Search Results (15,280)

Background: Coagulation markers are used to guide clinical anticoagulation decisions. We aimed to identify circulating metabolites that are associated with coagulation markers in children with congenital heart disease (CHD). Methods: Plasma samples were separated from whole blood under consistent conditions. Untargeted metabolomic data were measured in plasma from up to 203 young patients (age range: 0 days–24 years) with CHD before cardiac surgery. Coagulation markers included activated partial thromboplastin time (aPTT), prothrombin time (PT), and activated clotting time (ACT). Weighted Gene Co-expression Network Analysis (WGCNA) was performed to explore metabolite modules (clusters). Associations of metabolites with the coagulation markers were assessed cross-sectionally with regression models, with false discovery rate (FDR) correction for multiple comparison. Associations between coagulation markers and “eigenmetabolites” from WGCNA modules were assessed by correlation analysis. Results: A total of 776 metabolites were included in the final analysis. Among these, 20 metabolites were associated with PT and one (valine) with ACT (FDR q value < 0.05). Among the metabolites associated with PT, the top three were retinol, 1-palmitoyl-GPI (16:0), and X-25371 (identity unknown). One module from WGCNA with metabolites from the lipid super pathway was correlated with PT (p = 0.004). Conclusions: In this first attempt to identify novel metabolites for coagulation markers, we report 21 metabolites associated with PT or ACT in children with CHD. Future studies are needed to replicate these findings in independent cohorts and to elucidate the biological mechanisms linking these metabolites to hemostatic regulation. Full article

Background/Objectives: The extent to which inhibin B, a marker of Sertoli cell function, is affected by cardiometabolic disturbances remains insufficiently understood. The aim of this study was to evaluate the relationships between serum inhibin B levels and the atherogenic index of plasma (AIP), triglyceride–glucose (TyG) index, HOMA-IR, METS-IR, and C-reactive protein (CRP) in adult men aged 40–65 years and to secondarily investigate a possible association with coronary artery calcium score (CACS). Methods: This cross-sectional study included 67 men aged 40–65 years referred for coronary computed tomography angiography, sampled in a balanced manner across coronary artery calcium score (CACS) categories. Serum inhibin B levels were measured by a commercial sandwich ELISA; AIP, TyG index, HOMA-IR, and METS-IR were calculated from fasting biochemical measurements. Associations between inhibin B and cardiometabolic parameters were assessed using Spearman correlation analyses and age-adjusted partial correlations. Significant associations were further examined using multivariable linear regression. Results: The mean serum inhibin B level was 224 ± 35 pg/mL. The TyG index (ρ = −0.308, p = 0.011) and BMI (ρ = −0.348, p = 0.004) showed significant negative correlations with inhibin B, and both associations persisted after age adjustment. No significant associations were found with HOMA-IR, METS-IR, AIP, CRP, or CACS. Although BMI and the TyG index were not significantly correlated with each other (ρ = −0.084, p = 0.564), both variables remained independently associated with inhibin B in the multivariable model (TyG: β = −0.283, p = 0.015; BMI: β = −0.313, p = 0.007). The model explained 18.0% of the variance in inhibin B (R² = 0.180). Conclusions: In adult men, serum inhibin B levels were independently and inversely associated with BMI and the TyG index, whereas no significant relationship was observed with other metabolic, inflammatory, atherogenic, or coronary calcification markers. These findings suggest that the relationship between inhibin B and cardiometabolic health is not generalizable across all cardiometabolic indices and may be specifically related to the metabolic profile represented by adiposity and the TyG index. Full article

