Search Results (1,829)

Background: Malnutrition and metabolic dysregulation are common in motor neuron disease (MND) and contribute to accelerated functional decline and reduced survival. Routine serum biochemical analytes can be used to assess nutritional status; however, their interpretation in MND is confounded by systemic inflammation and disease-related metabolic changes. This study investigated the relationship between serum biochemical analytes, inflammatory status, disease severity, progression, and body composition in people living with MND. Methods: In this single-centre, longitudinal prospective cohort study, 19 participants with confirmed MND were assessed at enrolment and at three-month intervals up to nine months. Serum concentrations of albumin, prealbumin, creatinine, transferrin, ferritin, retinol-binding protein, and lipid fractions were measured alongside routine inflammatory markers. Disease severity and progression were assessed using the revised ALS functional rating scale and King’s College Staging System. Anthropometry included percentage weight change, body mass index, mid-upper arm circumference, triceps skinfold thickness, arm muscle area, and calf circumference. Participants with evidence of baseline inflammation were excluded from nutritional analyses. Results: Low-grade systemic inflammation was present in 9/19 (47%) of participants at enrolment, most commonly reflected by elevated fibrinogen. In the non-inflammatory sub-cohort (n/N = 10/19), serum creatinine was positively correlated with muscle-related functional subscores (p = 0.007) and declined between enrolment and three months (p = 0.02), showing predominantly negative trajectories by nine months. HDL cholesterol also declined over the nine-month follow-up (p = 0.03) and lipid fractions correlated positively with disease stage (p <0.001–0.02), suggesting evolving metabolic stress. Elevated serum retinol-binding protein was observed in 90% (n/N = 9/10) of participants without inflammation. Biochemical evidence of malnutrition (low transferrin and/or creatinine) was detected in one-third of participants, accompanied by weight loss and reductions in limb anthropometric parameters. Malnutrition risk was identified in 1/10 (10%) of the non-inflammatory sub-cohort using a modified ESPEN-based framework, and in 2/10 (20%) participants using GLIM criteria. Conclusions: Routine serum biochemical analytes provide complementary information on nutritional and metabolic status in MND when interpreted alongside inflammatory markers and anthropometry. Serum creatinine emerged as a longitudinal marker of muscle wasting, reflective of denervation and nutritional depletion, while lipid and retinol-binding protein alterations highlight non-nutritional disease mechanisms that may confound standard biomarker interpretation, informing more targeted nutritional assessments. These findings support a multimodal approach to nutritional monitoring in MND and emphasise the importance of accounting for inflammatory status in biomarker interpretation. Given the small sample size and the limited representation of non-ALS phenotypes, these findings should be regarded as hypothesis-generating and require confirmation in larger, multicentre cohorts with balanced phenotypic representation. Full article

Background: Machine learning (ML) has emerged as a promising approach for preoperative cardiovascular risk prediction; however, the generalizability of ML models across institutions remains uncertain. Moreover, comprehensive head-to-head comparisons between ML algorithms and established clinical risk scores for predicting 30-day major adverse cardiac events (MACE) are scarce. We therefore evaluated the performance and external transportability of multiple ML models across independent centers and compared their predictive accuracy with validated benchmark clinical risk scores. Methods: In a site-separated two-center cohort (derivation n = 707, 27 MACE; external validation n = 378, 38 MACE), ten algorithms trained on preoperative variables were externally validated without refitting and benchmarked against the American university of Beirut-HAS2 (AUB-HAS2), American society of anesthesiologists (ASA), and revised cardiac risk index (RCRI). We assessed AUROC, calibration, Brier score, and decision-curve net benefit, with paired bootstrap comparisons, DeLong testing, IDI, and NRI. Results: Among the ML models, no single algorithm consistently outperformed the others across all performance metrics. Naive Bayes achieved the highest external discrimination (AUROC 0.738, 95% CI 0.668–0.804) but showed poor calibration and threshold-dependent clinical utility. Gradient Boosting showed the most favorable balance of discrimination and calibration slope (AUROC 0.707; calibration slope 0.991), although absolute risk remained underestimated in external validation, whereas HistGradient Boosting yielded the best overall probability prediction, with the lowest Brier score (0.087) and the greatest decision-curve net benefit at clinically relevant risk thresholds. However, in external validation, no ML model demonstrated statistically significant AUROC superiority over the AUB-HAS2 score (all p > 0.05), although several models modestly outperformed the RCRI. Conclusions: In this site-separated external validation, ML models showed metric-dependent performance but no discrimination advantage over the AUB-HAS2 index. Given low event counts, flexible-model results are hypothesis-generating. These findings provide a cautionary, reproducible benchmark; local recalibration and prospective evaluation are prerequisites before clinical deployment. Full article

