Search Results (2,661)

Background: Lactose intolerance is a common gastrointestinal condition with variable clinical expression, often requiring both clinical and genetic evaluation. While genetic testing identifies genetic predisposition to lactase persistence or non-persistence, the relationship between specific LCT genotypes and clinical response to dietary intervention remains incompletely understood. Aim: To assess the association between LCT genotypes (CC, CT, TT) and symptom improvement following a lactose-free diet in an adult population and to explore the implications for clinical assessment. Methods: A retrospective observational study was conducted including 538 adult patients evaluated for suspected lactose intolerance. Genotype distribution and its association with clinical response to a lactose-free diet were analyzed. Group comparisons were performed using chi-square and non-parametric tests, and logistic regression analysis was used to identify genotype-specific predictors of symptom improvement. Results: The CC genotype was the most prevalent (70.8%), followed by CT (22.9%) and TT (6.3%). No significant differences were observed between genotype groups regarding age, sex, or area of residence. A significant association was identified between LCT genotype and clinical response to lactose restriction (p < 0.001). CT carriers demonstrated the highest rate of symptom improvement (70.7%), followed by CC (43.8%) and TT (17.6%). Logistic regression analysis confirmed higher odds of improvement among CT carriers (OR = 11.28, 95% CI: 4.30–29.56, p < 0.001) and CC carriers (OR = 3.64, 95% CI: 1.47–9.00, p = 0.005) compared with TT individuals. Conclusions: LCT genotype was significantly associated with clinical response to a lactose-free diet. These findings suggest that genetic variation may contribute to differences in symptom response to dietary lactose restriction and support the use of genotypic information as a complementary component of clinical assessment. However, the observed variability in clinical outcomes across genotype groups highlights the multifactorial nature of lactose intolerance and indicates that genetic predisposition alone does not fully explain symptom expression or dietary response. Full article

Sample sizes might be small in a variety of applications. Many classical and often-applied statistical methods rely on asymptotic approximations and, therefore, should not be used in the case of small sample sizes. Approaches that can be applied to small data sets often involve computer-intensive methods such as permutation tests and bootstrapping. As an alternative, a modified Chebyshev inequality was proposed by Beasley et al. (Applied Statistics 2004; 53, 95–108) and suggested for nonparametric testing. Here, it is shown that this modified Chebyshev inequality does not hold in general and, therefore, it should not be used to construct a statistical test. Available nonparametric tests that can be recommended for small sample sizes are discussed. Full article

Landfill leachate circuits that operate without discharge, by recirculating aerated leachate onto the waste mass, are widespread in South-East Europe, yet their long-term behaviour is rarely documented with sample-level data. This study reports a six-year (2020–2025) seasonal monitoring campaign at a sanitary landfill in northern Serbia (alluvial aquifer of the Sava River, transboundary Danube basin) and re-examines it with a transparent multivariate protocol. Seventy-two leachate samples (collection well, aeration lagoon, sedimentation lagoon; n = 24 each, 30 parameters), 28 realised surface-water campaigns, and six years of groundwater summaries were evaluated by principal component analysis/factor analysis (PCA/FA, Varimax normalized), hierarchical cluster analysis, PERMANOVA, non-parametric paired tests and, for benchmarking, supervised machine learning. The pooled leachate model (n = 72; 21 variables; KMO = 0.700; Bartlett χ² = 956, p < 0.001) retained four factors by parallel analysis, explaining 61.6% of total variance; after rotation the factors accounted for 27.7%, 14.3%, 10.4%, and 9.3%. Factor 1 grouped organic load with particle-reactive metals (COD, BOD₅, Fe, Ni, Cr, As, Zn), Factor 2 a reduced sulfur–fluoride–BTEX signature, Factor 3 temperature-driven nitritation, and Factor 4 a nitrate–manganese redox contrast. Crucially, paired campaign-by-campaign comparison showed no removal of the dominant pollutants along the circuit. Median COD, BOD₅ and NH₄-N were not lower in the sedimentation lagoon than in the collection well, while pH rose from 8.08 to 8.75 (p < 0.001); only Cu, Pb, NO₃-N, and NO₂-N decreased significantly. The circuit therefore homogenises and concentrates dissolved load rather than removing it. Downstream surface water was significantly enriched in electrical conductivity (+110 µS/cm), total dissolved solids, NH₄-N, and NO₂-N relative to upstream (Wilcoxon, p < 0.05), and groundwater showed episodic conductivity up to 12,760 µS/cm and NH₄-N up to 102 mg/L. Cytotoxicity (MTT) confirmed biological relevance, with MRC-5 viability falling to 37% after 24 h exposure to 50 vol.% groundwater (Pw3) versus 60% in A549 cells. A random-forest classifier separated circuit units far better than PCA-based discrimination (76.4% versus 54.2% cross-validated accuracy) and distinguished the 2020–2021 pandemic period from 2022–2025 with 94.2% accuracy, a period effect also confirmed by PERMANOVA (R² = 7.2%, p < 0.001). The results indicate that closed-loop recirculation without an engineered discharge barrier transfers, rather than eliminates, contaminant load, and that after-care of such systems requires mass-balance monitoring and polishing treatment. Full article

