Search Results (852)

Background/Objectives: Foods and beverages consumed during school lunch periods contribute substantially to children’s dietary intake; however, Canadian evidence of their nutritional contribution and quality remains limited. This study assessed nutrient content, nutrient density, and contributions to dietary recommendations among Saskatchewan elementary students. Methods: A descriptive quantitative study was conducted among 379 students aged 5–13. Dietary intake during school lunch periods was assessed using a photography-assisted plate waste method. Nutrient content was estimated using standard nutrient databases, nutrient density was evaluated using the Nutrient-Rich Food (NRF) 9.3 Index, and contributions to dietary recommendations were examined. Results: Median lunch energy was 411.4 kcal (IQR: 296.7), and the mean NRF 9.3 score was 292.6 (SD: 130.7). Compared with home-packed and mixed lunches, school-provided lunches contained less energy, carbohydrate, fat, and sugar, while protein was similar across lunch types. Overall, lunches contributed <25% of daily requirements for key nutrients, including fibre, vitamin D, calcium, and potassium. Older students had lower proportional nutrient contributions relative to their higher nutritional requirements. Nutrient density differed by lunch provenance, but not by age or reported gender, with school-provided lunches achieving the highest NRF 9.3 scores. Conclusions: Lunches contributed modestly to daily nutrient requirements, particularly among older students. In this sample, school-provided lunches were associated with higher nutrient density than home-packed lunches, although their absolute contributions to several nutrients remained limited. These findings provide baseline evidence on lunches consumed during school lunch periods among Saskatchewan elementary students and may inform future evaluations of school food systems and policies. Full article

Background/Objectives: Coronary artery disease (CAD) is a leading cause of cardiovascular morbidity and mortality worldwide. Type 2 diabetes mellitus (T2DM) further increases CAD risk through metabolic disturbances and endothelial dysfunction. Adropin, S100A1, and SERCA2b are important regulators of endothelial function, energy metabolism, and calcium homeostasis. This study aimed to investigate the gene and protein expression levels of these biomarkers in CAD patients with and without T2DM. Methods: Gene and protein expression levels of adropin (ENHO), S100A1, and SERCA2b were evaluated in peripheral blood samples obtained from healthy controls (n = 50), CAD patients (n = 46), and CAD patients with T2DM (CAD+T2DM) (n = 40). Gene expression was determined using real-time PCR, while protein levels were measured with ELISA. Additionally, in silico bioinformatics analyses, such as protein–protein interaction networks and pathway enrichment analyses, were performed to explore potential molecular relationships among these biomarkers. Results: Adropin and ENHO gene expression levels were significantly lower in CAD patients and inversely related to the SYNTAX score. S100A1 levels were also reduced, and SERCA2b gene expression was significantly decreased, especially in the CAD+T2DM group. Bioinformatics analyses revealed that these molecules participate in interconnected pathways related to calcium signaling, cardiac muscle contraction, and metabolic regulation. Conclusions: These findings demonstrate links between altered levels of adropin, S100A1, and SERCA2b and CAD with or without T2DM. However, these observations are preliminary and need validation in larger prospective studies and mechanistic research before drawing definitive conclusions about their clinical utility, disease progression, or prognostic value. Full article

Background and Objectives: Routine laboratory markers may support diagnostic risk stratification for osteoporosis, but their incremental value beyond the Osteoporosis Self-Assessment Tool for Asians (OSTA) remains uncertain in referral-based practice. We evaluated whether serum uric acid, albumin, alkaline phosphatase (ALP), and systemic inflammatory indices improve prediction of DXA-defined osteoporosis beyond OSTA in postmenopausal women. Materials and Methods: This retrospective cross-sectional study included 3504 postmenopausal women referred for DXA between January 2021 and May 2025. Osteoporosis was defined as the lowest T-score ≤ −2.5 at the lumbar spine, total hip, or femoral neck. Sequential exclusions removed patients with chronic hepatobiliary disease, chronic systemic inflammatory disease, bone-active medication exposure, systemic glucocorticoid use, abnormal liver biochemistry, or missing required variables. Multivariable logistic regression assessed associations, and OSTA-based prediction models were internally validated using stratified 10-fold cross-validation. Results: Osteoporosis was present in 1660 women (47.4%). Higher BMI, uric acid, and albumin were independently associated with lower odds of osteoporosis, whereas ALP and calcium were associated with higher odds. OSTA alone achieved an AUC of 0.679. Adding uric acid, albumin, and ALP increased AUC to 0.695 and slightly improved the Brier score, with good calibration. Adding the systemic immune-inflammation index did not materially improve performance. Conclusions: Routine laboratory variables provided only modest incremental value beyond OSTA. The model should be interpreted as an exploratory referral-pathway prioritization approach, not as a standalone population-screening tool. It should not be used as a diagnostic surrogate for DXA or as a fracture-risk model. Full article

