Search Results (302)

Background and Objectives: Vitamin D deficiency is a pervasive public health issue in high-latitude regions, yet large-scale population data for the Baltic states remain sparse. This study aimed to determine the prevalence of vitamin D status and identify its primary determinants within a primary care setting in Lithuania. Materials and Methods: We conducted a retrospective cross-sectional analysis of serum 25-hydroxyvitamin D [25(OH)D] concentrations from 14,330 unique patients (aged 1–101 years) collected during 2025 at a major clinic in Vilnius. Vitamin D status was categorized according to the Central and Eastern European Expert Consensus thresholds. Results: The overall median 25(OH)D concentration was 68.3 nmol/L, placing it in the “insufficiency” range (50–75 nmol/L). Seasonality emerged as the most significant predictor of deficiency; multivariable logistic regression showed a maximal risk reduction in September (OR 0.33; 95% CI: 0.27–0.41) and August (OR 0.34) compared to January, while June and November provided no significant protection. Age-specific analysis revealed a non-linear “U-shaped” distribution: children aged 0–6 years had the highest levels (median ~87–91 nmol/L), likely due to rickets prophylaxis, whereas adolescents (12–18 years) exhibited the highest vulnerability, with approximately 80% suffering from deficiency or insufficiency. Males faced a 13.9% higher likelihood of deficiency than females (OR 1.14; p = 0.0036), potentially due to lower rates of elective supplementation. Conclusions: These findings suggest that current supplementation strategies successfully protect infants but fail to sustain adequacy through adolescence and adulthood, particularly during the “vitamin D winter.” Targeted public health interventions for adolescents and year-round monitoring are recommended to mitigate the high prevalence of suboptimal vitamin D status in Lithuania. Full article

The processing of two-dimensional (2D) spectral images constitutes a critical and multifaceted discipline in contemporary astronomical data analysis. As spectroscopic instruments evolve towards higher multiplexing, resolution, and sensitivity, the raw 2D data captured by detectors present increasingly complex challenges that transcend simple one-dimensional extraction. This review provides a systematic and comprehensive examination of the methodological evolution in this field over the past two decades. It gathered relevant studies by searching mainstream academic repositories and general search engines with the core keyword ‘2D Spectral Image’, and selected qualified references according to accessibility and research relevance. We categorize the landscape into three major paradigms: (1) physics-based modeling and algorithmic correction techniques for geometric distortion, scattered light, and sky background; (2) data-driven machine learning and deep learning approaches for image correction, spectral classification, and faint signal detection; and (3) the development of open-source software pipelines that democratize advanced processing. A central contribution of this review is a detailed comparative analysis of the performance metrics, underlying assumptions, and practical limitations of prominent algorithms. We highlight the transformative impact of convolutional neural networks (CNNs) and vision transformers (ViTs) on tasks such as celestial object classification and exoplanet detection, while also acknowledging the enduring importance of robust physical models for calibration and uncertainty quantification. The discussion culminates in an assessment of persistent challenges—including computational scalability, model generalizability, and interpretability—and outlines promising future directions at the intersection of AI, statistical inference, and large-scale survey science. Full article

Background/Objectives: Anemia is frequently encountered in emergency departments (EDs). Although intravenous (IV) iron can be used as an alternative or adjunct to red blood cell (RBC) transfusion in selected hemodynamically stable patients, its use in the ED remains limited. This study described IV iron utilization and RBC transfusion patterns in ED patients with anemia and evaluated their associations with clinical outcomes. Methods: We conducted a single-center retrospective cohort study of patients who presented to a tertiary ED with hemoglobin (Hb) ≤ 10 g/dL between January 2019 and December 2021. Patients were categorized according to receipt of IV iron in the ED. Baseline characteristics, laboratory findings, transfusion practice, hospital length of stay (LOS), ICU admission, and in-hospital mortality were compared between groups. Results: Among 3340 patients, 89 (2.7%) received IV iron in the ED. IV iron recipients were older and had lower Hb levels than non-recipients. Gastrointestinal disorders were more frequent in the IV iron group (68.5% vs. 19.9%), and IV iron was commonly administered with ED RBC transfusion. ED transfusion (69.7% vs. 11.1%) and ICU admission (24.7% vs. 15.7%) were more frequent in the IV iron group. Among patients with available ferritin and transferrin saturation (TSAT), IV iron recipients had lower ferritin levels and more frequently showed ferritin-based or combined ferritin/TSAT findings suggestive of iron deficiency. In-hospital mortality was similar between groups (5.6% vs. 5.7%). Among hospitalized patients, median LOS was shorter in the IV iron group than in the non-IV iron group (6.6 vs. 9.7 days). Conclusions: IV iron was infrequently administered in ED patients with Hb ≤ 10 g/dL and was used mainly as an adjunct to RBC transfusion in older patients with gastrointestinal causes of anemia. Its association with shorter LOS should be interpreted cautiously. Structured ED-based anemia evaluation may help optimize IV iron use in selected patients. Full article