Pediatric nephrology is shifting from broad phenotype-based labels toward molecularly defined, genotype-guided diagnosis and management. Childhood kidney disorders are enriched for monogenic causes, yet persistent microscopic hematuria, bilateral kidney cysts, steroid-resistant nephrotic syndrome, and thrombotic microangiopathy may represent shared endpoints of biologically distinct mechanisms. Using these four scenarios, this narrative review illustrates how structured phenotyping, pedigree analysis, biochemical evaluation, and appropriately selected genomic testing can establish etiology, revise diagnoses, and guide clinical decision-making. Molecular diagnosis may support early nephroprotection, prevent ineffective immunosuppression, reveal tumor or extrarenal risks, enable mechanism-based therapy, and optimize transplantation planning. It also enables cascade testing, reproductive counseling, presymptomatic evaluation of relatives, and safer assessment of living-related donors. Genomic findings, however, require clinical context. Variants must be evaluated against gene–disease validity, inheritance, segregation, molecular mechanism, and phenotype, while variants of uncertain significance should not independently determine treatment or donor eligibility. Negative or inconclusive findings should prompt phenotypic reassessment, evaluation of analytical limitations, targeted studies, and periodic genomic reanalysis. Emerging genome and long-read sequencing, multiomics, artificial intelligence, and RNA-based therapeutics may further expand precision care, but rigorous interpretation, equitable access, appropriate counseling, and multidisciplinary collaboration remain essential. Precision nephrology derives value not from identifying variants alone, but from converting molecular etiology into safer, anticipatory, and individualized care. Full article

Within the broader sustainable-development transition of inland navigation, liquefied natural gas (LNG) may serve as a transitional fuel, but its use requires appropriate berthing conditions, controllable candidate transfer areas, landside access, operational procedures, and emergency-response arrangements. This study develops a preliminary desktop-screening framework for assessing whether inland-port locations warrant further investigation for LNG bunkering. Ten Polish inland-port locations within the Oder waterway system were screened using a common evidence structure, of which five representative cases—Gliwice, Koźle Port, Wrocław, Opole, and Głogów—were examined in greater detail. The assessment relies exclusively on publicly available documentary and geospatial information; no site inspections, interviews, or engineering verification were conducted, and the results do not constitute a formal safety or operational certification. The revised framework uses ordered evidence categories rather than a cardinal readiness index and distinguishes berthing conditions, spatial controllability of a candidate transfer area, landside and emergency access, physical feasibility of a reference truck-to-ship configuration, and documented operational preparedness. Critical conditions are evaluated using a non-compensatory bottleneck rule. The analysis does not determine LNG safety-zone dimensions or operational risk, which require site-specific engineering and risk assessment. Under the available documentary and geospatial evidence, Gliwice and Koźle Port provide the strongest basis for subsequent field and engineering verification. For Wrocław, Opole, and Głogów, feasibility of the reference configuration was not demonstrated at the preliminary desktop-screening stage, primarily because of spatial and functional constraints. Truck-to-ship bunkering is treated as a reference screening configuration rather than as an option proven to be superior to ship-to-ship or pipe-to-ship alternatives. The results therefore support sustainable-development-oriented infrastructure planning by identifying priorities for further verification rather than confirming operational readiness or definitive infeasibility. Full article