Background/Objectives: Lifestyle modification is central to non-alcoholic fatty liver disease, now termed metabolic dysfunction-associated steatotic liver disease (NAFLD/MASLD), yet comparable health-promoting lifestyle (HPL) data for patients and family members are limited. This study compared two independent samples and examined psychosocial correlates. Methods: Two convenience samples recruited at one tertiary hospital were analyzed: 305 adults with NAFLD/MASLD and 299 adult family members of affected patients. A self-administered electronic questionnaire comprised the Health-Promoting Lifestyle Profile II (HPLP-II), the Self-Rated Abilities for Health Practices scale, autonomous-motivation items from the Treatment Self-Regulation Questionnaire, the Medical Outcomes Study Social Support Survey, and sociodemographic items. Group comparisons used parametric and non-parametric tests. HPL correlates were examined using complete-case regression, HC3 inference, and rank-based sensitivity analysis. Cross-sectional indirect-association decompositions used 5000 bootstrap resamples. Results: HPLP-II scores were 102.2 ± 17.5 in patients and 104.2 ± 17.4 in family members (p = 0.171; Mann–Whitney p = 0.166); the adjusted patient-minus-family difference was −1.14 (HC3 95% CI −3.89 to 1.60; p = 0.413). Physical activity was the lowest-scoring dimension. Self-efficacy was the most robust correlate in both samples; social support was associated in the primary models but weakened under rank transformation in family members. Group-by-correlate interactions were not significant. Exploratory indirect associations through self-efficacy were 0.355 (95% bootstrap CI 0.234–0.512) in patients and 0.163 (0.071–0.287) in family members; reverse-order models were also non-zero. Conclusions: The independent unmatched samples reported similar moderate, physically inactive lifestyles. The results identify associations, not shared-household effects or causal mechanisms; objectively characterized, dyad-matched longitudinal studies are needed. Full article