Exposure to electromagnetic fields (EMFs) at different frequencies has been reported to induce apoptotic changes in brain tissue. Apoptosis is commonly evaluated using the TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling) method; however, conventional semi-quantitative scoring is subjective and may vary between observers. Therefore, this study aimed to evaluate the feasibility of transfer learning-based convolutional neural network (CNN) models for the objective and automated classification of apoptotic damage in TUNEL-stained brain sections. A total of 92 light microscopy images of TUNEL-stained rat brain tissue, obtained from experimental groups, were analyzed. Apoptotic damage was categorized into three classes (0: no, +1: slight, +2: moderate) based on semi-quantitative scoring. Pre-trained convolutional neural network models, including AlexNet, SqueezeNet, GoogLeNet, Inception-v3, and ResNet-101, were applied for image classification. All models were able to classify apoptotic damage levels, defined by the extent of TUNEL staining, from images with varying performance. The best-performing model achieved high classification accuracy and demonstrated strong agreement with manual scoring, as determined by visual assessments by experts. The models successfully distinguished between different levels of apoptotic damage observed across experimental groups. The findings suggest that transfer learning-based CNN models may provide an objective and reproducible approach for the classification of apoptotic damage in TUNEL-stained histopathological images, thereby reducing observer-dependent variability. This approach may also support histopathological evaluation in experimental models, including studies investigating EMF-induced brain injury. Full article

Background/Objectives: Menopause is accompanied by substantial changes in endogenous sex hormones that influence metabolic regulation. However, the associations of specific hormones with type 2 diabetes (T2D) risk in postmenopausal women remain inconsistent. This study aimed to quantify the relationships between incident T2D and follicle-stimulating hormone (FSH), oestradiol, testosterone, and sex hormone-binding globulin (SHBG), and to examine cross-sectional differences in hormone concentrations between postmenopausal women with and without T2D. Methods: MEDLINE, Embase and Cochrane CENTRAL were searched from database inception to 21 June 2024. Eligible studies included prospective cohort, nested case–control and case–control designs. Associations with incident T2D were pooled using Hartung–Knapp–Sidik–Jonkman random-effects meta-analysis. Both categorical and continuous estimates were extracted, prioritising maximally adjusted models. Risk of bias was assessed using ROBINS-E and the Newcastle–Ottawa Scale. Results: Sixteen studies (18 articles; n = 16,180) were included. Higher SHBG was consistently associated with lower T2D risk in cohort analyses (RR 0.55; 95% CI 0.38–0.72; I² ≈ 0%). Higher FSH was also associated with lower risk (high vs. low: HR 0.55, 95% CI 0.29–0.81), although continuous estimates showed heterogeneity. Higher oestradiol was associated with increased T2D risk (RR 1.61, 95% CI 1.18–2.03; I² ≈ 6%), while testosterone was not significantly associated with incident T2D (RR 1.11, 95% CI 0.73–1.50). Cross-sectional analyses indicated lower SHBG and higher testosterone in women with T2D. Conclusions: Endogenous hormone profiles and SHBG concentrations are associated with T2D in postmenopausal women, with the most consistent evidence for an inverse association between SHBG and incident T2D. Because the available evidence is observational and partly heterogeneous, these findings should be interpreted as associations rather than causal or clinically predictive effects. Standardised measurement, repeated pre-diagnostic sampling and external validation are required before these biomarkers can be considered for routine risk stratification. Full article

