Search Results (48,434)

Two-dimensional heterostructures have attracted considerable attention in electrocatalytic hydrogen evolution due to their pronounced interfacial effects, tunable electronic properties, and large specific surface areas. In this work, two representative oxygen-terminated transition metal carbides (MXenes) and three typical transition metal dichalcogenides (TMDs) were selected to construct six heterostructures. Using first-principles density functional theory (DFT) calculations, their binding energies, structural stability, electronic structures, and HER catalytic performance were systematically investigated. The results showed that all heterostructures possessed good thermodynamic stability and favorable electronic properties. In particular, SnS₂/Ti₂CO₂, SnSe₂/Ti₂CO₂, SnTe₂/Ti₂CO₂, and SnTe₂/Zr₂CO₂ exhibited near-optimal hydrogen adsorption Gibbs free energy, indicating excellent HER activity. Moreover, the variation in Gibbs free energy of hydrogen adsorption from isolated monolayers to heterostructures could be effectively correlated with the work function difference. The predicted trends provided a useful descriptor for catalytic performance. Overall, this study provides theoretical insights into the rational design of efficient, advanced HER catalysts and contributes to the advancement of sustainable energy conversion technologies. As this work is based solely on first-principles calculations, the predicted catalytic activity of the heterostructure should be regarded as a theoretical prediction and awaits experimental confirmation. Full article

The influence of carbon support and Cu loading on the structural, surface, and catalytic properties of Cu-based catalysts for furfural hydrogenation was systematically investigated. Two activated carbons with distinct textural and chemical characteristics were evaluated: a biomass-derived carbon (ACS) and commercial carbon (ACC). The ACC support exhibited a higher density of thermally stable oxygen-containing functional groups, which promoted stronger metal-support interactions and an increased proportion of surface reduced Cu species (Cu⁰/Cu⁺), resulting in superior catalytic performance compared to ACS. Based on these results, the effect of Cu loading (5–20 wt.%) was further studied on the ACC support. The catalysts were characterized by N₂ physisorption, XRD, TEM, H₂-TPR, He-TPD, NH₃-TPD, and XPS. Increasing Cu loading enhanced the amount and reducibility of Cu species; however, excessive loading led to particle growth, pore blockage, and reduced metal dispersion. Catalytic activity exhibited volcano-type behavior, reaching a maximum at 15 wt.% Cu, where an optimal balance between reduced availability of Cu species and metal-support interaction was achieved. Selectivity toward furfuryl alcohol remained essentially unchanged across all catalysts, indicating that the catalytic performance is closely related to the surface chemistry and relative concentration of reduced Cu sites and is not significantly affected by acidity. These results highlight the critical role of support properties and metal loading in controlling catalyst performance, providing insights for the rational design of efficient Cu-based catalysts for biomass valorization. Full article

The rational design of metal-free catalysts capable of efficiently converting CO₂ under atmospheric pressure remains a significant challenge in sustainable chemistry. Herein, we report a series of clamp-shaped dihydrogen-bonded iodide catalysts (CDBI catalysts) featuring a preorganized bifunctional framework that integrates dual hydrogen-bond donors and an intrinsic iodide nucleophile within a single molecular scaffold. Systematic structural variation revealed that catalytic activity is highly sensitive to electronic modulation, steric accessibility, and precise spatial arrangement between the hydrogen-bonding units and the iodide center. The optimal catalyst enabled solvent-free cycloaddition of CO₂ with epoxides at 1 atm CO₂, affording up to 99% conversion and >99% selectivity at 80 °C within 12 h. Substrate scope studies demonstrated efficient transformation of a wide range of terminal epoxides, while sterically demanding substrates exhibited reduced reactivity consistent with a confined activation mode. Mechanistic investigations support a cooperative pathway in which dual hydrogen-bond activation and proximal halide nucleophilicity operate synergistically within a preorganized clamp-shaped pocket. Comparative analysis with representative catalytic systems highlights the ability of this metal-free design to achieve high efficiency under atmospheric CO₂ without cocatalysts or solvents. These findings demonstrate that structural preorganization represents an effective strategy for promoting sustainable CO₂ utilization under operationally simple conditions. Full article