Transnational higher education (TNE) partnerships between Chinese and UK universities continue to expand. However, the structural conditions that shape teaching quality and the governance arrangements through which they are managed remain under-theorised from a faculty-centred perspective. Drawing on a survey-based mixed-methods cross-sectional study of 56 teaching staff (80% response rate) at a Sino-British dual-degree engineering programme in western China, this study provides single-case evidence that teaching workload was the strongest observed negative correlate of perceived institutional support/satisfaction. Total weekly teaching load was moderately and negatively associated with the overall support/satisfaction composite (Spearman’s ρ = −0.49, p < 0.001). Non-parametric paired comparisons showed that teaching facilities were the only support dimension that differed significantly between the two institutional contexts, with a moderate effect; the remaining dimensions showed no significant differences. Internal consistency was acceptable to good. Qualitative thematic analysis identified three faculty adaptation strategies: simplifying and contextualising course materials, using bilingual instructional resources, and scaffolding peer-based discussion. Exploratory teaching-method comparisons involving 13 paired tests, interpreted descriptively, indicated higher reported use of reflection exercises and project-based learning at the joint school campus. An exploratory, perception-based engagement paradox also emerged: faculty reported a higher proportion of students showing >75% active participation at the joint school campus (85.7%) than at the parent institution (70.4% of valid responses), despite rating joint-school infrastructure lower. This finding requires student-level validation. The study contributes an empirically grounded, faculty-centred account of workload governance in transnational partnerships, using the Sino-British case as an illustrative test site. Full article

Background: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the tooth-supporting tissues and may substantially impair oral health-related quality of life (OHRQoL). Although the clinical consequences of periodontitis are well documented, the extent to which disease severity is associated with patient-reported outcomes remains insufficiently understood. This study aimed to evaluate the association between periodontitis severity and OHRQoL and to examine sociodemographic, behavioral, and systemic factors associated with poorer OHRQoL. Methods: A cross-sectional analytical study was conducted among 136 adult patients diagnosed with stage II or stage IV periodontitis at the Periodontology Clinic of Universidad Tecnológica de México (UNITEC). OHRQoL was assessed using the Oral Health Impact Profile for Periodontal Disease (OHIP-14-PD). Sociodemographic characteristics, smoking status, and diabetes mellitus were recorded using a structured questionnaire. Periodontal status was determined through standardized clinical and radiographic examinations. The internal consistency of the OHIP-14-PD was evaluated using Cronbach’s alpha coefficient. Bivariate analyses were performed using non-parametric tests. An exploratory, partially adjusted multivariable linear regression model including sex, marital status, diabetes mellitus, and periodontitis stage was also performed. Results: Stage IV periodontitis was more prevalent than stage II periodontitis (55% vs. 45%). The mean OHIP-14-PD score was 24.9 ± 13.7, and the instrument demonstrated excellent internal consistency (Cronbach’s α = 0.89). Patients with stage IV periodontitis had significantly higher OHIP-14-PD scores than those with stage II disease (30.1 ± 12.4 vs. 18.6 ± 12.6; p < 0.001), indicating poorer OHRQoL. In the bivariate analyses, poorer OHRQoL was also observed among current smokers, participants with diabetes mellitus, those with lower educational attainment, and those with lower socioeconomic status (p < 0.05). In the exploratory partially adjusted model, male sex (β = 4.2; 95% CI: 0.1–8.2; p = 0.042), diabetes mellitus (β = 6.5; 95% CI: 2.1–10.9; p = 0.004), and stage IV periodontitis (β = 4.6; 95% CI: 0.4–8.7; p = 0.031) were associated with higher OHIP-14-PD scores. Conclusions: In this single-center cross-sectional sample, patients with stage IV periodontitis reported higher OHIP-14-PD scores than those with stage II periodontitis. These findings indicate an association within the studied clinical population and should not be interpreted as evidence of a causal effect or as directly generalizable to broader populations. Larger multicenter longitudinal studies including patients across all periodontitis stages are required to confirm the magnitude and external validity of this association. Full article