Writing is a key competence for academic and social success, and for future employability. From a sociocultural perspective, writing development is shaped by both school instruction and literacy-related experiences within the home. However, little is known about what specific writing practices and support families naturally provide, particularly for children at-risk of writing difficulties in early primary education. This study examines home writing practices and family support for 296 typically developing and at-risk children in Spain in grades 1 and 2. Students’ writing performance was monitored longitudinally using curriculum-based writing measures, identifying 48 at-risk writers. Parents completed the Home Writing Environment Questionnaire, assessing the frequency of formal and informal writing practices and types of family support, including procedural, motivational and material support. The results showed similar patterns of home writing environments between groups; however, at-risk children engaged in writing activities less frequently, especially those involving higher-level processes such as planning, composing and revising. Families of at-risk children reported slightly higher levels of contingent support, suggesting adaptive involvement. These findings highlight the importance of promoting systematic family engagement in early writing to support inclusion and prevent difficulties. Full article

Background: Mental health has become a fundamental component of the sports world. Although previous studies have addressed psychological aspects of women’s soccer, no comprehensive review has mapped both mental health symptoms and adaptive psychological resources and psychophysiological markers in professional, semi-professional, and competitive adolescent women’s soccer. Objective: This scoping review aimed to map recent evidence from 2020 to 2025 on mental health in professional and semi-professional women’s soccer including competitive settings for adolescents, identifying key psychological constructs, assessment instruments, and risk and protective factors within the competitive sport context. Methods: Following the methodological guidelines of the Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR), a systematic search was conducted in PubMed/MEDLINE, Scopus, and Web of Science. Thirteen empirical studies that explicitly assessed mental health dimensions in professional and semi-professional women’s soccer players were included. Results: The most frequently studied constructs were psychological stress, competitive anxiety, resilience, motivation, and well-being. The main risk factors included intense competitive demands, accumulated fatigue, and performance pressure. Predominant protective factors were individual resilience, social support, team cohesion, and self-confidence. The most used instruments were validated scales including the Brunel Mood Scale (BRUMS), Sport Anxiety Scale-2 (SAS-2), Competitive State Anxiety Inventory-2 Revised (CSAI-2R), Generalized Anxiety Disorder-7 (GAD-7), Sport Mental Health Assessment Tool-1 (SMHAT-1) and qualitative interviews. Resilience emerged as a central concept; although it was measured directly in only two studies, it emerged conceptually as a central theme in the evidence, and recent qualitative studies have highlighted the influence of the institutional environment and technical support. Conclusions: The available evidence which is heterogeneous and limited to 13 studies points to a growing body of research on mental health in women’s soccer, focused primarily on stress and resilience. However, significant gaps remain, including a lack of multi-season longitudinal studies tracking players across full competitive cycles, limited representation of Latin American and Asian contexts (one study each), the absence of position-specific analyses such as studies focused on goalkeepers and insufficient attention to positive well-being. Prospective and intervention-based studies are needed to develop a comprehensive understanding of mental health in elite sports and in competitive adolescent settings. Full article