Background/Objectives: Anaphylaxis is a severe systemic allergic reaction that may involve multiple organ systems and requires prompt recognition and treatment. In children and adolescents, food is a major trigger, and clinical presentation may vary according to biological factors, including sex. This study aimed to examine sex-related differences in the clinical presentation, triage acuity, measured emergency-care processes, and suspected triggers of anaphylaxis in pediatric patients treated at a tertiary hospital. Methods: A retrospective cross-sectional study was conducted in the pediatric emergency department of a tertiary hospital in Madrid, Spain, between 2015 and 2022. Sociodemographic characteristics, allergic history, clinical manifestations, TRIPED-GM triage level, Pediatric Assessment Triangle classification, measured emergency-care processes, suspected triggers, hospital admission, and final diagnosis were analyzed. Multiple comparisons were controlled using Bonferroni adjustment within clinically defined domains. Results: A total of 368 patients were included; 65.2% were boys and 57.3% were aged ≤5 years. Unadjusted analyses identified several apparent signals in specific clinical manifestations, triage distribution, and suspected triggers; none showed a consistent pattern after multiplicity adjustment. The difference in the overall distribution of TRIPED-GM triage levels was not statistically significant after multiplicity adjustment. Although Grade 3 assignment remained more frequent among boys in a category-specific post hoc analysis, this isolated finding was not supported by multivariable ordinal regression, in which sex was not independently associated with overall triage acuity. Tree nuts, cow’s milk protein, and egg were the most frequently suspected triggers. Conclusions: No consistent evidence of overall sex-related differences in suspected pediatric anaphylaxis presentation, measured emergency-care processes, suspected triggers, or triage acuity was found after multiplicity adjustment and multivariable analysis. Although an isolated difference in Grade 3 triage assignment persisted in a post hoc analysis, it should be interpreted cautiously. Pediatric emergency nursing assessment and triage should therefore remain primarily guided by acute clinical presentation and physiological severity rather than by sex. Larger multicenter studies are needed to determine whether more subtle or age-dependent sex-related patterns have clinical relevance. Full article

Background/Objectives: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect, and cardiac computed tomography (CT) is increasingly central to its anatomical and pre-procedural assessment. Artificial-intelligence research in TOF is dominated by MRI; deep learning on cardiac CT in congenital heart disease exists but addresses multi-class diagnosis and segmentation, and the one binary TOF-versus-control CT study used slice-level validation without confounder control, and, to our knowledge, no CT study reports controlling the confounding intrinsic to a TOF-versus-control comparison. This confounding is structural: TOF is imaged predominantly in infancy, so a naive classifier can learn age, body size, and acquisition protocol rather than pathology. We develop and internally evaluate a confounder-matched, anatomy-guided deep-learning pipeline for TOF on cardiac CT. Methods: Contrast-enhanced cardiac CT from a single scanner was de-identified and restricted to one reconstruction (FC15 kernel, 0.5 mm), then matched 1:1 on age and sex, yielding 42 TOF and 42 controls (n = 84); controls were children imaged for suspected but excluded cardiovascular disease, so scan indication, unlike age and sex, was not matched. Standardized volumes were decomposed into four fixed sub-volumes positioned to approximate the components of the diagnostic tetrad: malalignment ventricular septal defect (VSD), overriding aorta, right-ventricular outflow tract (RVOT), and right-ventricular hypertrophy (RVH). Whether each sub-volume contains its named target was audited against independent physician region-of-interest annotations. Per region, a 2.5D transfer-learning classifier (ImageNet ResNet18) and a 3D CNN (DenseNet121) were trained with leak-free patient-level five-fold cross-validation and the branches fused. Optimism was assessed by repeated cross-validation and, for model selection, by nested cross-validation with the component subset and operating point chosen inside an inner loop. Discrimination was reported with bootstrap 95% confidence intervals (CIs); AUROCs were compared by DeLong test, with Benjamini–Hochberg correction applied to a seven-member family (the four within-component comparisons, two hybrid-versus-VSD contrasts, and hybrid versus whole-heart) and other comparisons reported uncorrected. Results: Matching removed the age difference (median 0.33 years, IQR 0.17–0.92 vs. 0.33, IQR 0.27–0.73; p = 0.86) with balanced sex (p = 1.00). The pre-specified four-component hybrid reached AUROC 0.829 (95% CI 0.74–0.91); the VSD region alone reached 0.828 (0.74–0.91), so the tetrad decomposition did not improve accuracy, and the containment audit shows it does not deliver the intended anatomical interpretability either. The 2.5D model exceeded the 3D CNN for every component (0.769–0.828 vs. 0.573–0.656; raw DeLong p = 0.007–0.037, Benjamini–Hochberg q up to 0.065 under a seven-member family, the weakest comparison (RVH) not surviving correction). Repeated cross-validation gave 0.811 ± 0.026 and nested cross-validation 0.787 ± 0.029; a stronger backbone with multi-phase data, handcrafted radiomics, and a large CT foundation model did not significantly improve on the matched pipeline. Grad-CAM maps were sensitive to both model weights and labels and superior to a centred-blob null in all eight comparisons and significantly so in seven, but not consistently superior to a resolution-matched random attribution, so no localization claim is made. Calibration was imperfect (slope 0.67) and recalibration gave no net gain; at an in-sample Youden threshold sensitivity was 0.93 and specificity 0.64. Occlusion sensitivity on the whole-heart baseline model showed it relies on the physician-marked septal, aortic and right-ventricular sites 1.8–4.1 times more than distance-matched surrounding tissue, while gross morphometry alone reached 0.651–0.663. Two of the four sub-volumes did not contain their target: the RVOT prior contained the physician annotation in 48.1% of cases and, because the model samples only the central band, excluded it in 99.4%; the RVH box was offset toward the midline, containing the marked target in 43.4% of annotations. Repositioning the priors, leak-free and derived from controls only, did not change discrimination (all p≥ 0.10), and boxes placed at random positions inside the standardized heart reached 0.765 on average against 0.796 for the published priors, a difference this cohort cannot resolve. Conclusions: As a proof of concept, confounder-matched deep learning can recognize TOF on cardiac CT. Increasing model capacity did not significantly improve on the matched pipeline; the separate contribution of matching itself was not isolated against an unmatched comparator. Given the small, single-centre sample and the absence of external validation, these findings are hypothesis-generating and require external, multi-centre confirmation before any clinical use. Full article