Background: The genetic identification of Second World War (WWII) victims in Slovenia is a significant forensic challenge due to the varying taphonomic conditions of mass graves and the high degradation of skeletal remains. While recent studies highlight the potential of small cancellous bones and petrous parts, the variability of DNA preservation across different mass grave contexts remains under-investigated. Objectives: This study aimed to compare DNA quantity and quality across different skeletal elements grouped by anatomical and structural characteristics, specifically evaluating how two distinct burial sites—Konfin II and Huda Jama—influenced DNA preservation. Materials and Methods: A complete dataset of 785 samples was analyzed, integrating 114 newly processed samples from Huda Jama with previously published data from both sites. DNA was extracted using a total demineralization protocol and purified via the Biorobot EZ1 system. Quantification and degradation assessment were performed using the PowerQuant qPCR kit. Skeletal elements were categorized into six groups: temporal—pars petrosa, big long bones, torso bones, small long bones, short/sesamoid bones, and teeth. Results: Statistical analysis revealed significant differences in DNA yield and degradation between the two sites. Huda Jama samples exhibited significantly higher DNA yields in small long bones and short/sesamoid bones compared to Konfin II. Conversely, Konfin II showed superior DNA yield in teeth and torso bones. Regarding DNA quality, teeth were significantly more degraded in Huda Jama, while big long bones showed significantly higher degradation in Konfin II. No significant differences in the degradation index were observed between the sites for other skeletal elements, including small long bones and short/sesamoid bones. The temporal—pars petrosa remained a high-performing element at both locations. Conclusions: DNA preservation is highly site-specific and influenced by the complex taphonomic conditions of the burial site. While small cancellous bones are excellent candidates for DNA recovery in some environments (Huda Jama), teeth and torso bones may provide higher yields in others (Konfin II). However, the rate of DNA fragmentation (degradation) varies independently of yield, as seen in the extreme degradation of teeth in Huda Jama. A multi-sample strategy, prioritizing the petrous bone while accounting for site-specific preservation patterns, is essential for maximizing identification success in highly degraded skeletal remains from WWII mass graves in Slovenia. Full article

Pineapple glutinous rice wine is a popular fermented beverage, yet its flavor and quality remain highly affected by yeast strains. This study aimed to explore the effects of four commercial yeasts, namely La Raffinée (Ra), La Bayanus (Ba), La Délicieuse (De), and Angel wine yeast (AWY), on the quality of pineapple glutinous rice wine. Fermentation indices including Brix and alcohol content were dynamically monitored, while final wine samples were analyzed for color difference, sensory quality and aroma components by gas chromatography–ion mobility spectrometry (GC-IMS). Results showed that all yeasts had optimal fermentation efficiency, sugar-to-alcohol conversion, physicochemical properties and sensory quality at an addition level of 0.2 g/L. The 0.2 g/L De group achieved the optimal overall quality with an alcohol content of 10.01% vol, the highest ester content (22.55%) and the lowest acid content (12.18%), presenting a balanced flavor, prominent pineapple aroma and refreshing taste. In contrast, Ba led to higher acidity and Angel wine yeast contributed to greater sweetness. Overall, 0.2 g/L De yeast effectively coordinated pineapple aroma and glutinous rice wine characteristics, providing a practical reference for optimizing the production and quality improvement of pineapple glutinous rice wine. Full article

Background/Objectives: Given the growing need for prenatal care, Nordic Walking (NW) is a promising intervention for maintaining maternal physical activity and quality of life (QoL). We aimed to investigate the influence of NW on gait kinematics, pelvic girdle pain, low back pain (LBP), and QoL during pregnancy. Methods: This is a single-blind randomized controlled trial. A total of 44 pregnant women aged 20 to 40 years with 13–28 weeks of gestation and mild to moderate musculoskeletal pain were included. Participants were randomly assigned to either the study (NW) group or the control group. The study group received the NW program for 12 weeks, three sessions per week, each lasting 45 min. The control group received standard prenatal care plus 30 min of moderate walking three days a week. The GAITRite system was used to measure gait kinematics, and the Visual Analog Scale (VAS) for pain and the SF-36 for QoL were administered at baseline, the fourth week, and the twelfth week. Results: NW significantly improved gait kinematics and reduced musculoskeletal pain (p < 0.001) with improvements in pain and gait speed exceeding the previous reported MCID thresholds. QoL improved across all SF-36 domains in the NW group (p < 0.001) compared with the control group, with large effect sizes observed for the primary outcomes. Conversely, the control group experienced declines in several QoL domains, including energy/fatigue and emotional well-being, despite moderate walking exercise and standard prenatal care over 12 weeks. Conclusions: NW may represent an effective prenatal exercise regimen associated with improved gait, reduced pain, and better overall QoL compared with moderate exercise, consistent with standard prenatal care. Full article