Background: Low-flow, low-gradient aortic stenosis with reduced left ventricular ejection fraction is a heterogeneous condition with challenging severity assessment. Aortic valve calcification reflects fibro-calcific remodeling, while oxidative stress plays a key role in its pathogenesis. Serum uric acid, a marker of oxidative stress, may be associated with valvular calcification. This study investigated the relationship between serum uric acid levels and aortic valve calcification in this population. Methods: This retrospective study included 85 patients. Aortic valve calcification was quantified using computed tomography with the Agatston method, and patients were categorized as true severe or pseudo-severe according to sex-specific calcium thresholds. Of the patients, 57 were classified as true severe and 28 as pseudo-severe aortic stenosis. Results: Patients with higher calcification burden had significantly elevated serum uric acid levels (6.77 ± 1.57 vs. 5.08 ± 1.10 mg/dL, p < 0.001). Serum uric acid showed a modest correlation with aortic valve calcium score (ρ = 0.339, p = 0.002) and remained independently associated with CT-defined true severe low-flow, low-gradient aortic stenosis in multivariable analysis. ROC analysis yielded an area under the curve of 0.823 and identified a serum uric acid threshold of 5.45 mg/dL associated with a greater likelihood of CT-defined true severe low-flow, low-gradient aortic stenosis. Conclusions: Serum uric acid is associated with CT-derived aortic valve calcification and may provide insight into underlying fibro-calcific remodeling in this population. Full article

Peripheral Artery Disease (PAD) is increasingly recognized as a complex environmental pathology driven by “contaminant metals,” rather than solely lifestyle factors. This scoping review (2016–2025) analyses the correlation between anthropogenic soil/water-derived Cadmium (Cd) and Lead (Pb) and progressive vascular hardening. The analysis confirms a robust, non-linear dose–response relationship. Chronic Cd exposure functions as a potent independent toxicant (Risk Ratio = 2.58 at 1 µg/L), significantly lowering Ankle–Brachial Index scores by inducing oxidative stress, inhibiting nitric oxide bioavailability, and displacing calcium in endothelial walls. Synergistically, Pb exposure, even at levels <5 µg/dL, compounds toxicity, amplifying arterial stiffness and hypertension. Consequently, “Heavy Metal Hardening” constitutes a critical link between water quality management and public health. Current regulatory thresholds appear insufficient to prevent chronic vascular remodeling, mandating urgent remediation of metal-laden aquifers and agricultural soils to mitigate this silent cardiovascular epidemic. Full article

Background and Aims: The “quantity” of bone can be evaluated by dual-energy X-ray absorptiometry (DXA) scans, but not its “quality. We aim to study the clinical relevance of urinary-N-terminal telopeptide (NTx) in a retrospective exploratory study. Patients and Methods: The medical records of patients with osteoporosis, osteopenia with or without fractures, and with available urinary NTx were retrospectively reviewed; those on anti-osteoporotic medication before the start of the study were excluded. In all NTx levels, bone-specific alkaline phosphatase (BSAP), parathormone, serum calcium, and vitamin D were measured. In all cases, a recent DXA scan and fracture risk assessment (FRAX) had been performed. Appropriate statistics were applied using SPSS. 15. Results: Included were 93 patients (17.2% males); thirty-one (33.33%) had osteoporosis, 56 (60.21%) osteopenia, whereas 36 (38.7%) had prior or existing fractures. Older participants had lower NTx levels, and females had higher NTx levels, albeit NS. A negative correlation was found between the T-score of the left hip and NTx levels (p = 0.015) but not of the right hip or lumbar spine. In multivariate analysis, NTx levels (p = 0.013) and FRAX (p = 0.001) were significantly associated with fractures. Patients with osteoporosis had higher NTx levels when compared to patients with osteopenia (p = 0.015). NTx at a cut-off value of 207.4 showed a sensitivity of 80.6% and a specificity of 56.1% for the diagnosis of previous fracture with an area under the curve (AUC) of 0.72 (95% CI: 0.61, 0.83). Conclusions: Elevated NTx levels were significantly associated with existing or prior fractures. Combining DXA scan and FRAX, with NTx testing, may provide a comprehensive approach to osteoporosis assessment and treatment. Further prospective studies are warranted to validate its clinical utility. Full article