Background: Lymph node metastasis (LNM) is a major determinant of prognosis in gastric adenocarcinoma. Although lymphovascular invasion (LVI) and perineural invasion (PNI) are established markers of aggressive tumor behavior, their combined association with nodal dissemination has not been systematically evaluated. This study investigated the relationship between invasive histopathologic features and LNM and developed a composite invasion score. Methods: This retrospective study included 395 patients with gastric adenocarcinoma. Clinicopathological analyses involving LNM were performed in the surgical resection cohort. A composite invasion score (0–2) was generated based on the presence of LVI and PNI. Associations with LNM, metastatic lymph node burden, and lymph node ratio (LNR) were evaluated using non-parametric tests and multivariable logistic regression. Predictive performance was assessed using receiver operating characteristic (ROC) analysis. An exploratory external transcriptomic analysis was performed using the GSE15459 dataset. Results: Both LVI and PNI were significantly associated with LNM (both p < 0.001). The composite invasion score showed a stepwise association with nodal dissemination, with median metastatic lymph node counts increasing from 0 in score-0 tumors to 3.5 in score-1 and 9 in score-2 tumors (p < 0.001). After adjustment for pathological T stage, histological grade, Lauren classification, age, and tumor location, the composite invasion score remained an independent predictor of LNM (OR = 4.53, 95% CI: 1.81–13.00, p = 0.002). LNR also increased significantly across score categories (p < 0.001). The composite invasion score demonstrated good discriminatory performance for LNM (AUC = 0.848, 95% CI: 0.773–0.923). The exploratory transcriptomic analysis demonstrated significant upregulation of MMP11, MMP14, and FAP in advanced-stage tumors, consistent with increased extracellular matrix remodeling and stromal activation. Conclusions: A simple composite invasion score integrating LVI and PNI is independently associated with lymph node metastasis and metastatic burden in gastric adenocarcinoma. The accompanying exploratory transcriptomic analysis provides biological context for these clinicopathological findings by demonstrating stage-associated extracellular matrix remodeling rather than direct molecular validation of the proposed score. These findings support the potential utility of the composite invasion score as a postoperative pathology-derived risk stratification tool. Full article

Background/Objectives: In Kuwait, a marked decline in the number of quality nurses has been observed; however, the factors underpinning their intention to leave have never been investigated. This study aimed to determine the prevalence of turnover intention among quality nurses in Kuwait, describe the reported reasons for leaving, and explore the organizational and personal experiences underlying their intentions. Methods: A sequential explanatory mixed-methods design was used. The quantitative phase involved a total population survey of all eligible quality nurses working in public hospitals (n = 65), using a structured questionnaire that included demographic characteristics, the Turnover Intention Scale (TIS-6), and literature-informed reasons for leaving. Descriptive analyses and non-parametric group comparisons (Mann–Whitney U and Kruskal–Wallis H tests) were conducted. The qualitative phase comprised in-depth semi-structured interviews with seven nurses who voluntarily reported an intention to leave and agreed to explain and contextualize the quantitative findings. Interview data were analysed using inductive thematic analysis informed by phenomenological principles. Results: The mean turnover-intention score was 21.7 (SD = 3.9), exceeding the TIS-6 scale midpoint of 18. Overall, 54 of 65 participants (83.1%; 95% CI: 72.2–90.3%) scored above the TIS-6 midpoint of 18, consistent with the original developer’s scoring guidance for a desire to leave. The most frequently reported reasons for leaving were low salary (60.0%), stressful or unsupportive work environments (49.2%), and lack of recognition (44.6%). The qualitative findings expanded these results by illustrating how organizational factors were manifested in practice through poor communication, lack of managerial support, role ambiguity, blame culture, verbal mistreatment, emotional exhaustion, and perceived inequity. Three overarching themes were identified: organizational and workplace factors, compensation and benefits, and personal reasons. Predictable morning duty also emerged as a factor that participants perceived as supporting their willingness to remain in their roles. Conclusions: Turnover intention among quality nurses in Kuwait was reported primarily in relation to organizational and work-related factors rather than demographic characteristics. The qualitative findings contextualized the high turnover-intention scores by illustrating participants’ workplace experiences. These findings suggest that strengthening organizational support, clarifying professional roles, promoting equitable management practices, and reviewing remuneration structures might contribute to improving retention among quality nurses. Full article