Background/Objectives: Red beetroot (Beta vulgaris L.) is recognized for its antioxidant, anti-inflammatory, and metabolic properties. This study evaluated the effects of two beetroot cultivars (Boldor and Wodan) on blood serum parameters, body composition, and organ weights in male WKY rats fed a low-protein diet (LPD, 8.8% protein). Methods: Five-week-old male rats were maintained on an LPD for 8 weeks and subsequently continued on the LPD diet supplemented with 4% dried beetroot for 45 days. The experimental diets included beetroot from the Boldor and Wodan cultivars, either treated or untreated with a plant growth stimulator during cultivation. Results: Foliar application of the selenium-based plant growth stimulator did not significantly increase selenium or other element concentrations in beet roots. Elemental analysis showed higher levels of Fe, Zn, Cu, Cr, Pb, As, Cd, and Sb in the Wodan group, while Boldor increased Cr, Pb, and As; Ni and Se remained unchanged. Beetroot supplementation significantly affected 14 of the 30 measured biochemical parameters, including biomarkers of liver function (ALT, ALP, total bilirubin, albumin, and total protein), renal function (uric acid), pancreatic activity (amylase and lipase), electrolyte balance (sodium, potassium, and chloride), mineral metabolism (calcium), inflammatory status (CRP), and nutritional metabolism (iron). Conversely, no significant effects were observed on lipid profile parameters or biomarkers of cardiac and skeletal muscle injury. Among the beetroot cultivars evaluated, Wodan exerted distinct effects relative to Boldor, resulting in higher circulating total bilirubin and potassium concentrations, alongside reduced uric acid and lipase levels in treated rats. Boldor supplementation significantly increased body weight gain and fat mass, with a trend toward higher lean mass, and increased kidney weight. Wodan did not significantly affect body weight but increased kidney and spleen mass. Feed intake was similar across groups. No changes in cardiovascular function were observed ex vivo. Conclusions: Beetroot supplementation modulated multiple metabolic and physiological biomarkers in rats fed a low-protein diet, with distinct cultivar-specific effects, underscoring the importance of cultivar selection for optimizing functional dietary interventions. Full article

In contemporary engineering applications, deficiencies in dynamic mechanical properties, particularly impact toughness, are the leading cause of fracture incidents. Consequently, inadequate dynamic mechanical properties have emerged as the primary constraint limiting the further commercial application of precipitation-strengthened high-strength aluminum (Al) alloys, exemplified by the 2014 aluminum alloy. Since the dynamic mechanical properties of the 2014 wrought aluminum alloy are fundamentally governed by the decohesion and cracking of coarse second-phase constituent particles, it is necessary to quantify the correlation between microstructure and mechanical properties. Meanwhile, the size and volume fraction of constituent particles are largely dictated by the concentration of main and impurity alloying elements. Experimental results revealed that the volume fraction of coarse constituents increased with increasing Cu, Si, and Fe content, and that tensile ductility and impact toughness decreased following an inverse exponential relationship with the volume fraction of constituents. The aim of this study is to establish a quantitative relation to correlate the characteristics of coarse constituents with the tensile ductility and impact toughness of the 2014 aluminum alloy. A mathematical model was developed by regarding the coarse constituents as ellipsoidal inclusions. Their volume fraction and aspect ratio were considered in the model. Model predictions show broad agreement with experimental data. These properties are more sensitive to the volume fraction when it is low. Conversely, a larger aspect ratio leads to higher ductility and toughness. The sensitivity is also greater at a small aspect ratio. The model further indicates that reducing the volume fraction when it is high yields limited improvement, whereas further reduction at a low volume fraction leads to significant enhancement of ductility and toughness. This study correlates coarse constituent characteristics with tensile ductility and impact toughness quantitatively, and provides a theoretical framework for predicting and optimizing the mechanical properties of 2014 aluminum alloy. Full article

We report the oldest female identified to date with a pathogenic NBEA variant who has been followed longitudinally. She presented with a complex, diagnostically inconclusive psychiatric phenotype extending in adulthood and a suspected mild neurodevelopmental impairment. The 64-year-old patient experienced recurrent episodes of mental state decompensation characterized predominantly by persecutory and health-related delusional ideation and anxiety. Her most recent psychiatric diagnosis was mixed conversion disorder. Although she never underwent formal cognitive testing, mild intellectual disability was suspected based on her educational attainment, occupational history, and social functioning. Additionally, the patient presented with a likely coincidental tremor. A history of childhood epilepsy could not be confirmed, as detailed epilepsy records were unavailable. Furthermore, the patient declined neuroimaging, precluding assessment of a possible relationship with the identified EXT2 deletion. This case expands the currently recognized neuropsychiatric spectrum possibly associated with pathogenic NBEA variants, highlights the importance of extending phenotypic characterization in later adulthood, and underscores the value of longitudinal follow-up. Full article

