Search Results (10,520)

Background: Acute chest pain is a common cause for presentation to the emergency department (ED), where rapid identification of patients at high risk for acute coronary syndrome is essential. The HEART score combines medical history, electrocardiogram, age, risk factors, and troponin levels to provide structured risk stratification. However, evidence regarding the HEART score in COVID-19 survivors presenting with acute chest pain remains limited. This study examined the distribution of HEART scores and their associations with decisions made in the emergency department, hospital management, rises in cardiac troponin levels, coronary revascularization, and in-hospital mortality. Materials and Methods: In this single-center retrospective observational study, 400 consecutive adult COVID-19 survivors who presented to the ED with acute non-traumatic chest pain were included. HEART scores were retrospectively calculated from routinely available clinical and laboratory data, and patients were categorized as low (0–3), moderate (4–6), or high risk (7–10). Results: The median HEART score was 2 (IQR 0–5); 264 patients (66.0%) were classified as low risk, 50 (12.5%) as moderate risk and 86 (21.5%) as high risk. The distribution of the total score was bimodal, with 128 patients (32.0%) scoring zero and 78 (19.5%) scoring 8–10. Cardiac troponin was above the upper reference limit at presentation or at one hour in 96 patients (24.0%): 3 of 264 low-risk patients (1.1%), 7 of 50 moderate-risk patients (14.0%) and all 86 high-risk patients (100%). Eighty-three patients (20.8%) were admitted to hospital, almost all from the high-risk category (82 of 86, 95.3%), compared with 1 of 50 moderate-risk patients (2.0%) and no low-risk patient. All 51 revascularisation procedures (46 percutaneous coronary interventions and 5 coronary artery bypass grafts) and all five in-hospital deaths (1.2% of the cohort) occurred among high-risk patients. In an exploratory, hypothesis-generating multivariable analysis of troponin elevation, older age (adjusted odds ratio 2.38 per decade, 95% CI 1.88–3.09) and smoking (4.10, 2.12–8.06) were associated with elevation and female sex was inversely so (0.22, 0.11–0.41); renal function was not available for adjustment. Conclusions: HEART score categories were associated with ED disposition and in-hospital management in this retrospective cohort of COVID-19 survivors presenting with acute chest pain. High-risk patients accounted for nearly all hospital admissions, coronary revascularizations, and in-hospital deaths. However, systematic post-discharge follow-up was not available; therefore, 30-day or 6-week MACE could not be assessed, and the prognostic performance of the HEART score or the safety of HEART-based discharge cannot be determined. These findings should therefore be interpreted as descriptive associations reflecting real-world clinical practice and warrant confirmation in prospective studies with systematic follow-up. Full article

Background/Objectives: Rubus crataegifolius Bunge (Rosaceae, RC), a wild raspberry native to East Asia, has been investigated for the biological properties of its leaves and roots, while the dermatological potential of its fruit remains largely unexplored. This research evaluated the dermatological effects of RC fruit extracts, focusing on their potential for skin regeneration and anti-aging applications. Methods: RC fruit extracts were prepared by ultrasound-assisted extraction (UAE) and maceration extraction (ME) with distilled water or 70% ethanol as solvents. Phytochemical profiling was performed by liquid chromatography–electrospray ionization–time-of-flight mass spectrometry (LC-ESI-TOF-MS). Dermatological activities were evaluated using fibroblast and keratinocyte proliferation, collagen synthesis, wound healing, and gene expression assays. Safety was assessed by cytotoxicity and inflammation assays. Skin hydration was evaluated in a human application test. Results: Various phytochemicals, including flavonoids, phenolic acids, organic acids, and terpenoids, were putatively annotated by LC-ESI-TOF-MS in the RC fruit extracts. Ethanol extracts exhibited higher flavonoid content and antioxidant activity; however, dermatological activities were not correlated with antioxidant activity. UAE-derived extracts enhanced fibroblast proliferation. All extracts promoted collagen synthesis, with ME-EtOH showing the highest increase. In wound-healing assays, ME-DW extracts promoted fibroblast wound closure, while UAE-DW enhanced keratinocyte migration. In keratinocytes, UAE-DW specifically upregulated HAS1 and HAS2 mRNA expression. Clinically, UAE-DW extract produced a significant increase in skin hydration and moisture distribution in healthy volunteers. Conclusions: RC fruit extracts exhibit biological activities, including enhanced fibroblast proliferation, collagen synthesis, wound healing, and skin hydration. Full article