Civil infrastructure plays a critical role in ensuring societal safety and economic development. However, structural damages such as cracks inevitably occur during long-term service. Traditional manual inspection methods are insufficient to meet the demands of large-scale and routine monitoring. Unmanned Aerial Vehicles (UAV) remote sensing has become an important approach for Structural Health Monitoring (SHM), owing to its high spatial resolution imaging capability and superior operational flexibility. Nevertheless, existing studies focus on optimizing individual algorithms, lacking a systematic analysis oriented toward multi-scenario engineering applications. Therefore, we present a comprehensive review of UAV-based crack detection techniques for infrastructure using remote sensing imagery. First, publicly available datasets, UAV platforms, and evaluation metrics are systematically summarized. Then a multi-level visual analysis framework for UAV inspection is established. The framework categorizes existing methodologies into five levels: image-level classification, object-level detection, pixel-level segmentation, geometric quantification, and three-dimensional (3D) reconstruction, followed by a systematic evaluation of representative methods. Furthermore, the applicability of different methods across diverse scenarios, including bridges, pavements, dams, building facades and wind turbine blades, is systematically explored. Finally, the key challenges and future research directions are discussed. This review aims to provide a systematic theoretical foundation and methodological reference for advancing UAV-based infrastructure crack inspection from algorithm development toward practical multi-scenario engineering applications. Full article

Background: Late-onset neonatal sepsis (LONS) remains a major cause of morbidity in preterm neonates admitted to the neonatal intensive care unit (NICU), yet the contribution of vitamin D status to neonatal infectious susceptibility remains uncertain. Objective: To evaluate clinical and demographic variables and serum vitamin D levels assessed at birth in preterm neonates with and without LONS. Methods: A retrospective observational cohort study was conducted in a tertiary NICU in northeastern Mexico between May 2023 and October 2024. Preterm neonates (<37 weeks of gestation) with serum 25(OH)D measured within the first hour of life were included. Vitamin D status was classified as sufficient (≥30 ng/mL), insufficient (20–29 ng/mL), or deficient (<20 ng/mL). LONS was defined as sepsis occurring after 72 h of life. Comparisons between neonates with and without LONS were performed using Fisher’s exact test for categorical variables and Student’s t-test or Mann–Whitney U test for continuous variables, as appropriate. Results: Twenty-nine preterm neonates were included (mean gestational age: 32.0 ± 2.6 weeks; mean birth weight: 1748 ± 545 g). The mean serum 25(OH)D level at birth was 35.5 ± 13.0 ng/mL. LONS occurred in 31% (9/29) of neonates, of which 55% were microbiologically confirmed. No significant differences were observed in vitamin D levels between neonates with and without LONS (35.0 ± 12.0 vs. 35.7 ± 13.7 ng/mL; p = 0.899). Vitamin D deficiency was not associated with LONS (OR 1.13, 95% CI 0.09–14.28). The prevalence of vitamin D deficiency was low (10%) in this cohort. Conclusions: A clear association between serum 25(OH)D levels at birth and the development of LONS could not be demonstrated in this small exploratory cohort. Given the limited sample size and low prevalence of vitamin D deficiency, further multicenter prospective studies are required to better understand the potential relationship between vitamin D status and neonatal infectious outcomes. Full article

Objective: To examine the association between Life Essential 8 (LE8) and incident T2D in the Women’s Health Initiative (WHI), and to assess whether associations varied by race and ethnicity. Research Design and Methods: Prospective cohort study of 19,403 postmenopausal women enrolled in the WHI without T2D at baseline. Data were analyzed from 1993 through 2024. The LE8 score (range, 0–100), comprising blood glucose, blood lipids, blood pressure, smoking, physical activity, diet, sleep, and body mass index (BMI), categorized as high (80–100), moderate (50–79), and low (0–49) according to AHA definitions. Incident treated T2D was self-reported during follow-up. Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs for LE8 categories and continuous scores. Results: During a mean follow-up of 16.3 years, 3921 women developed T2D. Compared with the lowest category, women in the highest LE8 category had a 57% lower risk of T2D (HR, 0.43; 95% CI, 0.38–0.49). A 20-point increase in LE8 score was associated with a 43% lower risk (HR, 0.57; 95% CI, 0.54–0.60). Among individual domains, BMI and glucose were most strongly associated with T2D. Subgroup analyses by 20-point increase in LE8 showed greater risk reduction among Hispanic/Latina women (HR, 0.46; 95% CI, 0.41–0.53) compared with non-Hispanic women (HR, 0.58; 95% CI, 0.55–0.62), but no significant association with race was observed. Conclusions: Higher LE8 scores are associated with a reduced risk of T2D in postmenopausal women, supporting LE8 as a useful framework for lifestyle-based diabetes prevention strategies. Full article