Radiation-induced oral mucositis (RIOM) frequently causes severe pain and treatment interruptions in patients with head and neck cancer. While earlier guidelines suggested zinc supplementation, updated MASCC/ISOO guidelines downgraded it to ‘No Guideline Possible’ due to highly conflicting evidence. This study aims to resolve these inconsistencies by evaluating zinc’s prophylactic efficacy and investigating whether the route of administration determines its clinical benefit. Following PRISMA guidelines and INPLASY registration (INPLASY202620063), we searched PubMed, Embase, and the Cochrane Library through February 2026. We included randomized controlled trials (RCTs) comparing prophylactic zinc versus placebo or standard care in head and neck cancer patients receiving radiotherapy. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The primary outcome was severe (Grade 3–4) RIOM incidence. Data from five RCTs (332 patients) were pooled using a random-effects model. Overall, zinc significantly reduced severe mucositis risk (RR = 0.35, 95% CI: 0.17–0.73, p = 0.005). Crucially, an exploratory subgroup analysis revealed a striking divergence based on delivery route. Topical zinc mouthwash demonstrated encouraging protection (RR = 0.16, 95% CI: 0.05–0.49, p = 0.001) with zero heterogeneity (I² = 0%). In contrast, systemic zinc yielded borderline, inconsistent benefits (RR = 0.52, 95% CI: 0.27–1.01, p = 0.055, I² = 37%). In conclusion, the localized pool of contemporary evidence clearly demonstrates that the systemic oral ingestion of zinc supplements does not provide a reliable prophylactic benefit against severe radiation-induced oral mucositis in head and neck cancer care. Conversely, topical zinc mouthwashes exhibit an encouraging protective trend; however, the severe paucity of available randomized trials and low cumulative patient volume preclude definitive clinical verification. While these exploratory findings suggest that topical administration may provide a more consistent protective trend compared to systemic routes, they should be interpreted as hypothesis-generating rather than definitive. Future large-scale, multi-center RCTs are strictly warranted to validate these promising route-specific benefits before formal guideline integration. Full article

Background/Objectives: DNA-targeting small molecules that induce replication stress represent a promising strategy in anticancer drug development. 1,8-Naphthalimide (NI) derivatives are well-established DNA-intercalating agents, and heterocyclic annulation offers a rational approach to enhancing their potency and tumor selectivity. Here, we report the synthesis and biological evaluation of a novel series of benzofuran-containing naphthalimide derivatives, with particular focus on the lead dinitro-substituted compound 5d. Methods: Cytotoxic activity was assessed using the MTT assay in A549 (p53 wild-type), H1299 (p53-null), and MRC-5 cells. Long-term antiproliferative effects were evaluated by clonogenic survival assay. Cell cycle distribution was analyzed by propidium iodide staining and flow cytometry. Replication stress and DNA damage were quantified by EdU incorporation and γH2AX immunofluorescence, respectively. Apoptosis was assessed by Annexin V/PI staining and caspase-3/7 activation assay. p53 nuclear accumulation and autophagy induction were evaluated by immunofluorescence and Western blot, using LC3 as an autophagic marker. Results: All compounds exhibited cytotoxic activity in the nanomolar range, with 5d emerging as the most potent and selective. Clonogenic survival was significantly reduced, indicating durable suppression of proliferative capacity. Treatment with 5d induced G₁ arrest in A549 cells and the accumulation of H1299 cells in G₂/M, consistent with p53-dependent and p53-independent checkpoint activation, respectively. EdU incorporation was markedly reduced, while γH2AX intensity increased, collectively supporting a replication stress-driven mechanism of DNA damage. Apoptosis was confirmed by increased Annexin V-positive populations and caspase-3/7 activation. LC3 puncta formation and LC3-I/LC3-II conversion were increased, indicating LC3 processing and autophagosome accumulation consistent with the activation of autophagy-related processes. Conclusions: 5d induces a cellular phenotype consistent with replication stress, including reduced EdU incorporation, γH2AX accumulation, cell cycle arrest, and apoptotic cell death in a p53 status-dependent manner. These findings establish benzofuran-annulated naphthalimides as a promising scaffold for the development of anticancer agents that exploit replication stress vulnerabilities in tumor cells. Full article