Population ageing challenges the social sustainability of high-density cities, where equitable eldercare access underpins SDG 3, SDG 10 and SDG 11. In China, rapid expansion of community-based eldercare facilities (CEFs) under the “90-7-3” framework has produced a tripartite system of government, operating enterprises and older adult users whose spatial priorities conflict, threatening both distributive equity and long-term operational viability. Existing single-dimensional evaluations inadequately capture this complexity. This study develops an integrated four-dimensional spatial evaluation framework—supply–demand accessibility, spatial equity, functional diversity and market competition—applying the Gaussian two-step floating catchment area method, isochrone-based service-area analysis and a preference-weighted Shannon index to 697 CEFs across 130 sub-districts in Beijing’s central urban area. Results reveal a pronounced core–periphery divide. For service-type CEFs, 90.17% of communities (87.95% of older adults) lie within a 15-min walking catchment, yet service-area overlap reaches 199.32%, indicating redundant resource deployment and intense localised competition in core districts. For residential-type CEFs, only 53.91% of communities are within walkable reach and total coverage drops to 15.84%, exposing care blind spots and spatial inequity in outer districts. Functional diversity, by contrast, is evenly distributed and micro-environmentally shaped. The framework offers replicable diagnostics for sustainable ageing-in-place provision in rapidly ageing high-density cities. Full article

Background: Maternal overweight, obesity, and inappropriate gestational weight gain (GWG) are increasingly recognized as major contributors to adverse pregnancy outcomes worldwide. Elevated pre-pregnancy body mass index (BMI) is associated with gestational diabetes mellitus (GDM), hypertensive disorders, cesarean delivery, fetal overgrowth, and long-term cardiometabolic risks for both mother and child. Regional contemporary data from Bulgaria remain limited. Objective: The objective of this study was to evaluate trends in maternal obesity and gestational weight gain among pregnant women in Southeastern Bulgaria between 2021 and 2025, using a regional cohort from Burgas, and to assess associations with maternal and neonatal outcomes. Methods: This retrospective cohort study included 1176 singleton pregnancies registered for antenatal follow-up at MC Prime Clinic–Dr. Kirovakov Ltd., Burgas, Bulgaria, between January 2021 and December 2025. Women were classified according to World Health Organization BMI categories as underweight, normal weight, overweight, and obese. Gestational weight gain was categorized as below, within, or above Institute of Medicine recommendations. Maternal and neonatal outcomes were analyzed using comparative statistics and multivariable logistic regression. Results: The mean maternal age was 30.8 ± 5.4 years, and the mean pre-pregnancy BMI was 25.1 ± 4.8 kg/m². BMI distribution was: underweight 7.6%, normal weight 49.8%, overweight 27.9%, and obesity 14.7%. Overall, 42.6% of women entered pregnancy overweight or obese. Mean total GWG was 13.2 ± 5.6 kg. Excessive GWG occurred in 39.0% of women, while only 39.6% remained within recommended ranges. Excessive GWG was significantly more common among obese women (52.8%) than among women with normal BMI (34.7%, p < 0.001). Compared with women of normal BMI, obese women had significantly higher rates of gestational diabetes mellitus (16.7% vs. 5.8%), hypertensive disorders (12.9% vs. 4.2%), preeclampsia (8.4% vs. 2.1%), cesarean delivery (47.4% vs. 28.6%), macrosomia (14.5% vs. 6.1%), and preterm birth (10.7% vs. 6.9%) (all p < 0.05). In multivariable analysis, maternal obesity independently predicted GDM (aOR 2.94, 95% CI 1.82–4.73), preeclampsia (aOR 3.18, 95% CI 1.87–5.39), cesarean delivery (aOR 2.11, 95% CI 1.42–3.14), macrosomia (aOR 2.46, 95% CI 1.51–4.01), and preterm birth (aOR 1.67, 95% CI 1.02–2.74). Conclusions: Maternal obesity and excessive gestational weight gain were highly prevalent among pregnant women in Southeastern Bulgaria during 2021–2025 and were strongly associated with adverse maternal and neonatal outcomes. These findings support the need for preconception counseling, individualized antenatal weight management, and targeted regional public health strategies. Full article

