Search Results (590)

The progression of metabolic dysfunction-associated steatotic liver disease (MASLD) to severe forms, including metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis, involves metabolic dysfunction, genetics, and gut dysbiosis. People with HIV (PWH) represent a high-risk group for MASLD, but the role of gut microbiota alterations in disease severity within this population remains poorly understood. We prospectively recruited PWH with MASLD, defined as the controlled attenuation parameter (CAP) ≥ 238 dB/m, and excluded those with viral hepatitis coinfection or alcohol abuse. Severe MASLD was defined as the presence of MASH (cytokeratin-18 ≥ 130.5 U/L) and/or significant liver fibrosis (liver stiffness ≥ 7.1 kPa). Stool samples were collected for 16S rRNA gene sequencing to characterize gut microbiota composition. Functional predictions were generated using PICRUSt. The differential abundance of bacterial taxa and predicted functions were analyzed using a generalized linear model with a negative binomial distribution. Among 34 PWH with MASLD, 18 (53%) met the criteria for severe MASLD. Microbiota profiling revealed significant differences in bacterial genera between the PWH with and without severe MASLD. Enrichment was observed in the Ruminococcus gnavus group, Negativibacillus, Holdemanella, Subdoligranulum, the Eubacterium hallii group, and Butyricicoccus, while depletion was seen in Prevotella, Alloprevotella, Dialister, Catenibacterium, the Christensenellaceae R 7 group, Clostridium sensu stricto, Olsenella, Oscillospiraceae UCG-005, Libanicoccus, and the Eubacterium siraeum group. Predicted functional pathways related to fatty acid degradation, folate biosynthesis, and amino acids metabolism did not differ between groups. MASLD severity in PWH is associated with a distinct gut microbiota signature, though not with functional pathway alterations. Microbial profiling may complement existing non-invasive biomarkers for risk stratification in this high-risk population. Full article

Introduction: Negative behaviors in nursing undermine well-being, erode team cohesion, and jeopardize patient safety. Rooted in systemic stressors—workload, emotional strain, and power imbalances—they have far-reaching effects on job satisfaction and care quality. Objective: To systematically map the scientific evidence on negative behaviors among nurses in healthcare organizations. Methods: A scoping review was conducted using five databases: CINAHL, MEDLINE, Scopus, Psychology & Behavioral Sciences Collection, and RCAAP (for grey literature). The review followed the Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines. Two independent reviewers conducted data extraction and synthesis. Results: Eighteen studies published between 2017 and 2024 met inclusion criteria from an initial pool of 88 references. Eleven thematic domains emerged: (1) the cycle of violence; (2) victims profile; (3) perpetrator profile; (4) negative behaviors spectrum; (5) negative behaviors prevalence; (6) risk predictors; (7) protective predictors; (8) impact of negative behaviors on nurses; (9) impact of negative behaviors on patients; (10) impact of negative behaviors on healthcare organizations; (11) organizational strategies and the role of the nurse managers. Conclusions: The findings highlight the multidimensional nature of negative behaviors and the variability in how they are defined and assessed. This review highlights the need for conceptual clarity and standardized tools to address negative behaviors in nursing. Nurse managers, as key organizational agents, play a critical role in fostering psychological safety, promoting ethical leadership, and ensuring accountability. System-level strategies that align leadership with organizational values are essential to protect workforce well-being and safeguard patient care. Full article