Background/Objectives: The prognostic nutritional index (PNI) has been associated with outcome in metastatic breast cancer, but studies in CDK4/6 inhibitor-treated patients have used cohort-derived thresholds and examined only the pretreatment value. We assessed the PNI as a continuous variable, compared it with inflammatory indices, and examined whether repeated measurement added information. Methods: We reviewed 192 consecutive patients with hormone receptor–positive, HER2-negative metastatic breast cancer treated with a CDK4/6 inhibitor and endocrine therapy at a single centre. We calculated the PNI, neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI) before treatment and recalculated them before cycles 2 and 3. The Cox models were adjusted for age, liver metastasis and line of therapy; no threshold was derived from these data. Results: The median follow-up was 44.9 months. Each one-point increase in the baseline PNI was independently associated with lower hazards of progression (HR 0.952, 95% CI 0.923–0.983) and death (HR 0.919, 95% CI 0.884–0.956), corresponding to HR 0.782 (95% CI 0.670–0.918) and HR 0.656 (95% CI 0.540–0.799) per five-point increase. For overall survival, in formal comparisons on identical patient sets, neither the NLR nor the SIRI added prognostic information to a model containing the PNI (likelihood ratio p = 0.383 and p = 0.335), whereas the PNI added information to models containing either ratio (p < 0.001 and p = 0.004). In exploratory landmark analyses, change in the PNI added little to the baseline value; apparent associations between increases in the NLR or SIRI by cycle 3 and overall survival did not persist after winsorisation of extreme change scores. Conclusions: Baseline PNI, analysed as a continuous variable and without a data-derived threshold, was independently associated with progression-free and overall survival in this cohort. For overall survival, neither baseline inflammatory ratio added detectable prognostic information beyond the index, and repeated measurement during treatment added little to the baseline value, although the confidence intervals do not exclude modest effects. Because all patients received a CDK4/6 inhibitor and no comparator arm was available, these findings support a prognostic rather than a predictive interpretation, and external validation is required before the index can inform clinical decisions. Full article