Background: Body mass index (BMI) does not capture abdominal fat distribution and may classify adiposity differently from central-obesity indicators. We quantified discordance between BMI-defined overweight/obesity and waist-to-height ratio (WHtR)-defined central obesity among adults with type 2 diabetes mellitus (T2DM) in Malawi. Methods: This multicenter cross-sectional study included 1356 adults attending diabetes clinics at three tertiary hospitals. Overweight/obesity was BMI ≥ 25 kg/m². Central obesity was defined by waist circumference (WC ≥ 94/80 cm, men/women), waist-to-hip ratio (WHR ≥ 0.90/0.85), and WHtR ≥ 0.50. BMI and WHtR were cross-classified into four phenotypes, and agreement between the two classifications was summarized using observed agreement and Cohen’s kappa. Logistic and multinomial logistic regression models estimated (adjusted) odds ratios with 95% CIs; sensitivity analyses added study site as a fixed effect and modified Poisson models with robust variance provided adjusted prevalence ratios for the common binary outcomes. Results: Prevalence of BMI-defined overweight/obesity was 60.8%; central obesity was 67.5% (WC), 65.3% (WHR), and 80.1% (WHtR). Cross-classification showed 23.7% had central obesity only and 56.3% had combined overweight/obesity and central obesity; observed agreement between the two classifications was 71.8% and Cohen’s kappa was 0.35 (95% CI 0.30–0.40). Overweight/obesity was associated with older age (aOR 2.95), female sex (aOR 2.19), and physical inactivity (aOR 1.93). WC-defined central obesity was strongly associated with female sex (aOR 10.16), although the corresponding adjusted prevalence ratio was considerably smaller (aPR 2.25). WHR-defined central obesity was associated with older age, and anxiety. WHtR-defined central obesity was associated with older age, female sex, ever-married status, and late-evening eating behavior (aOR 1.36), although the association did not persist when study site was added. The combined phenotype was associated with age, sex, marital status, meal frequency, and physical inactivity. Conclusions: Overweight/obesity and central obesity were highly prevalent, with WHtR identifying the greatest burden and a substantial central-obesity-only phenotype that BMI alone would not detect. Incorporating WHtR alongside BMI may improve anthropometric assessment of adiposity in diabetes care, particularly among older and female patients. Full article

Background: Participation in physical and sports activities is essential for the overall health of persons with disabilities (PWD). However, these individuals encounter multiple environmental and contextual barriers limiting sports engagement. Objective: This study aimed to analyze the perceived barriers to sports participation among PWD in Chile using a socio-ecological framework, evaluating differences by sex and sports practice status while adjusting for potential demographic confounders. Methods: A quantitative, cross-sectional design was conducted with a convenience sample of 245 PWD. Perceptions across four socio-ecological dimensions (intrapersonal, interpersonal, organizational, and community) were measured using the short Spanish version of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI). Non-parametric Mann–Whitney U tests were performed as primary bivariate analyses due to non-normal data distribution, followed by Analysis of Covariance (ANCOVA) models controlling for age and sex. Results: Bivariate analyses showed no significant differences by sex. When comparing sports participants versus non-participants, athletes perceived significantly lower barriers in the organizational ($U=5357, p<0.001, r=0.286$) and community ($U=6216, p=0.020, r=0.172$) dimensions. After adjusting for age and sex via ANCOVA, sports practice remained a significant independent predictor of lower organizational barriers ($F=7.814, p=0.006, {\eta }_p^2=0.032$), and a significant interaction between sports practice and sex was identified in the community dimension ($F=4.671, p=0.032, {\eta }_p^2=0.019$). Community-level barriers were rated highest across all groups. Conclusions: Sports participation is associated with a lower perception of organizational barriers, even when controlling for age. The prominent community-level obstacles underscore the need for targeted, context-specific public policies that enhance accessibility and inclusive infrastructure. Full article