Background: Self-care and healthy dietary habits are fundamental components of heart failure (HF) management, yet the relationship between dietary quality and self-care remains insufficiently explored. This study investigated the association between dietary habits and self-care behaviors among patients with HF. Methods: A cross-sectional study was conducted among 137 adults with HF attending outpatient clinics in Greece. Self-care behaviors were assessed using the Hippocratic Heart Failure Self-Care Scale (HHFSCS), and dietary quality was evaluated using the validated Greek version of the Cardiovascular Diet Questionnaire-2 (CDQ-2). Associations between demographic characteristics, dietary measures, and self-care were examined using non-parametric tests and multivariable general linear models adjusted for demographic characteristics. Results: The mean HHFSCS score was 41.0 ± 11.3, indicating a moderate level of self-care. Higher scores were observed for medication adherence and appointment keeping, whereas lower scores were observed for exercise, smoking-related behaviors, alcohol-related behaviors, and symptom monitoring. The mean total CDQ-2 score was 8.57 ± 7.17. Overall dietary quality was not significantly associated with total self-care after adjustment for age, sex, marital status, educational level, and employment status (B = −0.102, 95% CI: −0.338 to 0.134, p = 0.394). Among the dietary components, only the saturated fatty acid (SFA) score remained significantly associated with total self-care after adjustment (p = 0.015), whereas fruit and vegetable and monounsaturated fatty acid scores were not significant. Employment status was also significantly associated with self-care (p < 0.001). Conclusions: Overall dietary quality was not significantly associated with total self-care in this sample of patients with HF. However, the observed association between the SFA component and self-care suggests that specific aspects of dietary behavior may warrant further investigation. Given the cross-sectional design and reliance on self-reported measures, these findings should be interpreted cautiously and do not establish directionality or causality. Prospective studies incorporating objective dietary and behavioral measures are needed to further clarify the relationship between dietary habits and self-care in HF. Full article

Background and Objectives: Inborn errors of immunity (IEI), also referred to as primary immunodeficiencies, are chronic conditions characterized by recurrent infections and long-term treatment requirements that may adversely affect psychological well-being. Although mental health outcomes in patients with IEI have been increasingly recognized, data regarding the psychological impact on family members remain limited. This study aimed to evaluate anxiety and depressive symptoms in patients with IEI and their family members compared with healthy controls and to examine the association of sociodemographic and clinical factors with anxiety and depressive symptom scores. Materials and Methods: A total of 375 participants were included, comprising 34 patients with IEI, 102 family members, and 239 healthy controls. Anxiety and depressive symptoms were assessed using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Group comparisons were performed using non-parametric statistical tests. Multivariable linear regression analyses were conducted to identify independent predictors of anxiety and depressive symptoms. The internal consistency of the scales was evaluated using Cronbach’s alpha, McDonald’s omega, and Guttman’s lambda-2 coefficients. Results: Both patients with IEI and their family members demonstrated significantly higher BAI and BDI scores than healthy volunteers in the unadjusted comparisons (all p < 0.001), with no statistically significant differences between patients and relatives. After multivariable adjustment using HC3 robust standard errors, healthy volunteers had significantly lower BAI and BDI scores than patients with IEI. Patient relatives had significantly lower BDI scores, but their adjusted BAI scores did not differ significantly from those of patients. Female sex remained independently associated only with higher BAI scores. The BAI and BDI showed excellent internal consistency, with all reliability coefficients exceeding 0.90. Conclusions: Patients with IEI and their family members had higher anxiety and depressive symptom scores than healthy volunteers. Although patients and relatives had comparable BAI and BDI scores in the unadjusted comparisons, adjusted analyses showed significantly lower BDI scores among relatives, whereas the adjusted BAI difference was not statistically significant. Healthy volunteers had significantly lower adjusted BAI and BDI scores than patients, and female sex was independently associated with higher BAI scores. These findings support consideration of psychological well-being at both the patient and family levels in IEI, although the cross-sectional design precludes causal inference. Full article