The fine-scale monitoring of plantation cover disappearance and appearance is challenging because these changes are often expressed as weak within-class variations in high-resolution images. This study proposes MLLAForestCD, a three-class pixel-level semantic change-detection network for Eucalyptus plantations. The model uses an MLLA encoder to model the long-range spatial context with efficient linear attention, while a dual-axis change extractor reorganizes paired bi-temporal features through complementary layouts before contextual interaction. Multi-scale fusion then combines semantic cues with boundary-level details. We further construct the Eucalyptus Change Detection Dataset (ECDD), which contains plantation scenes with weak spectral contrast, fragmented boundaries, and directional canopy textures. Under the retained patch-level training/validation split, MLLAForestCD achieves an F1-score of 96.66% and an mIoU of 93.59%. After separate training and evaluation based on WHU-CD, it achieves an F1-score of 97.29% and an IoU of 90.10%; this result reflects performance under an independent WHU-CD training protocol. Finally, annual change maps from 2020 to 2023 are used to derive the most recently detected plantation-appearance time within the observation window. The resulting product is interpreted as a recent stand-renewal event map and requires independent forestry records before biological stand age can be inferred. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is increasingly recognised as a risk factor for physical frailty, driven by sarcopenia, microvascular disease, and chronic hyperglycaemia. Simple, low-cost performance tests may offer a practical means of identifying frailty risk in this population, but data combining several such measures in T2DM remain limited. This study aimed to characterise physical performance and quantify the proportion of adults with T2DM meeting thresholds for low physical performance. Methods: In this cross-sectional study, physical performance was assessed in adults with T2DM using the Timed Up and Go (TUG) test, handgrip strength (HGS), and the six-minute walk distance (6MWD). TUG cutoffs of 8 and 10 s were applied as exploratory external reference thresholds, consistent with cutoffs previously applied in chronic disease and older-adult populations. Results: Participants had a mean age of 55.6 ± 4.8 years; 42 (64.6%) were male, and mean BMI was 29.6 ± 4.4 kg/m². Mean TUG time was 9.30 ± 3.02 s, right and left HGS were 30.8 ± 10.1 kg and 28.0 ± 9.3 kg, and mean 6MWD was 401.2 ± 96.3 m. Forty-four participants (67.7%; 95% CI 55.6–77.8) exceeded the 8 s threshold, and 16 (24.6%; 95% CI 15.8–36.3) exceeded 10 s. TUG correlated strongly and inversely with 6MWD (r = −0.75, 95% CI −0.84 to −0.61; p < 0.001). This remained unchanged after adjustment for age, sex, and BMI (r = −0.76) and held within men (r = −0.79) and women (r = −0.78) separately. Handgrip strength correlated with 6MWD (right r = 0.40; left r = 0.39; both p ≤ 0.001) and attenuated to non-significance after adjustment for sex (r = 0.22, p = 0.076) and for age, sex, and BMI (r = 0.18, p = 0.16). In multivariable regression, TUG was independently associated with 6MWD (−21.4 m per second, p < 0.001), whereas handgrip strength was not (p = 0.064). Conclusions: A substantial proportion of adults with T2DM in this cohort displayed low-physical-performance profiles. Simple performance batteries combining TUG, handgrip strength, and 6MWD warrant further study as a potential means of identifying patients with T2DM who could benefit from targeted rehabilitation. Full article

This study aimed to evaluate the ability of different categories of direct restorative materials to withstand artificial dentin alterations. A total of 360 human dentin specimens were allocated into 18 groups (n = 20). An ion-releasing bulk-fill resin-based composite (Cention Forte/CF), a resin-modified glass ionomer cement (Fuji II LC/FJLC), and an experimental conventional glass ionomer cement (EXP) were applied on sound, artificially hypermineralized, and demineralized dentin. Shear bond strength (SBS) was performed after 1 week and 6 months of storage, followed by fractographic analysis. Statistical analysis was performed using one- and three-way ANOVA, Games–Howell post hoc test, independent t-tests (α = 0.05), and Weibull analysis. SBS and bond reliability of CF on sound and hypermineralized dentin were higher than on other materials after both aging periods. On these two substrates, the SBS values of FJLC were higher than those of EXP, except for sound dentin after 6 months. Demineralized dentin significantly reduced the SBS of all materials under both aging conditions, with a high number of pre-test failures. The impact of aging was significant only in demineralized dentin for all materials. Ion-releasing resin-based composite performed best in terms of bond strength and reliability on sound and hypermineralized dentin. Artificially demineralized dentin severely compromised the bonding performance and maturation of all materials. Full article