Background/Objectives: Diabetes mellitus is characterized by chronic hyperglycemia, insulin resistance, and low-grade inflammation, and adipose-tissue-derived adipokines are increasingly implicated as regulators of glucose homeostasis. This study compared circulating ghrelin, nesfatin-1, and vaspin levels across three glycemic-control categories defined by HbA1c and evaluated their association with glycemic status. Methods: In this cross-sectional comparative study, serum ghrelin, nesfatin-1, and vaspin were measured by enzyme-linked immunosorbent assay (ELISA) in 161 adults stratified into three groups: HbA1c 6.0–8.4% (n = 55), HbA1c ≥ 8.5% (n = 52), and non-diabetic controls with HbA1c < 6.0% (n = 54). Distributional assumptions were tested with the Kolmogorov–Smirnov and Shapiro–Wilk tests. Because all three adipokines deviated from normality, the primary omnibus comparison was the Kruskal–Wallis test, followed by Dunn’s post hoc test with Bonferroni adjustment; effect sizes are reported with 95% confidence intervals. Group differences were additionally examined after adjustment for age and sex, and HbA1c was analysed as a continuous variable. Results: Ghrelin (Kruskal–Wallis p = 0.726) and vaspin (p = 0.364) did not differ among the three groups. Nesfatin-1 differed significantly (H = 15.16, p < 0.001, ε² = 0.095) and non-monotonically: concentrations were higher in the HbA1c 6.0–8.4% group than in controls (median 824 versus 650 pg/mL; Dunn p = 0.018) and than in the HbA1c ≥ 8.5% group (824 versus 600 pg/mL; p < 0.001), whereas the HbA1c ≥ 8.5% and control groups did not differ (p = 0.909). The nesfatin-1 difference persisted after adjustment for age and sex (p < 0.001) and after excluding controls with impaired fasting glucose (p < 0.001). Within the diabetic participants, nesfatin-1 correlated inversely with continuous HbA1c (ρ = −0.373, p < 0.001). Conclusions: Nesfatin-1, but not ghrelin or vaspin, differed significantly between HbA1c-defined glycemic-control categories in a non-monotonic manner, with the highest concentrations in the intermediate-HbA1c group. Because body mass index, diabetes duration, and antidiabetic medication were not available, and because the design is cross-sectional, these between-group differences cannot be interpreted as a within-person trajectory or attributed to glycemic status independently of adiposity. These exploratory findings require confirmation in larger, prospective, BMI- and medication-adjusted cohorts before nesfatin-1 can be considered a candidate biomarker. Full article

This paper presents a multi-parameter characterisation of the atmospheric composition at the RADO-Bucharest observatory, a regional WMO-GAW and ACTRIS facility in southeastern Europe, by anchoring recent observations within a multi-annual baseline (2015–2024). This paper utilises data from multi-wavelength active remote sensing, high-resolution near-surface speciation, and modelling to evaluate complex urban and transboundary processes across different aerosol and clouds regimes. The year 2025 was marked by an atmospheric perturbation, which was characterised by a quantifiable departure from the decadal climatology. Using Z-score analysis, this perturbation was identified as a seasonal decoupling: an atypical reversal in the vertical particle-size distribution occurred in the free troposphere between July and October, while a transition toward a high-absorption aerosol regime was recorded near the surface during the winter months. These shifts are quantified by a significant drop in the columnar Single Scattering Albedo and a systemic increase in high-troposphere Lidar ratios exceeding 70 ± 12 sr, indicating the presence of advected combustion products aloft. At the surface level, chemical speciation measurements recorded an overall increase in wintertime particulate mass concentrations alongside elevated levels of More-Oxidized Oxygenated Organic Aerosol (MOOOA) compared to previous years, reflecting an intensified accumulation of aged, processed emissions during the January–February period. Furthermore, this paper documents cloud vertical structure and phase occurrence, highlighting a persistent seasonal stratification. The application of unified inversion frameworks is demonstrated through case studies of smoke and mineral dust, applying the Generalized Retrieval of Atmosphere and Surface Properties (GRASP) algorithm to retrieve vertically distributed aerosol microphysics through lidar–photometer integration. Maintained under rigorous quality assurance protocols, these results demonstrate the value of continuous, multi-instrumental profiling to quantify transboundary perturbations and improve regional energy budget representations. Full article