Background/Objectives: This systematic review addresses the disproportionate impact of the opioid epidemic on American Indian and Alaska Native (AI/AN) populations by examining the socio-ecological and social network factors that influence opioid use and misuse. While previous reviews have largely focused on treatment modalities or structural determinants such as socioeconomic status and rurality, few studies have explored the role of social networks as risk or protective factors, particularly within AI/AN communities. Methods: Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the review synthesized findings from three scholarly databases (PubMed, EBSCOhost, ProQuest), six institutional repositories (e.g., Indigenous Studies Portal), and one academic search engine (Google Scholar). Studies that examined the influence of social network domains on opioid misuse in AI/AN populations in the United States, reported quantitative or qualitative data, and were published between 2010 and 2022 were included in this review. Study quality was assessed with the JBI Checklists for Analytical Cross Sectional Studies and Qualitative Research. Of the 817 articles initially identified, 7 met the inclusion criteria, with most studies focusing on AI/AN adolescents and young adults, a demographic shown to be especially susceptible to opioid misuse. Results: The review identified several social network domains that significantly affect opioid use patterns, including familial relationships, peer associations, community dynamics, educational influences, cultural traditions, social media engagement and the effect of historical and intergenerational trauma. These domains can function either as protective buffers or as contributing factors to opioid misuse. Conclusions: The findings underscore the necessity for future longitudinal research to elucidate the causal pathways between these social network factors and opioid behaviors, particularly concerning trauma and digital media exposure. Furthermore, the study highlights the importance of culturally grounded, evidence-based prevention strategies that address the multifaceted social environments of AI/AN individuals. Such approaches are critical to fostering resilience and mitigating the opioid crisis within these historically marginalized populations. Full article

Parkinson’s disease (PD) is a common neurodegenerative disorder caused by progressive loss of dopaminergic neurons in the substantia nigra and the presence of Lewy bodies. While PD is most recognized by its motor symptoms (resting tremor, rigidity, bradykinesia, and postural instability), cognitive decline (CD) may become apparent as PD progresses, leading to Parkinson’s disease dementia (PDD). Type 2 diabetes mellitus (T2DM) and insulin resistance (IR) are risk factors for dementia, especially Alzheimer’s disease; however, their influence on dementia in PD is underexplored. Therefore, we sought to determine the effect of T2DM and IR on dementia in PD. A systematic search of articles from 2005 to March 2025 was undertaken using Embase, PubMed, Scopus, Web of Science, and citation searching. Case–control, cross-sectional, longitudinal, and non-human population studies assessing cognitive outcomes in individuals with PD, with and without T2DM and IR, were included (PROSPERO registration number CRD420251013367). In total, 27 studies met the inclusion criteria, with clinical sample sizes ranging from 23 to 544,162 participants. Among the 23 clinical studies, 15 identified T2DM as a contributor to cognitive decline (CD) in PD, and 4 specifically examined insulin resistance (IR). Elevated HbA1c was consistently associated with poorer cognitive performance and increased risk of Parkinson’s disease dementia (PDD); HbA1c ≥ 7% independently predicted cognitive impairment (OR = 4.25, 95% CI: 1.59–11.34). Vascular and inflammatory markers, including elevated LDL-C, fibrinogen, and hs-CRP, further exacerbated CD. MoCA and MMSE scores were the most common cognitive measures, consistently showing worse outcomes in PD patients with T2DM. Preclinical studies supported these associations, showing that high-fat-diet-induced T2DM and IR aggravated dopaminergic neuronal loss by 38–45%, increased α-synuclein by 35%, and heightened microglial activation, providing mechanistic evidence for the observed clinical associations. This systematic review, the first to examine the impact of T2DM and IRs on the occurrence and advancement of CD in PD patients, demonstrates a possible association between the two. However, these results demonstrate the need for larger sample sizes and the inclusion of additional clinical variables, such as HbA1c levels and pharmacological interventions, providing further information about the link between metabolic dysfunction and CD in PD. To further strengthen this link, longitudinal studies with systematic follow-ups are essential to establish causal links and avoid misdiagnosis in clinical practice. Full article

