporting index. The evaluation is conducted on analytically constructed BPMN scenarios with controlled routing configurations and fixed inputs, without reliance on statistical estimation or learning. Results show that construct-level classifications and process-level scores are well-defined and vary deterministically with threshold parameters and routing structure. Sensitivity analysis confirms consistent behavior under controlled parameter variation. The IEPI provides a reproducible analytical mapping from process structure to quantified uncertainty for evaluating routing behavior in BPMN-based models.

Abstract: Remote sensing has become a key non-invasive tool in archaeological prospection, partic-ularly in regions where logistical constraints limit sustained fieldwork. This study pre-sents the results from Zar Tepe (1st–5th centuries AD), in the Surkhandarya province of southern Uzbekistan, within northwestern Bactria. The research aimed to document the site’s urban layout, accurately relocate Soviet-era excavation sectors within the pre-sent-day topography, and refine the interpretation of earlier interventions that were only partially documented and lacked precise georeferencing. A multiscale and multitemporal methodology was applied, integrating CORONA and WorldView-3 satellite imagery, UAV and terrestrial photogrammetry, GNSS Precise Point Positioning, magnetic prospection, and targeted archaeological verification. The workflow followed an iterative laboratory–field sequence, combining remote-sensing analysis, field checks, data refinement, and sys-tematic ground-truth validation. Fieldwork was conducted during two contrasting phe-nological periods, in June 2024 and December 2025, to assess seasonal variability in sur-face and subsurface visibility. The integrated approach enabled accurate spatial fitting of legacy excavation sectors and cross-validation of optical and salt-efflorescence-related anomalies with geophysical evidence. These results strengthen the interpretation of buried architectural features and provide a robust basis for reconstructing Zar Tepe’s urban or-ganization and occupational dynamics.

Abstract: Background/Objectives: Type 1 diabetes mellitus (T1DM) diagnosed in primary school children presents unique challenges due to developmental dependence on adults, limited self-care abilities, and the need for continuous medical supervision. These challenges may affect health-related quality of life (HRQoL), particularly within early educational environments. The aim of this study was to test validity, reliability and factor structure of the Croatian version of the Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module. Methods: The sample included 70 children aged 7-14 years and their parents or caregivers. HRQoL was measured using the existing Croatian version of the PedsQL 4.0 Generic Core and the Croatian version of the PedsQL 3.2 Diabetes Module which we validate in this study. Croatian version of the PedsQL 3.2 Diabetes Module was developed using forward-backward translation. Reliability was assessed through Cronbach’s α and test-retest analysis. Spearman’s correlation examined the relationship between the PedsQL 3.2 Diabetes Module total scale and its scales. Construct validity was evaluated with exploratory factor analysis. Results: Children with T1DM reported higher overall HRQoL comparable than their parents, except in Diabetes symptoms scale of the PedsQL 3.2 Diabetes Module and School functioning scale of the PedsQL 4.0 Generic Core. All scales of the Croatian version of the PedsQL 3.2 Diabetes Module demonstrated satisfactory internal consistency (Cronbach’s α = 0.71-0.85) and favourable pattern of Spearman’s correlations with total scores (ρ = 0.61-0.92). The test-retest reliability of all PedsQL 3.2 Diabetes Module scales and total scores were excellent (ICC: 0.982-0.996). Bartlett’s test of sphericity indicated a high and significant correlation for child self-report (χ2 =1398.57, p&lt;0.001) and parent proxy-report (χ2 =1302.74, p&lt;0.001). The Kaiser-Meyer-Olkin value measured was sufficient, 0.65 for child’s and 0.68 for parents. The factors extracted for child self-report accounted for 66.30% of the total variance, with factor loadings ranging from 0.41-0.89. The factors extracted for parent proxy-report accounted for 61.80% of the total variance, with factor loadings ranging from 0.41-0.85. Conclusions: The Croatian version of the PedsQL 3.2 Diabetes Module is reliable, valid and feasible instrument for assessing HRQoL in Croatian primary school-aged children diagnosed with T1DM.

Abstract: In this paper we first give a new formula of the Liouville function and then by using the method for proving the Bateman-Horn conjecture, we give a parallel proof of the Chowla conjecture.

Abstract: Currency instability in emerging markets has become increasingly consequential for trade flows, investment allocation, and macroeconomic management. This study examines the volatility dynamics of the South African rand against the US dollar (ZAR/USD) using two advanced econometric frameworks: the Family GARCH (fGARCH) model and the first-order Beta-Skew-T-Generalised Autoregressive Conditional Heteroskedasticity (Beta-Skew-T-EGARCH) model. As one of the most heavily traded emerging-market currency pairs, the ZAR/USD serves as a barometer of South Africa’s economic health and vulnerability to external shocks. Standard GARCH specifications, however, impose symmetry constraints that fail to accommodate the long-memory effects, distributional skewness, and leverage dynamics consistently observed in emerging-market currency returns. This study addresses these limitations by deploying the fGARCH and Beta-Skew-T-EGARCH frameworks on daily ZAR/USD returns spanning 5 January 2000 to 1 October 2024. The sGARCH and fGARCH specifications were assessed across five innovation distributions, Student’s t, skewed Student’s t (SSTD), generalised error (GED), skewed generalised error (SGED), and generalised hyperbolic (GH), with model fitness evaluated using the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), Hannan-Quinn criterion (HQ), and Shibata criterion (SIC), selecting the specification with the lowest combined penalty. The fGARCH(1,1) model fitted to return-frequency data under the SSTD achieves the lowest AIC, outperforming the sGARCH benchmark. Among the covariates examined (day, month, trend, oil, platinum), the trend variable is the sole statistically significant predictor (p = 0.007), exerting a positive influence on ZAR/USD volatility. The two-component Beta-Skew-T-EGARCH model, by decomposing volatility into long-run structural and short-run transient components, delivers a superior fit over the one-component variant, evidenced by a lower BIC (3.068435) and a higher log-likelihood (-748.464826). Seven-day-ahead forecasts confirm that the two-component model captures declining conditional volatility, whereas the one-component model sustains persistently elevated estimates.

Abstract: Carcinoid heart disease is a progressive right-sided valvulopathy caused by serotonin and other vasoactive mediators released by metastatic neuroendocrine tumours. As oncological therapies have extended survival, cardiac disease has become a leading determinant of mortality. Operative mortality has decreased to 5–6% in contemporary high-volume centres, and long-term survival appears increasingly determined by tumour biology rather than cardiac disease when surgery is appropriately timed. The principal determinant of operative outcome is preoperative right ventricular function; symptom-based referral alone is insufficient because many patients remain compensated until ventricular dysfunction is advanced. This review synthesises the evidence on surgical timing, operative strategy, prosthesis selection, perioperative endocrine management, and emerging transcatheter options. Tricuspid valve replacement is required in the majority of patients, with concomitant pulmonary valve replacement advocated where concurrent disease is present. Bioprosthetic valves are preferred. Continuous perioperative octreotide infusion has substantially reduced the incidence of carcinoid crisis. Structured multidisciplinary decision-making integrating echocardiographic surveillance, biomarker monitoring, and oncological status assessment is essential.