Glacier retreat is creating extensive areas of newly exposed terrain where primary succession drives the transition from abiotic substrates to developing ecosystems. Monitoring these early successional stages remains challenging because pioneer communities, including biological soil crusts (BSCs), often exhibit weak and heterogeneous spectral signatures. This study investigates the potential of Sentinel-2 multispectral imagery for detecting and mapping primary succession within the Forni Glacier forefield (Italian Alps), using terrain exposed by glacier retreat between 1954 and 2015 as a natural chronosequence. A hierarchical classification framework integrating vegetation-sensitive (NDVI-Narrow), moisture-sensitive (NDMI-Narrow), and water-sensitive (NDWI) indices was developed to identify four major land-cover classes: Water/Snow/Ice, Intermediate Pioneer Stage, Initial Moisture-Sensitive Stage, and Barren Rock/Debris. The classification revealed that Barren Rock/Debris was the dominant class (73.4%), followed by Initial Moisture-Sensitive Stage (13.9%), Water/Snow/Ice (10.7%), and Intermediate Pioneer Stage (2.0%). Independent validation yielded Overall Accuracy values ranging from 72.5% to 80%, supporting the robustness of the proposed approach despite the intrinsic heterogeneity of proglacial environments. Analysis of seven exposure-age intervals revealed significant age-related changes in land-cover distribution. Spearman’s rank correlation showed a strong positive association between the Initial Moisture-Sensitive Stage and terrain exposure age (rs = 0.93), whereas Water/Snow/Ice exhibited a strong negative correlation (rs = −0.78), supporting the existence of a directional successional trajectory following glacier retreat. The results also suggest the presence of a possible ecological transition occurring approximately 18–25 years after deglaciation, potentially associated with increasing ecosystem stabilization. The proposed framework provides a scalable and transferable approach for monitoring ecosystem development in glacier forefields and demonstrates that moisture-sensitive spectral information can complement vegetation-based indicators by identifying distinct moisture-sensitive transitional surfaces within recently deglaciated terrain. Full article

Population-level evidence on gambling-related risk remains limited in Central Asia, and no validated bilingual screening instrument has been available in Kazakhstan. This study evaluated the psychometric performance of the bilingual Kazakh–Russian Problem Gambling Severity Index (PGSI) and examined the distribution and correlates of PGSI-defined gambling severity in a multi-regional sample. A total of 1015 adults aged 18–60 years were recruited across all 17 regions and three cities of republican significance. Among the 474 respondents who directly completed all nine PGSI items, internal consistency was good (Cronbach’s α = 0.846), and the first principal component accounted for 45.9% of the variance. Of these respondents, 275 (58.0%) met the conventional PGSI ≥ 8 screening threshold. The same 275 respondents constituted 27.1% of the overall survey sample (N = 1015). These percentages reflect different analytic denominators and are interpreted as sample-specific rather than as estimates of national prevalence. Item-level patterns indicated that elevated scores predominantly reflected cumulative moderate-frequency endorsements across multiple domains. In adjusted analyses, gambling expenditure and frequency showed the strongest associations with PGSI ≥ 8 status. Continuous-score analyses yielded a broadly consistent pattern, indicating that the principal behavioral associations were not solely attributable to dichotomization at the screening threshold. These findings provide initial psychometric evidence for the bilingual PGSI in Kazakhstan and support continued psychometric investigation before its use in epidemiological research or population-level screening. Full article