Background: Virtual reality (VR) technology has emerged as a promising tool for promoting physical activity through immersive gaming experiences. This study aimed to compare the physiological responses and perceived exertion during VR gaming using two different locomotion interfaces: omnidirectional treadmill and traditional controllers. Methods: Twenty-one university students (7 women, 14 men; age 23.5 ± 1.4 years) participated in a crossover study comparing physical activity intensity during VR gaming using traditional controllers versus an omnidirectional treadmill (Virtuix Omni). Participants played VRZ Torment for 15 min in each condition, separated by 30 min washout periods. Physiological responses were measured using indirect calorimetry (Cortex METAMAX® 3B), heart rate monitoring (Polar V800), and subjective ratings of perceived exertion (RPE). Exercise intensity was classified according to established guidelines, and user satisfaction was assessed using a 10-point scale. Results: Omnidirectional treadmill locomotion resulted in significantly higher physiological responses and perceived exertion across all measured variables compared to controller-based movement: heart rate (76.7 ± 11.7% vs. 51.7 ± 9.5% HRmax, p < 0.001), metabolic equivalents (7.3 ± 1.7 vs. 2.1 ± 0.3 METs, p < 0.001), and RPE (14.4 ± 2.9 vs. 9.3 ± 1.5, p < 0.001). Treadmill gaming achieved vigorous-intensity exercise, while controller gaming remained at light intensity. User satisfaction was significantly higher with treadmill locomotion (8.5 ± 1.3 vs. 5.0 ± 2.3, p < 0.001). Strong correlations were observed between physiological measures only during high-intensity treadmill exercise. Conclusions: Omnidirectional treadmill VR gaming achieves vigorous-intensity physical activity sufficient to meet health recommendations, while traditional controller gaming provides only light-intensity exercise. These findings support the potential of locomotion-enhanced VR systems for health promotion. Full article

Background and Objectives: Patent ductus arteriosus (PDA) is one of the most common cardiovascular conditions affecting preterm infants, with incidence rates reaching 60% in neonates born before 28 weeks gestation. Traditional clinical assessment alone often proves inadequate for accurate diagnosis, potentially leading to both overtreatment and undertreatment. Targeted neonatal echocardiography (TnECHO) has emerged as a powerful bedside tool that enables neonatologists to perform focused cardiac evaluations, providing real-time assessment of ductal significance and systemic hemodynamics. This systematic review aimed to comprehensively evaluate the clinical utility of TnECHO in the management of PDA in preterm infants, with specific focus on its diagnostic accuracy, impact on treatment decisions, and influence on clinical outcomes. Materials and Methods: Following PRISMA guidelines, we conducted a systematic search of PubMed, Web of Science, and Scopus from inception (earliest available date of each database) through February 2025. The search strategy combined terms for “Targeted Neonatal Echocardiography” and “Patent Ductus Arteriosus.” We included observational studies and randomized controlled trials (RCTs) evaluating TnECHO in PDA management, while excluding reviews and case reports. Data extraction focused on study design, population characteristics, TnECHO protocols, and clinical outcomes. Results: From 173 initial records, 11 studies met inclusion criteria. Eight studies were rated as high-quality (NOS score ≥ 7). TnECHO implementation was associated with a 49% reduction in PDA ligation rates and decreased need for multiple treatment courses. Studies demonstrated improved diagnostic precision in assessing shunt significance and myocardial function, leading to more tailored therapeutic approaches. The establishment of dedicated TnECHO services enhanced interdisciplinary collaboration between neonatologists and cardiologists. However, limitations included operator dependence, variable institutional protocols, and occasional missed minor cardiac anomalies. Conclusions: TnECHO represents a transformative approach to PDA management in preterm infants, enabling physiology-guided decision-making that reduces unnecessary interventions while maintaining patient safety. Current evidence supports its role in improving diagnostic accuracy and optimizing treatment timing. Future research should prioritize multicenter RCTs to establish standardized protocols and evaluate long-term neurodevelopmental outcomes. The integration of TnECHO into routine neonatal practice requires investment in training programs and quality assurance measures to maximize its clinical potential. Full article