Post-fire rehabilitation structures are widely used in Mediterranean burned landscapes to reduce runoff and sediment transfer, yet their ecological associations with early vegetation recovery remain insufficiently documented. This observational study assessed vascular plant composition, species richness, vegetation cover, plant density, aboveground biomass, and soil properties across log barriers, wattles, and log dams in the burned landscape of Ancient Olympia, western Greece. The study area belongs to the humid climatic class of the United Nations Environment Programme (UNEP) aridity framework based on the Thornthwaite aridity index, providing a comparatively wetter Mediterranean post-fire context. Paired depositional and eroded microsites in operationally restored post-fire areas were monitored in 2022 and 2023. The sampling design comprised nine plots and 18 microsites (n = 9 plots, 18 microsites). Generalized estimating equations (GEE), change-score models, principal component analysis (PCA) and permutational multivariate analysis of variance (PERMANOVA) were performed to examine associations of monitoring year, microsite condition and rehabilitation structure type with soil and vegetation patterns. A total of 27 vascular plant species belonging to 16 families were recorded. The average vegetation cover increased from 39.17 ± 21.44% in 2022 to 75.11 ± 12.90% in 2023. Model-based marginal estimates with 95% confidence intervals indicated a large positive increase in vegetation cover over this period. Further, rapid early recovery was indicated by large increases in species richness, plant density and biomass. Depositional microsites were associated with stronger recovery signals than eroded ones, characterized by a larger increase in vegetation cover, density, biomass and species richness. Among rehabilitation structures, log dams showed the highest cumulative floristic richness and a broader observed floristic spectrum, although the species-level contingency analysis provided only marginal evidence for structure-associated differences in floristic composition. Changes in selected soil properties including total nitrogen (total N), ammonium nitrogen (NH4-N), nitrate nitrogen (NO3-N), pH, electrical conductivity (EC), and exchangeable calcium (Ca), magnesium (Mg), and potassium (K), were detected between 2022 and 2023; the multivariate soil pattern was driven primarily by mineral nitrogen, pH, and EC. These findings suggest that, under operational post-fire restoration conditions, rehabilitation structures are associated not only with erosion-control functions but also with microsite differentiation that may shape early plant establishment and biodiversity recovery in Mediterranean burned landscapes. Full article

Background: The deep learning-derived retinal cardiovascular risk index (Reti-CVD) is a deep learning-derived retinal biomarker calculated from non-mydriatic fundus photographs for cardiovascular risk assessment. This study examined whether obesity phenotype, particularly central adiposity, modifies the association between Reti-CVD and coronary artery calcium score (CACS) in asymptomatic adults undergoing routine health screening. Methods: We retrospectively analyzed 237 Korean adults who underwent fundus photography for Reti-CVD assessment and cardiac computed tomography for CACS measurement. Abdominal obesity was defined as waist circumference (WC) ≥ 90 cm in men and ≥85 cm in women, and general obesity as body mass index (BMI) ≥ 25 kg/m². Multivariable linear regression models with sequential adjustment were used to evaluate the association between Reti-CVD and CACS. Effect modification was assessed using interaction terms for Reti-CVD×WC and Reti-CVD×BMI. Discriminatory performance for coronary calcification, defined as CACS > 0, was evaluated using the area under the receiver operating characteristic curve (AUC). Results: Abdominal obesity was present in 78 participants (32.9%), and general obesity in 102 (43.0%). Participants with CACS > 0 had significantly higher Reti-CVD scores than those with CACS = 0 (0.15 ± 0.09 vs. 0.09 ± 0.05; p < 0.001). Reti-CVD remained positively associated with CACS after adjustment for metabolic and lifestyle factors. In fully adjusted models, WC significantly moderated this association (interaction p = 0.0288), whereas BMI did not (interaction p = 0.5381). Overall discrimination for CACS > 0 was moderate (AUC = 0.735) and numerically higher in participants with abdominal obesity than in those with normal WC (0.787 vs. 0.695). Conclusions: Reti-CVD is independently associated with coronary calcification, and WC-based central adiposity modifies this relationship. Incorporating obesity phenotype may improve personalized interpretation of retinal biomarker-based cardiovascular risk assessment. Full article