Background: Right-sided aortic arch with Kommerell diverticulum (RAA-KD) has complex three-dimensional anatomy. Methods: We retrospectively analyzed computed tomography angiography data from 65 adults with RAA-KD using centerline-based reconstruction. Patients were stratified by conventional maximal KD diameter (D_KDmax) into <55 mm (n = 38) and ≥55 mm (n = 27) groups. Age associations, adjusted group differences, and continuous associations with centerline-derived KD diameter at maximal cross-sectional area (D₁₀) were examined. Results: After sex adjustment and false-discovery-rate correction, all aortic diameters increased with age; the ascending aorta, arch, and descending thoracic aorta also elongated, whereas aortic isthmus (L₄) and KD (L₅) lengths were not age-associated. After age and sex adjustment and false-discovery-rate correction, diameters of the ascending aorta, aortic arch, and descending thoracic aorta (D₂–D₈), as well as KD-related diameters (D₉–D₁₂), remained larger in the ≥55 mm group; L4 was shorter and L5 longer. In continuous models, D₁₀ was positively associated with all non-KD diameters, most strongly with the adjacent proximal descending aorta (D₇), and independently associated with shorter L₄ (B = −0.548; 95% CI, −0.828 to −0.268) and longer L₅ (B = 0.639; 95% CI, 0.412–0.866; both p < 0.001). Conclusions: RAA-KD demonstrates generalized age-associated thoracic aortic enlargement and localized KD-associated remodeling. Comprehensive three-dimensional assessment may inform evaluation of the adjacent aorta and proximal sealing zone for thoracic endovascular aortic repair. Full article

The central point of evolutionary ecology is understanding the drivers of variation in life-history strategies among organisms. The post-fledging dependence period is a critical life-history stage in the life cycle of altricial birds, influencing their future long-term survival, fitness, and reproduction. This period represents the transition between fledging and the onset of natal dispersal or migration, when offspring are highly dependent on parental care. In this study, we used GPS-GSM telemetry to analyze for the first time the duration of this phase and the size of the ranging area of Lesser Spotted Eagles during the dependence period, testing the importance of various extrinsic (habitat type, territory, region) and intrinsic (body condition, sex, fledging date, fledging age) factors. Our survey was conducted between 2020 and 2025 in Bulgaria, SoutheastEurope. The mean duration of the post-fledging dependence period (PFDP) in the juveniles was 47 ± 5 days (SD) (n = 14). The age of independence of eagles ranged from 71 to 110 days (median = 95 days). Our results show that the fledging date is the main determinant shaping the dependence period both temporally and spatially. The size of the ranging area (90% home range) of juveniles during the PFDP varied from 0.03 to 16.72 km², with a mean value of 2.41 km² ± 4.34 SD (n = 14). Home range was influenced mainly by surrounding habitats (grassland types and forests). In line with our hypothesis, we found that birds are habitat-selective, strongly preferring forests and avoiding human-modified landscapes (infrastructure and agricultural fields) during this early life-history stage. We established a relatively small ranging area inhabited by eagles and a low-mobility pattern with a gradual increase in movements that is highly individual-specific. In general, forests occupied the largest share of the home range of eagles, ranging from 0.38% to 87.45%, with a mean value of 49.47% ± 26.57. The duration of the post-fledging dependence period and the size of the ranging area were constrained by the onset of first migration, coinciding with the beginning of birds’ independence. The home range overlap of eagles varied from 56.35% to 100%, with an average value of 87.94%. The high similarity among ranging areas identified in this study emphasizes the importance and consistency of environmental conditions, such as habitat features, compared to others that would vary yearly. The key aspects (spatial and temporal) of the post-fledging dependence pattern, identified by our study, are important for species conservation and must be integrated into future landscape planning. Our results also contribute to a better understanding of the complex factors shaping raptors’ space-use pattern in this key, a poorly studied life-history trait of raptors, thus enhancing knowledge for similar species of conservation concern. Full article