Background: Subacromial impingement or pain syndrome (SAPS) is the most common diagnosis for chronic shoulder pain. Current surgeries do not reduce long-term pain, suggesting they miss the root etiology. Previously, we described the Human Disharmony Loop (HDL), where the unique lower trunk innervation to the pectoralis minor (PM) causes scapular dyskinesis and deforms its connections, including tugging the acromion down and impinging the subacromial structures. We hypothesize that SAPS patients who meet HDL criteria would benefit significantly from PM tenotomy with infraclavicular brachial plexus neurolysis (PM + ICN) alone. Methods: SAPS patients who met HDL diagnostic criteria were treated with PM + ICN, with secondary distal neurolysis if needed. Outcomes included pain and shoulder abduction ROM. Six-month follow-up minimum was required. Results: N = 140 patients were included. Median age was 49. Prior surgeries included 27% subacromial decompression/acromioplasty, 21% rotator cuff repair, 16% biceps tenodesis, 4% SLAP repair, 2% labral repair, 7% distal clavicle resection, 10% reverse total shoulder arthroplasty (rTSA), 1% rib resection with scalenectomy, 16% cervical spine fusion, 28% distal neurolysis. Median pain decreased from 8 to 2 and median shoulder ROM increased from 90 to 180 degrees. Positive impingement signs on exam decreased from 100% to 11%. (p < 0.01) Conclusions: In a large series of SAPS patients, evaluation and treatment for the HDL significantly reduced pain and restored motion. These findings suggest that in many patients SAPS may be a subset of the HDL: the ventral PM disturbing the scapula constitutes the anatomic basis and optimal surgical target behind SAPS. Full article

Parvovirus B19 (B19V) re-emerged across Europe in 2024, raising concerns about vertical transmission and neonatal morbidity. We undertook a prospective, single-centre cohort study to characterise the early clinical course of congenitally infected neonates born between April and December 2024. Seventy-one pregnancies with serologically or PCR-confirmed maternal infection were enrolled; seven neonates met laboratory criteria for congenital B19V infection and were followed with serial clinical, biochemical and imaging assessments through the first year of life. Troponin I and CK-MB were measured on days 1, 3, 7 and 15; electrocardiogram (ECG) and echocardiography were repeated in parallel, and cranial ultrasound (US), ophthalmologic and audiologic screening were scheduled prospectively. Mean troponin rose from 50.7 ng L⁻¹ on day 1 to a peak of 120.7 ng L⁻¹ on day 7 (p < 0.01), normalising by one month, while echocardiograms remained structurally normal, and only one transient arrhythmia was recorded. CK-MB exceeded the reference range in 29% of infants but showed no clinical sequelae. Multiple periventricular hyperechogenicities were identified in 8/70 neonates (11%), and moderate anaemia (Hb ≤ 9.8 g/dL) occurred in 2 cases. Serum PCR detected high-level viraemia (>10⁸ genome equivalents mL⁻¹) in 40% of those tested; saliva and urine were consistently negative. No instances of myocarditis or hydrops were observed. Our findings indicate that congenital B19V infection during the current outbreak is marked by transient biochemical myocardial stress and subtle neurosonographic changes rather than overt cardiac disease, supporting an outpatient-focused follow-up strategy incorporating serial biomarkers and targeted neuroimaging. Full article

Background: This systematic review evaluates the efficacy of rehabilitation-focused exercise interventions for lumbar degenerative disc disease (DDD), a leading cause of chronic low back pain. Methods: Following PRISMA guidelines, a comprehensive search was conducted across international and regional databases (PubMed, Scopus, Web of Science, Magiran, SID, and Noormags) covering the period from January 2010 to January 2025. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251088811. Using keywords such as “lumbar DDD,” “exercise therapy,” and “rehabilitation,” a total of 2495 records were identified. After screening, 20 studies—including clinical trials, quasi-experimental, and experimental designs—met the inclusion criteria and were assessed using the McMaster Critical Review Form for Quantitative Studies. Results: Interventions such as hydrotherapy, core stability training, Pilates, and suspension exercises were found to significantly reduce pain and improve functional outcomes. While multimodal approaches (e.g., aquatic exercise combined with acupuncture) showed positive effects, the comparative studies revealed no significant differences between modalities. Suspension training demonstrated superior efficacy in pain reduction compared to isolated core stability exercises. The methodological quality of included studies ranged from good to excellent, with the majority rated as very good or excellent (McMaster scores: 8 “excellent,” 7 “very good,” and 5 “good”). Common limitations among the studies included methodological heterogeneity, small sample sizes (n = 14–30), and insufficient long-term follow-up. Conclusions: Exercise-based rehabilitation is an effective strategy for managing lumbar DDD. Evidence particularly supports the use of suspension training and aquatic therapy for superior improvements in pain and functional outcomes. Future research should aim to adopt standardized protocols, recruit larger sample sizes, and include extended follow-up periods to produce more robust and generalizable findings. Full article