Background: Rheumatic heart disease (RHD) remains a significant public health problem in low- and middle-income countries. Beyond its clinical consequences, RHD adversely affects the health-related quality of life (HRQoL) of affected children and adolescents, their families, and healthcare systems. Addressing the HRQoL of children and adolescents with RHD will contribute to strengthening patient-centered care and policy development. Objective: To determine the health-related quality of life of children and adolescents with rheumatic heart disease attending follow-up at the pediatric cardiology clinic of Moi Teaching and Referral Hospital (MTRH), Kenya. Methods: This was a hospital-based cross-sectional study conducted between January and July 2024. A total of 171 children and adolescents aged 5–18 years were consecutively enrolled while attending follow-up at the pediatric cardiology clinic of MTRH. The EuroQol EQ-5D-Y and EQ-5D-L questionnaires were used to assess HRQoL across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Overall HRQoL was evaluated using the EQ visual analog scale (EQ-VAS) and categorized as optimal (≥80%), suboptimal (70–79%), or poor (≤70%). Results: Overall HRQoL was optimal in 70.8% (n = 121) of participants, suboptimal in 8.2% (n = 14), and poor in 21.1% (n = 36). Impaired HRQoL was significantly associated with poor self-care (95% CI: 0.066–0.853; p = 0.028), anxiety/depression (95% CI: 0.111–0.678; p = 0.005), pain/discomfort (95% CI: 0.142–0.758; p = 0.009) and missing more than five school days (95% CI: 0.109–0.584; p = 0.001). Caregiver characteristics (age, education level, and income), surgical correction, RHD-related hospital admissions, comorbidities, and Ross classification were not significantly associated with HRQoL. Conclusion: Health-related quality of life among children and adolescents with RHD was most adversely affected in the mental health and mobility domains. Routine assessment of HRQoL should be incorporated into the clinical care of children and adolescents with RHD to reduce disease-related morbidity and support holistic management. Full article

Background and Objectives: Molecular classification has emerged as a key determinant of prognosis in endometrial cancer and has recently been incorporated into the 2023 FIGO staging system. Tumors are categorized into four molecular subgroups—POLE-mutated (POLEmut), p53-abnormal (p53abn), mismatch repair-deficient (dMMR), and no specific molecular profile (NSMP)—each associated with distinct biological behavior and clinical outcomes. However, real-world data evaluating the relationship between molecular classification, FIGO stage distribution, and survival outcomes remain limited. Materials and Methods: This retrospective study included patients diagnosed with endometrial cancer between 2014 and 2022 at Dokuz Eylül University Hospital. Tumor samples were classified according to the ProMisE molecular algorithm using next-generation sequencing for POLE mutations and immunohistochemical evaluation of mismatch repair proteins and p53 expression. Clinicopathological characteristics, recurrence patterns, and survival outcomes were analyzed. Appropriate statistical analyses were performed. Results: A total of 156 patients were included (mean age 60.2 ± 10.0 years). The most common histology was endometrioid carcinoma (51.9%). Molecular subgroup distribution was NSMP (58.3%), dMMR (25%), p53abn (11.5%), and POLEmut (5.1%). Most patients presented with early-stage disease (83.4%). According to the 2023 FIGO molecular staging, 8.3% were classified as stage 2C m-p53abn and 5.8% as Stage 1Am-POLEmut. After a median follow-up of 39.5 months, the overall survival rate was 81.6%. Survival differed significantly across molecular subgroups, with the most favorable outcomes observed in the POLEmut (100%), followed by NSMP (85.2%), dMMR (78.4%), and p53abn (64.7%) (p = 0.011). Lymph node metastasis was significantly more frequent in the p53abn subgroup (p = 0.002), whereas distant metastasis rates did not differ between groups. Conclusions: Molecular classification was associated with differences in FIGO stage distribution and survival outcomes in this retrospective cohort and may provide additional prognostic information beyond traditional clinicopathological factors. The integration of molecular profiling into routine practice and staging systems may enable improved risk assessment and facilitate more personalized therapeutic strategies in endometrial cancer. Full article