Chronic kidney disease-mineral and bone disorder (CKD–MDB) is a systemic disorder that occurs as a complication of advanced chronic kidney disease. It includes biochemical alterations (calcium, phosphorus, parathyroid hormone, vitamin D), abnormalities in bone turnover and mineralization, and vascular and soft-tissue calcifications. The development of secondary hyperparathyroidism and profound alterations in bone remodeling culminate in renal osteodystrophy, which contributes to adverse cardiovascular outcomes and increased mortality. This narrative review article aims to summarize the role of novel diagnostic techniques in the early identification of reduced bone mass and risk of fractures in patients with chronic kidney disease. The use of bone turnover markers independent of renal clearance (such as bone-specific alkaline phosphatase, procollagen type 1 N-terminal propeptide and tartrate-resistant acid phosphatase 5b) integrated with dual energy X-ray absorptiometry, trabecular bone score and radiofrequency echographic multispectrometry improves the characterization of mineral status, enabling targeted intervention to prevent bone and cardiovascular complications associated with CKD–MBD. Full article

The present study investigates the effect of whey powder incorporation on the nutritional composition, structural characteristics, and functional properties of rice flour-based gluten-free systems. Composite flours and biscuits were formulated by substituting rice flour with 5%, 10%, and 15% whey powder. Proximate composition, mineral profile, and structural modifications were evaluated using standard analytical methods, complemented by Fourier Transform Infrared Spectroscopy (FTIR) and Small-Angle X-ray Scattering (SAXS). The results showed that whey addition significantly improved the protein content of both flours and biscuits, increasing from 8.45% in the control to 15.06% at the highest enrichment level. Whey powder showed elevated phosphorus (912 mg/kg), sodium (434.65 mg/kg), and calcium (526.49 mg/kg) contents compared to rice flour. Consequently, mineral levels increased progressively in the composite flours, with phosphorus rising from 528 mg/kg to 647 mg/kg, sodium from 105.66 mg/kg to 132.81 mg/kg, and calcium from 102.15 mg/kg to 137.33 mg/kg as the whey incorporation level increased. Iron content showed minor variations among the gluten-free biscuit formulations (76.01–95.16 mg/kg). Whey incorporation led to a progressive increase in copper content, from 8.91 mg/kg in the control biscuits to 15.50 mg/kg, while zinc levels decreased from 27.47 mg/kg to 18.47 mg/kg with increasing whey addition. FTIR analysis revealed clear structural changes associated with whey addition, including the progressive intensification of amide I and II bands and a reduction in starch-specific signals, confirming the incorporation of whey proteins into the starch matrix and the formation of protein–starch interactions. These findings were supported by SAXS analysis, which indicated modifications in the internal structural organization of the systems. Sensory evaluation indicated good overall acceptability of the fortified biscuits at moderate whey incorporation levels, while higher whey addition slightly reduced taste scores due to the characteristic salty flavor associated with acid whey. Overall, the study demonstrates that whey powder is an effective functional ingredient for enhancing the nutritional and structural properties of gluten-free products. However, achieving an optimal balance between improved nutritional quality, technological performance, and mineral composition remains essential for the development of high-quality gluten-free formulations. Full article