Background/Objectives: Sleep and circadian disturbances are common in neurodevelopmental conditions, yet the developmental cortical programs linking clock-related transcriptional regulators to disease vulnerability remain unclear. Methods: Here, we integrated human developmental brain transcriptomes, weighted gene co-expression network analysis (WGCNA), human and mouse cortical single-cell atlases, prenatal immune activation transcriptomes, and ASD postmortem brain datasets to characterize the developmental architecture of BrainSpan-derived cortical programs and examine their behavior in perturbational and disease contexts. Results: In the BrainSpan frontal cortex, canonical clock-related genes followed structured but heterogeneous developmental trajectories rather than behaving as a coordinated oscillator-like unit. WGCNA identified a postnatal-rising BrainSpan-derived primary developmental module that was strongly associated with developmental age and enriched for synaptic signaling, neurotransmitter transport, ion transport, membrane excitability, cellular respiration, metabolic regulation, and proteostatic processes. Network analysis placed multiple canonical clock-related and clock-regulatory genes, including NPAS2, BHLHE40, BHLHE41, PER family members, RORA, NR1D1/2, and CLOCK, within a broader neuronal and homeostatic co-expression architecture, although their module-membership strengths varied substantially. Projection onto a human cortical developmental single-cell atlas revealed a non-uniform distribution of the corrected BrainSpan-derived developmental signature, with relatively higher scores in excitatory and inhibitory neuronal populations and lower scores in neuroblast and radial glial populations. A mouse cortical developmental single-cell atlas provided a comparative view of the stage- and cell-type-dependent expression of clock-related genes and the transferred developmental signature during corticogenesis. In a Poly(I:C)-based maternal immune activation dataset, litter-aware reanalysis identified stage-resolved genome-wide transcriptional responses following E12.5 exposure. However, neither the aggregate core clock-gene expression score nor the independently transferred BrainSpan-derived developmental signature showed a significant overall treatment effect or collection-stage-by-treatment interaction, indicating that this bulk dataset provides a perturbational context rather than evidence for selective disruption of the developmental program. An exploratory region-stratified analysis of GSE28521 yielded near-null effects for the BrainSpan-derived developmental signature, with confidence intervals crossing zero across all examined regions. These ASD postmortem findings were therefore treated as a boundary assessment rather than evidence of ASD-specific convergence. Conclusions: Collectively, these findings position clock-related genes as components of a developmentally regulated cortical maturation program enriched for neuronal signaling, synaptic maturation, metabolic regulation, and stress-response processes. Full article

Background/Objectives: Molar incisor hypomineralization (MIH) is a qualitative enamel defect affecting pediatric populations, predisposing to hypersensitivity, caries, and post-eruptive breakdown, and potentially impacting oral health-related quality of life (OHRQoL). Therefore, the primary aim of the present umbrella review was to evaluate the overall OHRQoL among pediatric subjects with MIH, as well as individual domains from both children and parents. Secondary aims were to evaluate the influence of MIH severity, extent/distribution pattern, age, and dentition status on overall- and domain-specific OHRQoL outcomes, and to assess the impact of different dental treatments on OHRQoL. Methods: Following PRISMA guidelines and PROSPERO registration, six systematic reviews were included. To address metric heterogeneity, mean scores were normalized into a 0–100% descriptive percentage impact index. Treatment-related changes were calculated as percentage improvements. Results: A total of 4028 respondents (3193 children and 835 parents/caregivers) were evaluated for OHRQoL. The overall impact on children and parents was highest in the oral domain (26.43%), followed by the psychological (20.25%), functional (19.50%), and social (11.75%) domains. Parental underestimation of MIH was consistently observed across all domains. Children in early mixed dentition reported a higher perceived impact than those in late mixed/permanent dentition (26.77% vs. 14.43%). In an exploratory subsample (n = 494), MIH severity appeared to impact OHRQoL, particularly in oral and functional domains. Overall, post-treatment OHRQoL improved across all domains, although evaluated in a limited sample (n = 491). Conclusions: MIH showed a relevant impact on pediatric OHRQoL. Notably, children consistently report a greater perceived impact than parents, suggesting potential parental underestimation. However, findings regarding dentition stage, MIH severity, and post-treatment improvements should be interpreted with caution, as heterogeneity in assessment tools, limited subsamples, and variable follow-up intervals precludes definitive conclusions. Full article