The prevention and treatment of cardiovascular disease (CVD) are undergoing a paradigm shift from a lipid-centric approach to a holistic metabolic perspective. Central to this evolution is the gut–fat–heart axis, a sophisticated three-dimensional communication network that integrates neural, endocrine, and immunometabolic signaling to regulate systemic lipid homeostasis. This manuscript systematically explores how the gut microbiota acts as a “metabolic organ” to remotely control host health through the production of bioactive metabolites and the modulation of molecular communication networks. At the physiological level, microbial products such as short-chain fatty acids (SCFAs) and modified bile acids regulate energy balance and lipid synthesis via the FXR-FGF15/19 axis and G protein-coupled receptors. Furthermore, gut hormones like GLP-1 and neuro-reflex pathways involving the vagus nerve provide rapid control over postprandial lipid clearance and feeding behavior. Conversely, pathological dysbiosis triggers the accumulation of harmful metabolites, such as trimethylamine N-oxide (TMAO) and lipopolysaccharides (LPS), which drive lipotoxicity, vascular inflammation, and “dysfunctional HDL” formation. These processes accelerate the progression of atherosclerosis, heart failure, and metabolic syndrome. Finally, the article outlines promising clinical translation strategies, including the development of TMA lyase inhibitors, next-generation probiotics, and the use of phytochemicals to reshape the microbial landscape. By decoding the molecular dialogues within the gut–fat–heart axis, this research provides a novel strategic vantage point for the integrated management of cardiovascular–kidney–metabolic (CKM) syndrome. Full article

Background/Objectives: This investigation was performed because corticosteroid injections are commonly used for symptomatic relief in patients with meniscal deficiency, yet their effect on graft survivorship and postoperative outcomes following meniscal allograft transplantation (MAT) remains poorly understood, with limited literature specifically addressing this topic. The aim of this study is to evaluate whether preoperative intra-articular corticosteroid injections (ICS) are associated with reoperation after MAT. Secondary aims included comparing reoperation-free survival, patient-reported outcome measures (PROMs), and patient acceptable symptom state (PASS) achievement. Methods: A retrospective review of 130 adults undergoing meniscal allograft transplantation (MAT) between 2011 and 2023 was performed. Patients with documented corticosteroid injection (CSI) status and ≥2 years of follow-up were included. Exclusion criteria included prior meniscal allograft transplantation, receipt of non-corticosteroid injections (e.g., hyaluronic acid or platelet-rich plasma), concomitant osteotomy procedures, multi-ligament knee reconstruction or inadequate follow-up. Propensity score matching (2:1 no steroid: steroid) based on age, sex, body mass index, fixation technique, operative compartment, and concomitant procedures yielded 54 matched patients (35 no steroid, 19 steroid). The primary outcome was ipsilateral knee reoperation, categorized as major reoperation (revision MAT, anterior cruciate ligament reconstruction, osteochondral allograft transplantation, conversion to total knee arthroplasty, meniscectomy and meniscus repair). Minor reoperations included irrigation and debridement, lysis of adhesions or manipulation under anesthesia, hardware removal, chondroplasty, and synovectomy. Reoperation-free survival was assessed using Kaplan–Meier analysis. PROMs and PASS were compared using adjusted regression models. Statistical significance was set at p < 0.05. Results: Baseline characteristics and follow-up were comparable between groups (7.6 ± 3.5 vs. 6.6 ± 3.2 years; p = 0.30). Overall reoperation occurred in 37.1% of patients in the no-steroid group and 31.6% in the steroid group (p = 0.771). Major reoperation rates were similar (17.1% vs. 15.8%; p = 1.000. There was no significant difference in minor reoperations between groups (20.0% vs. 10.5%; p = 0.468). Kaplan–Meier analysis demonstrated no difference in reoperation-free survival (p = 0.903), with comparable survival at the 1-, 2-, and 5-year time points. No individual subtypes differed significantly between groups. PROMs and PASS achievement were also similar, with no statistically significant differences observed. Conclusions: Preoperative corticosteroid injection was not associated with increased reoperation risk, inferior reoperation-free survival, or worse patient-reported outcomes following meniscal allograft transplantation. However, given the study’s limited power, lack of detailed injection characteristics, and the use of a heterogeneous complication outcome, these findings should be interpreted cautiously, as further investigation is warranted. Full article