Objectives: The aim of this study is to investigate the relationship between the lactate/albumin ratio (LAR) and 28-day mortality in gastric cancer patients undergoing monitoring in a postoperative intensive care unit due to reasons such as haemodynamic instability, need for vasopressor support, or intraoperative bleeding. Methods: This retrospective study included patients followed up at the tertiary surgical intensive care unit of Kastamonu University Faculty of Medicine between January 2020 and October 2025 who were diagnosed with histologically confirmed gastric adenocarcinoma and underwent total open surgery or subtotal gastrectomy + D2 lymphadenectomy. The patients were categorized into two groups: non-survivors within 28 days (n: 45) and survivors within 28 days (n: 139). Results: A total of 184 critically ill patients (110 males, 74 females) who underwent gastric adenocarcinoma surgery and were followed up in the surgical intensive care unit were included in this study. The mean age of the patients was 72.2 ± 11.3 years. Of these patients, 139 (75.5%) were survivors, and 45 (24.5%) were non-survivors. Albumin, the C-reactive protein (CRP)/albumin ratio, lactate, and the lactate/albumin ratio were associated with 28-day mortality. Receiver operating characteristic (ROC) analysis showed that the LAR (area under the curve (AUC): 0.839) was superior to the serum albumin (AUC: 0.736) and lactate levels (AUC: 0.796) for predicting 28-day mortality. The optimal cut-off value of the LAR was 0.82, and an LAR of ≥ 0.82 was shown to be a significant and independent prognostic factor for 28-day mortality in patients with stomach cancer in a critical postoperative condition (odds ratio (OR): 4.78, confidence interval (CI): 1.09–21.08, p = 0.0386). Conclusions: The lactate/albumin ratio is a prognostic parameter for 28-day mortality in critically ill postoperative gastric cancer patients. The optimal cut-off value for the lactate/albumin ratio is 0.82. Full article

Background/Objective: Postoperative recovery after spine surgery varies substantially and cannot be fully explained by structural pathology alone. This study evaluates postoperative outcomes using a structured 2 × 2 Surgical Trauma Gradient integrating exposure-related invasiveness (minimally invasive vs. open) and biomechanical strategy (decompression vs. fusion), and examines the modifying role of Type-D personality. Methods: This observational cohort study included 200 patients undergoing elective spine surgery. Patients were stratified into four surgical subgroups: minimally invasive decompression, open decompression, minimally invasive fusion, and open fusion. Primary outcomes included pain intensity (Visual Analog Scale), functional disability (Oswestry Disability Index), patient satisfaction (Patient Satisfaction Index), and postoperative complications at 12-month follow-up. Surgical invasiveness was modeled both categorically and as an ordinal gradient. Multivariable regression, logistic regression, interaction analysis, and longitudinal mixed-effects models were applied. Results: Postoperative outcomes demonstrated a consistent gradient across increasing surgical burden. In multivariable models, higher surgical invasiveness independently predicted greater residual pain (β = 0.69; 95% CI 0.55–0.82; p < 0.001) and higher functional disability (β = 6.20; 95% CI 5.10–7.30; p < 0.001). Increasing invasiveness was also associated with lower patient satisfaction (β = −0.38; 95% CI −0.47 to −0.29; p < 0.001) and higher complication risk (OR = 1.64; 95% CI 1.12–2.41; p = 0.01). Type-D personality independently predicted worse postoperative pain (β = 0.41; p = 0.008) and significantly modified the association between surgical burden and pain (interaction β = 0.22; p = 0.012). Conclusions: Postoperative outcomes follow a structured Surgical Trauma Gradient influenced by both surgical burden and psychosocial vulnerability, particularly Type-D personality. Integrating these dimensions may improve perioperative risk stratification and support individualized treatment strategies. Full article

Background and Objectives: Thrombocytopenia complicates 6.6–11.6% of pregnancies. While gestational thrombocytopenia (GT) is usually benign, etiologies such as immune thrombocytopenia (ITP), preeclampsia, and HELLP syndrome require individualized management. This study aimed to characterize the etiological spectrum, maternal peripartum hematologic outcomes, blood product utilization, and mode of delivery in a tertiary-center cohort of thrombocytopenic pregnancies and to assess whether platelet count should influence delivery mode decisions. Materials and Methods: This retrospective cohort study included 137 thrombocytopenic pregnant women at a tertiary center (2010–2019), categorized by etiology and severity. Peripartum hemoglobin, hematocrit, and platelet counts were compared between delivery groups. Blood product utilization was recorded and analyzed using t-test, ANOVA, chi-square, Fisher’s exact, and Fisher–Freeman–Halton tests; binary logistic regression was used for multivariable analysis. Results: GT (43.1%) and ITP (32.1%) were the most prevalent diagnoses; cesarean delivery rate was 52.6%. Postpartum Hb was higher in the vaginal delivery group (10.24 ± 1.28 vs. 9.80 ± 1.26 g/dL; p = 0.003), while platelet counts were paradoxically lower (p = 0.039). Platelet transfusion rates did not differ significantly between delivery modes (23.1% vs. 27.8%; p = 0.621). Severe thrombocytopenia required platelet transfusion in 92.6% of cases versus 11.6% (moderate) and 0% (mild) (p < 0.001). RBC transfusion was highest in gestational hypertensive disease (41.2%) versus GT (5.1%) and ITP (2.3%) (p < 0.001). General anesthesia was used in 75% of cesarean cases. Conclusions: Delivery mode in thrombocytopenic pregnancies should be guided by obstetric indications, not platelet count alone. Although postpartum platelet counts declined more steeply after vaginal delivery, this did not increase transfusion requirements. Gestational hypertensive disorders carried the greatest hemorrhagic burden, highlighting the need for etiology-specific multidisciplinary planning. The high general anesthesia rate warrants prospective institutional audit of anesthetic decision-making protocols to determine adherence to current neuraxial anesthesia thresholds. This study is limited to maternal peripartum hematologic outcomes; neonatal outcomes were not captured and should be addressed in future prospective research. Full article