Background: This study aimed to compare grazing behavior scores between adolescents with essential hypertension (HTN) and controls. It also investigated the associations of grazing behavior with obesity, emotion regulation difficulties (ERD), problematic smartphone use, and screen time. Methods: This cross-sectional case–control study enrolled 60 adolescents with essential HTN and 60 controls selected via frequency matching based on age and sex, all aged 12–18 years. The diagnosis of essential HTN was confirmed using 24-h ambulatory blood pressure monitoring (ABPM). Grazing behavior, ERD, problematic smartphone use, screen time and body mass index (BMI) were assessed in all participants. Group comparisons and associations between grazing behavior and the study variables were analyzed. Results: The essential HTN and control groups were comparable with respect to age and sex distribution (p > 0.05). The mean BMI in the essential HTN group was 31.18 ± 6.81 kg/m², which was significantly higher than that in the control group (23.35 ± 4.47 kg/m²) (p < 0.001). A significant positive correlation was found between total Grazing Questionnaire (GQ) scores and BMI (r = 0.252; p = 0.006), ERD (r = 0.187; p = 0.041), and problematic smartphone use (r = 0.315; p < 0.001). A statistically significant difference was observed between the essential HTN and control groups in total GQ scores [F(1, 117) = 4.85, p = 0.030, η²p = 0.040]. After adjustment for BMI, participants with hepatic steatosis had significantly higher total GQ scores (p = 0.019, η²p = 0.138), Grazing Behaviors subscale scores (p = 0.046, η²p = 0.107), and Uncontrollability subscale scores (p = 0.025, η²p = 0.123) than those without hepatic steatosis. Conclusions: Adolescents with essential HTN had higher grazing behavior scores than controls after adjustment for BMI. Grazing behavior was also associated with ERD and problematic smartphone use across the study sample. The findings regarding grazing behavior and hepatic steatosis warrant cautious interpretation, as the subgroup analysis was exploratory and included a relatively small number of participants. Full article

Background/Objectives: Obesity care requires nutritional prescriptions that are individualized, nutritionally coherent, understandable, and feasible within high-volume clinical services. We describe the NUTRI-OBEDIGITHUM pathway, which integrates multidimensional digital phenotyping, clinician-supervised exchange-based nutritional prescription, patient-oriented materials, and structured education, and we report preliminary descriptive outcomes from a retrospective real-world cohort. Methods: This descriptive methodological and operational study included a retrospective observational analysis of anonymized routine-care data. NUTRI-OBEDIGITHUM integrates OBEDIGITHUM, a digitally enabled obesity-care pathway, with Dietcamb^®, a software-supported method that translates individualized energy and macronutrient targets into food exchanges, meal distributions, household measures, food lists, and example menus. The source database comprised 3928 unique patients. Among patients with a plausible baseline weight and an observable 6-month window, the eligible outcome was the measurement closest to day 183 within ±60 days, after prespecified plausibility checks. Baseline characteristics were compared descriptively according to outcome availability. Baseline medication exposure was assessed using free-text mentions only. Results: By the data cutoff, the 6-month window had opened for 3215 patients; 929 (28.9%) had an eligible 6-month weight and 2286 (71.1%) did not. In the analyzed cohort, mean age was 53.7 ± 14.0 years, 70.5% were women, and mean body mass index was 35.9 ± 6.3 kg/m². Mean weight changed from 98.5 ± 20.7 kg at baseline to 94.2 ± 20.3 kg at follow-up, corresponding to a descriptive paired change of −4.3 kg (95% CI −4.7 to −3.9); median total body-weight loss was 3.4%. Losses of at least 5%, 10%, and 15% were observed in 39.6%, 17.8%, and 6.4% of patients, respectively. A baseline GLP-1 receptor-agonist mention was present in 151/929 patients (16.3%); medication timing, dose, duration, dispensing, persistence, and adherence were unavailable. Conclusions: NUTRI-OBEDIGITHUM provides an operational framework for converting multidimensional obesity phenotyping into a structured, flexible, clinician-supervised, and patient-oriented nutritional prescription. The observed weight trajectories are descriptive complete-case findings from a selected, uncontrolled cohort and cannot establish the independent effectiveness of the pathway, Dietcamb^®, or pharmacotherapy. Prospective studies should evaluate reach, adoption, fidelity, usability, adherence, nutritional adequacy, safety, NUTRI-specific workload and cost, and metabolic outcomes. Full article