Background: Geriatric dentistry prepares dentists to care for an aging population. Yet, its integration into undergraduate curricula remains inconsistent. Objectives: To map evidence on the barriers to and facilitators of the implementation and development of undergraduate geriatric dental education. Methods: A scoping review was conducted using systematic searches of PubMed, Scopus, and Embase for English-language original research articles published from 1 January 2016 onward. Two reviewers screened titles, abstracts, and full texts independently against eligibility criteria. Studies were included if they examined barriers and/or facilitators related to undergraduate geriatric dental education. Data were extracted independently and synthesized descriptively to identify themes and evidence gaps. No critical appraisal was performed. Results: This review identified 1376 studies and included 11 studies, including seven cross-sectional and four cohort studies. Barriers clustered into three themes: structural and workforce-related barriers (resource constraints and a lack of equipped/trained staff), curricular and regulatory barriers (overcrowded curricula and a lack of curriculum guidelines), and interprofessional and attitudinal barriers (limited interprofessional collaboration and negative attitudes among students and teaching staff towards older adults). Facilitators were grouped into three themes: pedagogical and experiential learning strategies (didactic teaching, clinical training, extramural exposure, simulation-based training, and communication training), curricular and policy enablers (integrated curricula and national guidelines), and institutional and faculty support (staff support). Conclusions: This review identifies the multifaceted, modifiable educational, institutional, and policy factors that influence the implementation and development of geriatric dental education. By consolidating the existing evidence, this review provides a foundation for curriculum development and policy planning to prepare graduates to deliver age-responsive oral healthcare. Full article

The Naglieri Nonverbal Ability Test–Individual Form (NNAT-I) is widely used to assess nonverbal reasoning while minimizing language demands, yet evidence regarding its psychometric properties in Turkish middle school students is limited. This study examined the reliability, convergent validity, internal structure, item functioning, and differential item functioning (DIF) of the NNAT-I in 1130 students aged 10–14 years attending schools across socioeconomic development strata in Aydın, Türkiye. Internal consistency, test–retest and alternate-form reliability, convergent validity, confirmatory factor analysis (CFA), Rasch analyses, multiple-group Rasch DIF analyses, and linear mixed-effects modeling were conducted. The NNAT-I demonstrated high internal consistency (Cronbach’s α = 0.93; McDonald’s ω = 0.94), strong test–retest and alternate-form reliability, and strong correlations with the Test of Nonverbal Intelligence–Third Edition (TONI-3) and Raven’s Standard Progressive Matrices (RSPM). CFA provided qualified rather than unequivocal evidence for a predominantly unidimensional structure, with model fit varying according to item response distributions and the treatment of structurally nonadministered responses. Rasch analyses of the calibrated items supported an ordered hierarchy of item difficulty, with all items showing Infit values within the prespecified descriptive reference range. After adjustment for multiple comparisons, DIF analyses identified significant gender-related DIF for only one item, while no items showed significant age-related DIF. Linear mixed-effects modeling showed that grade level and gender were significantly associated with NNAT-I scores, whereas chronological age was not independently associated with performance. These findings provide evidence regarding the reliability, convergent validity, internal structure, and item functioning of the NNAT-I in this Turkish middle-school sample, while also indicating that conclusions regarding unidimensionality should remain qualified. The findings underscore the importance of local psychometric evaluation before applying nonverbal measures in new educational and cultural contexts. Full article