Background: Behçet’s Disease (BD) was traditionally classified according to the International Study Group (ISG), where oral ulcers were mandatory. The International Team for the Revision of the International Criteria for BD (ICBD) introduced a scoring system instead. Our aim was to assess (a) sensitivity, (b) concordance between ISG and ICDB criteria in global and severe BD cases (ocular, vascular, and neurological), and (c) evaluate their clinical implications. Methods: Retrospective cohort study including 142 BD patients diagnosed in a well-defined population in Northern Spain, between January 1980 and November 2023. Both ISG and ICBD criteria were compared, sensitivity and concordance were assessed using Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) and the unadjusted Kappa. Results: A total of 142 BD patients diagnosed by expert rheumatologists (73 men; mean age of 36.4) were studied. Among them, 84 met ISG criteria, while 116 fulfilled ICBD criteria. Sensitivity of ISG and ICBD criteria in the overall cohort was (59.1% and 81.6%), respectively. Among patients with severe manifestations (ocular, vascular, or neurological), sensitivity increased to 71.2% for ISG and 92.5% for ICBD. Overall concordance was moderate (Kappa = 0.490), with 70.4% of patients classified identically. When adjusting prevalence and bias, concordance improved slightly (PABAK = 0.549). Of the 32 patients classified as BD exclusively by ICBD, 7 were receiving anti-TNF therapy, and 2 were receiving apremilast. Conclusions: The ICBD criteria demonstrated higher sensitivity than the traditional ISG criteria in classifying BD, particularly in severe cases. Classifying these additional patients under ICBD facilitated the initiation of on-label biologic treatments, potentially enhancing BD management, especially for severe cases. Full article

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases. Full article

Augmented reality (AR), which overlays digital content within the user’s view, is gaining traction across domains such as education, healthcare, manufacturing, and entertainment. The hardware constraints of commercially available HMDs are well acknowledged, but little work addresses what design or interactions techniques developers can employ or build into experiences to work around these limitations. We conducted a scoping literature review, with the aim of mapping the current landscape of design principles and interaction techniques employed in near-field AR environments. We searched for literature published between 2016 and 2025 across major databases, including the ACM Digital Library and IEEE Xplore. Studies were included if they explicitly employed design or interaction techniques with a commercially available HMD for near-field AR experiences. A total of 780 articles were returned by the search, but just 7 articles met the inclusion criteria. Our review identifies key themes around how existing techniques are employed and the two competing goals of AR experiences, and we highlight the importance of embodiment in interaction efficacy. We present directions for future research based on and justified by our review. The findings offer a comprehensive overview for researchers, designers, and developers aiming to create more intuitive, effective, and context-aware near-field AR experiences. This review also provides a foundation for future research by outlining underexplored areas and recommending research directions for near-field AR interaction design. Full article