Cropland and rural settlements are core components of rural human–environment systems, and their coordinated development is crucial for regional sustainability, particularly in China’s major agricultural production regions. Taking the Huang-Huai-Hai region as the study area, this study systematically investigates the spatiotemporal evolution of cropland and its coupling relationship with rural settlements using land use data from 1990 to 2020. Grid-based analysis and multiple spatial modeling methods were employed. The results show that: (1) From 1990 to 2020, the cropland in the region decreased by a net total of 21,021.94 km², with annual dynamic degrees ranging from −0.13% to −0.28%. Cropland conversion to other land uses far exceeded conversion from others, with construction land being the primary destination. Among these, rural settlements and urban construction land accounted for 43.75% and 55.58% of the total cropland loss, respectively. (2) The spatial distribution of cropland exhibited a distinct pattern of “hot in the center and south, cold in the periphery and north” (Moran’s I = 0.232, p < 0.001), indicating significant positive spatial autocorrelation. Hot spot areas clustered in the North China Plain and the Huang-Huai Plain, while cold spot areas were distributed in the Yanshan–Taihang mountains and the hilly regions of the Shandong Peninsula, clearly controlled by topography. (3) Cropland change exhibited stage-specific characteristics. The pattern was relatively stable during 1990–2000. During 2000–2010, cropland conversion to other uses intensified, with high-value conversion areas concentrated around urban agglomerations. In the 2010–2020 period, these high-value conversion areas diffused from the core plain areas to urban fringe zones. (4) The spatial coupling between cropland and rural settlements was predominantly characterized by the Moderately Coordinated Type (MCT), accounting for 48.38–58.44% of the area. However, the proportion of Rural Settlement-Dominant Type (RC) increased from 15.51% to 21.58%, indicating a trend toward intensifying human–environment conflicts. Overall, the Huang-Huai-Hai region experienced significant cropland changes. While its spatial pattern remains relatively stable, the coupling relationship between cropland and rural settlements is deteriorating, posing challenges to regional food security and rural sustainable development. Full article

Background: Cardiovascular (CV) risk is increased in psoriatic arthritis (PsA), yet vascular assessment has largely focused on carotid arteries, potentially underestimating systemic atherosclerosis. Objective: The objective of this study was to characterize the distribution and concordance of atherosclerotic plaques across carotid, femoral, and aortic territories in PsA and evaluate their incremental value over SCORE2. Methods: In this cross-sectional study, 250 unselected patients with PsA underwent carotid and femoral ultrasound and abdominal X-ray. Plaque prevalence and multiterritorial involvement (≥2 vascular beds) were assessed. Agreement between territories was evaluated using Cohen’s κ. In patients aged 50–69 years, the incremental value of vascular territories over SCORE2 was evaluated using ROC curves, bootstrap-corrected decision curve analysis (DCA), and reclassification metrics (IDI and continuous NRI). Results: Plaques were detected in carotid (36.0%), femoral (62.8%), and aortic (31.6%) territories, with multiterritorial involvement in 43.2%. Agreement between vascular beds was moderate (κ ≈ 0.35). Notably, 48.1% of patients without carotid plaques had femoral involvement. SCORE2 categories showed a strong gradient with plaque prevalence (p < 0.0001). In patients aged 50–69 years, adding vascular imaging improved discrimination for multiterritorial disease (AUC 0.73 vs. 0.86–0.90). Reclassification analyses demonstrated that carotid plaque substantially improved the identification of multiterritorial atherosclerosis (IDI 0.32, 95% CI 0.18–0.50; continuous NRI 1.33, 95% CI 1.08–1.60), with similar results observed for aortic plaque (IDI 0.33, 95% CI 0.20–0.50; continuous NRI 1.24, 95% CI 0.99–1.48). Femoral plaque provided a more modest improvement (IDI 0.26, 95% CI 0.16–0.37; continuous NRI 1.11, 95% CI 0.80–1.33). Conversely, when the outcome was defined as the presence of any plaque, femoral plaque provided the greatest incremental value over SCORE2 (AUC 0.96, 95% CI 0.93–0.99). Bootstrap-corrected DCA confirmed improved net benefit. Conclusions: The incremental value of vascular imaging over SCORE2 appears to be phenotype-dependent. Femoral plaque provided the greatest improvement for detecting the presence of subclinical atherosclerosis, whereas carotid and aortic plaques offered greater incremental value for identifying multiterritorial vascular involvement. These findings support a tailored, multiterritorial approach to cardiovascular risk assessment in patients with PsA. Full article