Background: As Taiwan transitions into a super-aging society, the government has launched “Long-term Care (LTC) 3.0,” a policy initiative that marks a strategic shift from service expansion to integrated quality verification, digital oversight, and social resilience. This transition demands a robust quality verification mechanism. Ensuring perceptual consistency between service providers and external evaluators is critical for systemic fairness and sustainable service quality. Objective: This study utilized a two-dimensional gap analysis to examine the discrepancy in service quality benchmarks between home-based LTC center managers and assessment committee members, identifying critical divergence zones for institutional improvement. Methods: A cross-sectional evaluative study was conducted, involving center managers (evaluatees, n = 50) and external experts (evaluators, n = 28). The data were collected via a structured instrument covering 20 consensus benchmarks. Results: Significant perceptual gaps were identified across all dimensions (p < 0.001), with “Professional Care Quality” exhibiting the largest effect size (Cohen’s d > 1.5). Benchmarks with low external scores but high internal ratings were categorized into the “Overestimation (Management Blind Spot)” quadrant, signaling a systemic overestimation bias in administrative and clinical risk management. Conclusions: This study provides empirical evidence for the refinement of LTC 3.0 assessment systems. The results offer a strategic roadmap for policymakers to enhance organizational resilience by transitioning from subjective self-perception to objective, data-driven quality management through the two-dimensional gap model. Full article

Background/Objectives: Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits beyond glycemic control, yet the specific biological pathways potentially linking SGLT2 inhibitor exposure to cardiovascular outcomes after acute myocardial infarction (AMI) remain incompletely characterized. Two biologically plausible pathways, serum uric acid (SUA) reduction and renal functional preservation, have been proposed, but not directly compared in a unified analytical framework. This study aimed to explore whether associations between SGLT2 inhibitor exposure and recurrent post-AMI outcomes may be more strongly linked to SUA reduction and to renal functional changes, using a hypothesis-generating causal mediation analysis. Methods: This retrospective observational cohort study included 142 consecutive patients hospitalized for AMI who underwent percutaneous coronary intervention (PCI) during the index hospitalization, reflecting standard-of-care management for AMI in this tertiary center. Patients were categorized by SGLT2 inhibitor exposure (n = 57) vs. controls (n = 85). Both diabetic (47.2%) and non-diabetic (52.8%) patients were included. The primary endpoint was change in SUA (ΔUA); the secondary endpoint was myocardial infarction (MI) recurrence. Causal mediation analysis with nonparametric bootstrap simulation tested both mechanistic pathways. Results: SGLT2 inhibitor therapy was associated with significant SUA reduction (ΔUA = −0.99 mg/dL vs. +0.56 mg/dL in controls; p < 0.001), consistent across diabetic and non-diabetic subgroups and independent of AMI recurrence. Each 1 mg/dL decrease in SUA was associated with lower odds of recurrent MI in the initial model (β = −0.25; p = 0.041). However, after incorporation of renal functional change, the uric acid-mediated pathway lost significance (ACME p = 0.462), whereas the renal-mediated pathway remained significant (ACME p = 0.038). Serum creatinine change emerged as the strongest independent predictor of MI recurrence (β = 2.22; p = 0.015). Conclusions: The findings are more consistent with a renal-mediated pathway than with an independent uric acid-mediated pathway in explaining the observed associations between SGLT2 inhibitor exposure and recurrent post-AMI outcomes. These hypothesis-generating results from a retrospective design warrant prospective validation. Full article