Background: Chronic primary orofacial pain (COFP) affects approximately 7% of the population and often leads to reduced quality of life. Patients frequently undergo multiple assessments and treatments across healthcare disciplines, often without a definitive diagnosis. The 2019 ICD-11 classification of chronic primary pain clusters together COFP subtypes based on chronicity and associated functional and emotional impairment. Objective: This study aimed to evaluate whether these subtypes of COFP share common underlying mechanisms by comparing neuroimaging findings. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Searches were performed using Medline (OVID) and Scopus up to April 2025. Inclusion criteria focused on MRI-based neuroimaging studies of participants diagnosed with COFP subtypes. Data extraction included participant demographics, imaging modality, brain regions affected, and pain assessment tools. Quality assessment used a modified Coleman methodological score. Results: Fourteen studies met the inclusion criteria, all utilising MRI and including two COFP subtypes (temporomandibular disorder and burning mouth syndrome). Resting- and task-state imaging revealed overlapping alterations in several brain regions, including the thalamus, somatosensory cortices (S1, S2), cingulate cortex, insula, prefrontal cortex, basal ganglia, medial temporal lobe, and primary motor area. These changes were consistent across both TMD and BMS populations. Conclusions: The findings suggest that chronic primary orofacial pain conditions (TMD and BMS) may share common central neuroplastic changes, supporting the hypothesis of a unified pathophysiological mechanism. This has implications for improving diagnosis and treatment strategies, potentially leading to more targeted and effective care for these patients. Full article

A total of 38% of Americans do not meet the Recommended Dietary Allowance (RDA) for calcium including those at risk for osteoporosis. To increase the percentage of patients at risk for osteoporosis who achieve goal calcium RDA intake, a collaborative specialty pharmacy-registered dietitian-nutritionist (RDN) quality improvement program was developed. Patients aged 18 to 90 years old receiving osteoporosis therapy (denosumab, teriparatide, zoledronic acid) or medications that increase bone loss (elagolix, oral prednisone) were provided with a structured assessment and educational intervention. Daily calcium intake included patient self-reported dietary intake plus supplement use. Written and verbal education on increasing dietary intake based on patient preferences was provided with 5 calcium-rich food-source store coupons. Recommendations for supplement selection (citrate vs. carbonate) and/or medication-related problem resolution were provided. Follow-up occurred at 3–6 months. Fifty patients enrolled [94% female, mean age 66.6 years (SD 15.3)] were taking denosumab (36), teriparatide (1), zoledronic acid (1), elagolix (7) and prednisone (5). The mean baseline daily dietary calcium intake was 500 mg (SD 247) with none achieving goal intake with diet alone. Average calcium supplement use in 22 (44%) patients was 686 mg daily (SD 284). At baseline, 17 (34%) met goal daily calcium intake compared to 30 (60%) at post intervention follow-up (p = 0.009). Over half of the store coupons were redeemed. A specialty pharmacy-RDN customized intervention program provides a model for aiding patients to modify calcium intake. Full article

Potassium fertilizer management is critical for achieving high yields of Korla fragrant pear, yet current practices often overlook or misuse potassium inputs. In this study, a two-year field experiment (2023–2024) was conducted with 7- to 8-year-old pear trees using four potassium levels (0, 75, 150, and 225 kg/hm²). Metagenomic sequencing was employed to assess the effects on soil microbial communities, sulfur cycle functional genes, and fruit yield. Potassium treatments significantly altered soil physicochemical properties, the abundance of sulfur cycle functional genes, and fruit yield (p < 0.05). Increasing application rates significantly elevated soil-available potassium and organic matter while reducing pH (p < 0.05). Although alpha diversity was unaffected, NMDS analysis revealed differences in microbial community composition under different treatments. Functional gene analysis showed a significant decreasing trend in betB abundance, a peak in hpsO under K150, and variable patterns for soxX and metX across treatments (p < 0.05). All potassium applications significantly increased yield relative to CK, with K150 achieving the highest yield (p < 0.05). PLS-PM analysis indicated significant positive associations between potassium rate, nutrient availability, microbial abundance, sulfur cycling, and yield, and a significant negative association with pH (p < 0.05). These results provide a foundation for optimizing potassium fertilizer strategies in Korla fragrant pear orchards. It is recommended that future studies combine metagenomic and metatranscriptomic approaches to further elucidate the mechanisms linking potassium-driven microbial functional changes to improvements in fruit quality. Full article