Background: Whether the physiological response during positive airway pressure (PAP) titration predicts adherence independently of baseline severity is unclear. Methods: In 304 patients who underwent manual PAP titration at a tertiary university hospital between 2020 and 2022, adherence was defined by Korean reimbursement criteria (≥4 h/night on ≥70% of nights within any consecutive 30-day period during the initial 90 days). Titration parameters were compared using tests appropriate to each distribution and entered into logistic regression adjusted for age, sex, body mass index and baseline apnea–hypopnea index (AHI), with bootstrap validation. Results: Adherent (n = 238) and non-adherent (n = 66) groups had comparable baseline severity. Three titration parameters differed: AHI reduction rate (p = 0.033), lowest oxygen saturation (SpO₂; p = 0.010) and rapid eye movement-sleep proportion (p = 0.021). Adding these parameters to a confounder-only model raised the area under the curve from 0.566 to 0.683 (p < 0.001; optimism-corrected, 0.632). Adjusted for confounders alone, all three were significant, but with mutual adjustment only the lowest SpO₂ remained independent (odds ratio, 1.117 per 1%; 95% CI, 1.028–1.214). Conclusions: Among the physiological parameters recorded during PAP titration, the lowest SpO₂ was the most robust predictor of short-term adherence, independent of both baseline disease severity and baseline hypoxemia. Prospective validation is required. Full article

Background: Epicardial adipose tissue (EAT) has been associated with coronary artery disease (CAD) in middle-aged and mixed-age populations, but its value in adults aged 80 years and older remains uncertain. This study investigated whether computed tomography (CT)-derived EAT volume provides incremental value for discriminating CAD in this very elderly population. Methods: We retrospectively included 155 patients aged ≥80 years who underwent coronary imaging evaluation between 2020 and 2022. EAT volume was quantified from non-contrast chest CT. Logistic regression, CatBoost modeling, and SHapley Additive exPlanations (SHAP) were used to assess the association of EAT with CAD, its discriminative value, and its relative contribution. Results: Forty-five patients (29.0%) had CAD. Median EAT volume did not differ between groups (p = 0.716) and was not associated with CAD after adjustment for age, sex, body mass index, diabetes, and glycated hemoglobin A1c (HbA1c). Adding EAT did not improve discrimination in logistic regression [area under the curve (AUC) 0.698 vs. 0.697; likelihood-ratio p = 0.945] or in cross-validated CatBoost analysis (AUC 0.623 vs. 0.614). SHAP ranked EAT eighth of eighteen predictors, below lipoprotein(a), total cholesterol, left atrial diameter, HbA1c, low-density lipoprotein cholesterol, diabetes, and atrial fibrillation. Conclusions: In adults aged 80 years and older, CT-derived EAT volume was not independently associated with CAD and added no discriminative value beyond conventional clinical risk factors. Total EAT volume may have limited utility as a CAD marker in very elderly adults. Full article

Background/Objectives: Spiritual care is an important component of holistic palliative care. This study aimed to examine the association between spiritual care competence and perceived quality of palliative nursing care among nurses providing palliative care across different clinical settings. Methods: A descriptive, cross-sectional, correlational study was conducted among 160 nurses providing palliative care in palliative care units, oncology wards, and intensive care units between 1 September and 31 October 2024. Data were collected using a Personal Information Form, the Palliative Care Quality Scale for Nurses (PNCQS), and the Spiritual Care Competence Scale (SCCS). Descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression analyses were performed. Statistical significance was set at p < 0.05. Results: The mean age of the nurses was 30.43 ± 8.95 years; 77.5% were female, 49.4% had received palliative care training, and 21.9% had received spiritual care training. Overall, 21.9% considered themselves competent in providing spiritual care, while 23.8% identified excessive patient workload as a barrier to providing spiritual care. The mean PNCQS and SCCS scores were 75.08 ± 10.15 and 92.8 ± 12.1, respectively. PNCQS scores were significantly higher among female nurses and nurses with postgraduate education. PNCQS and SCCS scores were weakly but significantly positively correlated (r = 0.161, p = 0.042). In the multiple linear regression analysis, postgraduate education, gender, and SCCS scores were significantly associated with PNCQS scores. The model explained 15.0% of the variance in PNCQS scores (adjusted R² = 0.134). Conclusions: Spiritual care competence was weakly associated with nurses’ perceived quality of palliative nursing care. Given the cross-sectional design and the use of self-reported measures, this association should not be interpreted causally. The limited explanatory power of the regression model suggests that perceived quality of palliative nursing care is influenced by multiple individual, clinical, educational, and contextual factors. Future longitudinal and multimethod research should examine these factors using objective and patient-centered indicators across diverse clinical settings. Full article