Background/Objectives: The prognostic value of serial coronary artery calcium (CAC) progression remains uncertain in Asian populations and statin-treated patients. We evaluated the association between CAC progression and subsequent major adverse cardiovascular events (MACE) in a Taiwanese cohort. Methods: We retrospectively studied 1791 individuals undergoing two CAC-scoring cardiac CT scans at a tertiary center in Taiwan from 2006 to 2021, excluding those with MACE before the second scan. CAC progression was defined as an annualized Agatston score increase of ≥20 units/year. Time-to-event analyses used landmark Cox models beginning at the second scan, with inverse probability weighting (IPW), balance diagnostics, multivariable Cox regression, and multiple-imputation sensitivity analyses. Results: CAC progression occurred in 365 participants (20.4%). Progressors were older and had greater cardiometabolic risk and baseline CAC burden. In a landmark IPW analysis, CAC progression was associated with higher subsequent MACE risk (HR 2.02, 95% CI 1.49–2.74), with a graded association across annualized CAC change categories: HR 1.72 (95% CI 1.17–2.74) for 21–49 units/year and HR 2.86 (95% CI 2.29–3.57) for ≥50 units/year. The association remained consistent in multiple-imputation analysis (HR 1.90, 95% CI 1.36–2.66) and across major clinical subgroups. Discrimination for 10-year MACE was stronger among statin users than non-statin users (AUC 0.774 vs. 0.571), although statin-stratified analyses were exploratory. Conclusions: CAC progression was independently associated with subsequent MACE and showed a graded risk relationship. Serial CAC assessment may serve as a useful dynamic marker for refining longitudinal cardiovascular risk stratification, while prospective studies are needed to validate progression-guided management. Full article

This prospective case series evaluated the short-term outcomes following percutaneous cementoplasty as the sole palliative treatment for appendicular osteosarcoma in 10 dogs. Synthetic self-hardening calcium phosphate bone substitute was injected into the osseous defect under fluoroscopic guidance after curettage of the bone tumor. Clinician assessment included a numerical rating score for lameness, offloading, and ease of lifting the contralateral limb as well as the 4A-VET postoperative pain scale. Owner assessment was obtained using three descriptive questionnaires, the Helsinki Chronic Pain Index (HCPI), the Canine Brief Pain Inventory (CBPI) and the Canine Symptom Assessment Scale (CSAS). Measures were recorded preoperatively and at 2, 4, 8, and 12 weeks following surgery. Early improvement in the 4A-Vet score was noted at the 2-, 4-, 8-, and 12-week time points for all major pain and function metrics. Similarly, the CBPI pain severity and interference scores demonstrated early postoperative improvement during the 2- and 4-week time points with partial attenuation by 8 and 12 weeks. Panting, difficulty sleeping, whining/moaning, and lack of appetite were significantly reduced when assessed via the CSAS. Cementoplasty as a monotherapy, affording early pain relief and improved structural integrity, supports its role as a palliative limb-preserving option for dogs unable to undergo amputation. Full article

Background: The management of white spot caries lesions (WSCLs) presents a clinical challenge due to a lack of standardized protocols. This study aimed to evaluate the knowledge, attitudes, and practices of dental practitioners in Russia regarding the diagnosis and treatment of WSCLs. Methods: A cross-sectional online survey was conducted from October 2024 to July 2025 among 397 dental professionals in Russia. A validated questionnaire assessed four domains: demographics, knowledge, attitudes, and clinical practices concerning WSCL management. Data were analyzed using descriptive statistics, Kruskal–Wallis tests, and Spearman’s correlation. Results: The majority of respondents were females (83%), with over half having less than five years of experience (55%). A majority of the practitioners (62.5%) demonstrated a good level of knowledge (mean score 12.8 ± 2.2). Knowledge was significantly better among female practitioners (p < 0.001) and inversely correlated with years of clinical experience (p < 0.001). Attitudes towards minimally invasive treatment were mainly positive (mean score 13.5 ± 2.6), with 86% of respondents showing a positive score (>10 points). While awareness of minimally invasive techniques like resin infiltration (84%) and remineralization (79.1%) was high, clinical practice varied. Remineralization was the most frequently used treatment (68% used casein phosphopeptide–amorphous calcium phosphate and 62% used fluoride), whereas resin infiltration was used by 46% and microabrasion by only 5% of the respondents. A majority of dentists (52%) preferred monitoring lesions rather than immediate intervention. Conclusions: Russian dental practitioners possess good theoretical knowledge and positive attitudes toward contemporary, minimally invasive management of WSCLs. However, a significant gap exists between knowledge and clinical practice, particularly concerning the use of resin infiltration and microabrasion. These findings underscore the need for continuous education on the topic. Full article