Background: Artificial intelligence (AI) systems, including large language models, are increasingly used in clinical practice, whether consulted informally by clinicians or introduced by employers into decision workflows. It remains unclear how physicians attribute moral responsibility when a decision follows an AI recommendation and whether that attribution varies with the type of decision at stake. Methods: We conducted a cross-sectional, within-subject vignette survey of physicians in Romania. Each respondent rated the same three scenarios—urgent clinical, elective clinical, and administrative—in which a physician followed an AI recommendation under two extenuating institutional constraints. Five-point Likert items addressed the mitigation of blame by circumstances, physician responsibility despite the AI recommendation, and institutional co-responsibility. Analyses were non-parametric, with corrections for multiple testing. Results: Among 72 physicians from 17 specialties, respondents endorsed full personal responsibility in every scenario, including the administrative one, with no significant difference between scenarios. They rejected extenuating circumstances as mitigating in both clinical scenarios but were divided about them in the administrative scenario, which had the largest effect. Institutional co-responsibility was endorsed alongside personal responsibility rather than in place of it, and the two attributions were largely uncorrelated. No demographic association survived correction, although the study was not powered to detect small-effect sizes. Conclusions: Physicians treated AI as an instrument rather than a bearer of responsibility, which is unsurprising. The substantive findings lie elsewhere: personal responsibility was retained across all decision contexts, while what varied was the admissibility of institutional constraints as excuses and the emphasis placed on the institution’s share. Because respondents did not treat responsibility as a fixed quantity to be divided, the pattern is consistent with distributed-responsibility accounts rather than with a responsibility gap, though attitudinal data cannot adjudicate between normative accounts. The findings are exploratory and require confirmation in larger, more representative samples. Full article

This exploratory randomized study examined whether manual diaphragm therapy is associated with masseter muscle activity, mandibular motor function, and perceived stress in healthy women. Forty-two asymptomatic women aged 20–30 years were randomized to an intervention group (n = 20), receiving six sessions over two weeks, or a no-intervention control group (n = 22). Before and after the intervention period, bilateral masseter surface electromyography (sEMG) was recorded at rest and during standardized mandibular motor tasks; mandibular range of motion was measured with an electronic caliper, and perceived stress was assessed using the Perceived Stress Questionnaire. Non-parametric tests with Bonferroni correction were applied. No significant within-group changes were observed in resting masseter sEMG. The only task-related within-group result that remained significant after correction was a reduction in normalized right masseter mean RMS amplitude during protrusion in the intervention group (p = 0.001; adjusted p = 0.032; r = 0.685). Mandibular range of motion increased in both groups, but change scores did not differ between groups. Stress-related outcomes and correlations with sEMG or mandibular motion were not significant after adjustment. These findings do not demonstrate consistent group-specific effects. The isolated within-group finding should be regarded as preliminary and hypothesis-generating and cannot be attributed specifically to manual diaphragm therapy. Full article

Pseudotolithus elongatus is one of the most commercially important species supporting artisanal fisheries in Guinea-Bissau; however, its population biology and reproductive characteristics remain poorly understood, particularly in estuarine ecosystems. This study provides the first integrated biological characterisation of P. elongatus in the Cacine River Estuary, Guinea-Bissau, based on 1776 specimens collected through three independent sampling programmes. Length at first sexual maturity (L₅₀) was estimated using binomial generalised linear models (GLMs); length–weight relationships were assessed by ordinary least squares regression and analysis of covariance (ANCOVA); sexual size dimorphism was evaluated using a battery of parametric and non-parametric tests (ANOVA, Welch’s t-test, Kruskal–Wallis, Kolmogorov–Smirnov); and sex ratio was tested using chi-square goodness-of-fit tests with Yates’ continuity correction. Females attained sexual maturity at a significantly smaller size than males (L₅₀ = 224.9 mm vs. 306.8 mm), and both sexes exhibited positive allometric growth. Females attained larger body sizes and predominated in the largest length classes, confirming pronounced sexual size dimorphism. Reproductive activity occurred throughout the year, with a distinct spawning peak during the dry season (February–April), and the overall sex ratio remained close to parity despite significant variation among length classes and months. These findings provide a biological baseline to support evidence-informed fishery management of P. elongatus in Guinea-Bissau and highlight the need for long-term, standardised monitoring in the Cacine River Estuary. Full article