Background/Objectives: Rubidium-82 (⁸²Rb) PET myocardial perfusion imaging (MPI) yields, in a single study, quantitative absolute myocardial blood flow (MBF, mL/min/g), myocardial flow reserve (MFR), and gated left ventricular (LV) function (LVEF, EDV, ESV, SV). These quantitative values depend on the tracer, scanner, kinetic model, software, and underlying population and have been characterised almost exclusively in North American and European cohorts. The Arabian Gulf, where Kuwait has among the highest age-standardised diabetes prevalence worldwide (25.6%), is essentially unstudied, so the distribution and behaviour of these parameters in such a real-world cardiometabolic population are unknown. To evaluate the distribution of the quantitative ⁸²Rb PET parameter set in a real-world Arabian Gulf cohort and, within a small clinically defined normal subgroup, to describe sex- and age-related patterns in absolute MBF, MFR, and LV function. Given the limited size of the normal subgroup, these values are presented as exploratory, hypothesis-generating observations rather than definitive population reference norms. Methods: Retrospective single-centre study of 330 consecutive ⁸²Rb PET/CT studies (analytic cohort n = 292 after exclusion of repeat studies and those with incomplete quantitative output; mean age 63.1 ± 12.1 years) who underwent adenosine-stress ⁸²Rb PET/CT MPI. The clinically defined normal subgroup, normal perfusion (C1), normal global MFR (≥2.0), normal resting LVEF, and no documented cardiac history, comprised 44 patients (25 female, 19 male). Reference values are reported as sex- and age-stratified centiles (5th, 25th, median, 95th percentiles), with the 5th percentile reported for each parameter. Sex differences used Mann–Whitney U with rank-biserial r and Cohen’s d (95% CI); age was examined across broad bands. All analyses followed APA 7 standards with Bonferroni correction. Results: In the clinically defined normal subgroup, median global stress MBF was 2.94 mL/min/g (5th percentile 2.03) and median global MFR was 2.72 (5th percentile 2.06); every value satisfied the C1 definition (MFR ≥ 2.0) by construction, so these limits describe the preselected subgroup and cannot independently validate the 2.0 threshold. Women had higher resting MBF than men (median 1.07 vs. 0.90 mL/min/g; p = 0.007), with numerically lower global MFR that did not survive correction for multiple comparisons (2.57 vs. 2.98; p = 0.022); stress MBF did not differ by sex (3.00 vs. 2.91; p = 0.522). LV volumes were smaller in women, while LVEF was similar between sexes. The 5th percentile for stress LVEF was 54% (women) and 53% (men). These absolute-flow reference values are lower than those reported for Western low-risk cohorts (stress MBF ~3.25 mL/min/g; MFR ~3.18), consistent with the higher cardiometabolic burden of this population. Conclusions: In this exploratory single-centre evaluation, quantitative ⁸²Rb PET flow values in a small clinically defined normal Arabian Gulf subgroup were lower than Caucasian-derived values, while sex-related differences in resting flow were evident and age-related differences were numerically consistent with previously reported trends. Because the normal subgroup is small, these findings are hypothesis-generating and require confirmation in larger, prospectively screened cohorts before use as population reference values; they nonetheless indicate that population- and pipeline-specific calibration is needed when quantitative ⁸²Rb thresholds derived elsewhere are applied locally. Full article