Background/Objectives: Trace elements may influence autism spectrum disorder (ASD) severity through interactions with the gut microbiota and microbial metabolic functions, but calcium-related evidence remains limited. This cross-sectional study examined associations among hair calcium, gut microbial taxa, metabolic pathways, and behavioral phenotypes in children with ASD. Methods: We analyzed 183 children with ASD who had behavioral assessments, hair calcium measurements, and fecal shotgun metagenomic sequencing data. Participants in the lowest and highest calcium quartiles were first compared to characterize group-level microbiome differences. Full-sample analyses then tested associations among continuous hair calcium, microbial taxa, metabolic pathways, and behavioral measures after covariate adjustment. Benjamini–Hochberg false discovery rate correction was applied for multiple testing. Results: Hair calcium was positively associated with CARS, ATEC-Total, ATEC-1, and ATEC-3 scores, with the strongest associations involving ATEC-1 and ATEC-3. Alpha and beta diversity did not differ significantly between calcium quartile groups, but group-based microbiome analyses identified 63 differential species and 22 differential MetaCyc pathways. Full-sample integrated analyses connected calcium-associated microbial taxa, metabolic pathways, and ASD behavioral measures. Conclusions: Hair calcium was associated with ASD behavioral severity, selected gut microbial species, and microbial metabolic pathways. These findings support an association framework connecting longer-term calcium-related mineral profiles, gut microbial functional potential, and behavioral phenotypes, providing a basis for future longitudinal and multi-omics studies. Full article

Background: Pregnancy-related transient osteoporosis of the hip (PR-TOH) is an uncommon and frequently underdiagnosed condition that typically presents with acute hip pain during late pregnancy or the early postpartum period. Because its clinical presentation is nonspecific and overlaps with pregnancy-related pelvic girdle pain, the diagnosis is often delayed, and the initial management is suboptimal. Although bilateral involvement has been reported, comparative data on diagnostic work-up, multidisciplinary management, and follow-up remain limited. Case Presentation: We report a case of bilateral PR-TOH in a 35-year-old Caucasian primigravida (G1, P0) who presented at 31 + 6 weeks of gestation with progressively worsening bilateral hip pain that culminated in severe functional impairment and wheelchair dependence. Initial ultrasound, laboratory work-up, and rheumatological screening were inconclusive, and intra-articular corticosteroid injections failed to relieve symptoms and were temporally associated with deterioration of glycaemic control and a periorbital and palmar eczematous rash. Magnetic resonance imaging (MRI) demonstrated diffuse bone marrow oedema in both femoral heads with preserved articular cartilage and no evidence of avascular necrosis, supporting a diagnosis of bilateral PR-TOH. Postpartum dual-energy X-ray absorptiometry (DXA) confirmed reduced bone mineral density at both femoral necks (Z-scores below −2.0). Pregnancy was prolonged until 37 + 4 weeks, and delivery was by elective caesarean section. Postpartum care included analgesia, calcium and vitamin D supplementation, structured physiotherapy, and a graded weight-bearing rehabilitation programme. Bone mineral density improved markedly on follow-up DXA at six months, with complete clinical recovery and no further imaging abnormalities at 12, 24, and 30 months. Conclusions: PR-TOH should be considered in pregnant or postpartum women with persistent hip pain and progressive functional limitation. MRI is the key imaging modality for early diagnosis and for excluding alternative causes, whereas DXA remains the reference standard for quantifying bone mineral density and monitoring recovery. Bilateral presentations require a multidisciplinary, individualised approach that addresses both maternal and obstetric outcomes. Full article