Background/Objectives: Cutaneous melanoma prognosis is largely determined at diagnosis, with Breslow thickness, subtype and other histopathological aspects being key prognostic indicators. Variations in healthcare organization and environmental factors may influence melanoma presentation. This study aimed to compare epidemiological, clinical, and histopathological characteristics of primary cutaneous melanoma between two national referral centers in Southeastern Europe. Methods: A multicenter retrospective cohort study was conducted at the University Clinical Center of Serbia (Belgrade) and the Clinical Center of Montenegro (Podgorica). Consecutive patients treated for primary cutaneous melanoma between January 2018 and December 2022 were included. Data of interest were extracted from medical records. Annual regional sunshine hours were obtained from publicly available climatological databases. Group comparisons were performed using appropriate parametric and non-parametric tests, followed by a multivariable ordinal logistic regression analysis. Results: A total of 412 patients were analyzed. Age and sex distributions were comparable between cohorts. Nodular melanoma predominated in Montenegro, whereas superficial spreading melanoma was most common in Belgrade (p < 0.001). Median Breslow thickness was significantly higher in Montenegro (p = 0.001), with a greater proportion of tumors >4 mm (p = 0.001). In multivariable analysis, increasing age (p < 0.001), male sex (p = 0.027), and treatment in Montenegro (p = 0.001) were independently associated with higher Breslow thickness categories. Conclusions: Patients treated in Montenegro presented with thicker melanomas and a higher proportion of nodular subtype. These differences may reflect multifactorial influences, including healthcare accessibility and diagnostic pathways. Further prospective studies incorporating other histopathological aspects, time-to-diagnosis and survival outcomes are warranted. Full article

This study evaluates the unique ecological and floristic identity of the coastal dune vegetation in the Enez delta and adjacent dune coast of Saros Bay (southern Thrace) by comparing it with diverse dune systems across the Anatolian peninsula. A comprehensive data matrix of 97 phytosociological relevés across nine representative coastal dunes spanning the East Mediterranean, Aegean, Marmara, and Black Sea coasts was analyzed. Methodologically, univariate non-parametric approaches (Friedman variance analysis and Durbin–Conover tests) were integrated with multivariate techniques, including Hierarchical Cluster Analysis and Principal Coordinates Analysis (PCoA) based on a Bray–Curtis dissimilarity matrix. Ephedra distachya ssp. monostachya was found to be the most characteristic and differentiating taxa from the clustering. Friedman test results demonstrated highly heterogeneous species abundance across localities (χ² = 27.2, p < 0.001). The multivariate synthesis revealed a profound ecological decoupling for Saros Bay dunes: while macroclimatic filtering forces a powerful functional convergence with arid Mediterranean models dominated by therophyte, strict composition-based metrics isolate Saros Bay coastal dunes into an entirely independent taxonomic clade. PCoA ordination confirmed this distinctiveness (p < 0.05 against six of the eight national localities), with the first two axes explaining 33.58% of the total variation (Axis 1: 19.66%, Axis 2: 13.92%). This isolation is driven by a high density of Irano-Turanian elements and specialized local lineages like Silene kotschyi. Conversely, a sharp latitudinal bio-climatic macro-gradient was mapped, showing a transition toward humid Black Sea systems strictly dictated by macroclimatic filtering rather than biotic competition (p > 0.05). To preserve these specialized niches, designating coastal dunes of Saros Bay as a Priority Conservation Unit and establishing international, transboundary catchment to coast monitoring frameworks are essential. Full article