Background: Delayed onset of lactogenesis II or delayed secretory activation, defined as milk onset > 72 h postpartum, is a recognized barrier to successful breastfeeding initiation and duration. Prenatal identification and screening for risk factors associated with delayed secretory activation remains underutilized in maternal–child health services. This project aimed to develop and validate content for the Prenatal Evaluation and Referral for Lactation (PEARL) tool, a prenatal screening and referral instrument designed to identify lactation risk factors and guide anticipatory counseling and early referral to an International Board Certified Lactation Consultant (IBCLC) or breastfeeding medicine physician. Methods: Tool development was informed by a structured literature review conducted on 2 October 2024, across four databases (CINAHL, PubMed, Scopus, and Embase), identifying clinical and other health factors associated with delayed lactogenesis II. A three-round Delphi process was used to establish content validity through multidisciplinary expert consensus. Item-level content validity (ICV) was evaluated using a predefined consensus threshold (≥0.80), while average-measures Intraclass Correlation Coefficients (ICC) were calculated as a complementary assessment of interrater consistency. Following tool refinement, a pilot implementation training was conducted to obtain preliminary feedback regarding clarity, usability, and implementation. Results: Twelve lactation experts were selected from 59 eligible respondents to participate in the Delphi process. Most of the proposed items achieved the predefined content validity threshold (ICV ≥ 0.80) across the first two Delphi rounds, resulting in refinement and consensus on the final PEARL instrument. Interrater reliability improved from moderate agreement in Round 1 (ICC = 0.769; 95% CI 0.425–0.953) to excellent agreement following refinement in Round 2 (ICC = 0.911; 95% CI 0.787–0.979). Qualitative feedback informed revisions to item wording, organization, and content. A pilot implementation training indicated that the tool was perceived as understandable, usable, and appropriate for prenatal practice. Conclusions: The PEARL demonstrated strong evidence of content validity and preliminary implementation feasibility as a standardized prenatal lactation screening tool. Future research should evaluate additional psychometric properties, implementation outcomes, and prospective clinical performance to determine its effectiveness in improving referral practices and breastfeeding outcomes. Full article

Lithium-ion battery (LIB)-powered locomotives have emerged as a promising alternative to conventional rail electrification by reducing dependence on overhead catenary systems, lowering infrastructure costs, and improving operational flexibility. However, train failures involving power loss or mechanical faults present significant challenges for battery-powered rail systems, particularly on single-track corridors where alternate route options are limited. Consequently, the implementation of a reliable limp-home strategy is more complex than in road electric vehicles (EVs), requiring consideration of battery availability, rescue logistics, and track accessibility. This study investigates limp-home operation and rescue planning for a battery-powered historic trolley operating on a 20 km heritage route in North Carolina. The trolley is powered by a dedicated LIB trailer and supported by battery-charging (BC) infrastructure based on inductive power transfer (IPT) technology. A comprehensive framework is developed that integrates time–space analysis, cellular automata (CA)-based failure-risk modeling, and battery-energy assessment to evaluate train-failure scenarios and recovery strategies. The results identify critical failure regions along the route and demonstrate the benefits of strategically deploying additional LIB rescue trailers and wireless power transfer (WPT) infrastructure. A revised rescue strategy incorporating two additional LIB trailers, together with static and dynamic WPT systems, substantially reduces recovery time and improves the likelihood of maintaining scheduled excursions. Emergency energy analysis further shows that WPT-assisted operation can significantly extend limp-home capability under low state-of-charge conditions. Based on the integrated analysis, a tiered limp-home decision framework is developed to support operator decision-making during train failures. The proposed methodology provides a practical approach for enhancing the resilience, recoverability, and operational reliability of battery-powered heritage rail systems and can serve as a foundation for future battery-electric rail applications. Full article

A quantitative assessment of the characteristics and driving mechanisms of black soil erosion is essential to sustainable agricultural development. In this study, we analyzed the spatiotemporal dynamics of the soil erosion modulus (SEM) in the Typical Black Soil Region (TBSR) of Northeast China from 1980 to 2020. The SEM dataset we utilized was derived from a high-resolution dataset utilizing the Revised Universal Soil Loss Equation (RUSLE) model. The independent and interactive effects of nine driving factors, including geographic, climatic, and anthropogenic variables, were quantified. Our findings are as follows: (1) The annual average SEM exhibited a slight but non-significant increase (0.002 t·ha⁻¹·a⁻¹), with a notable fluctuation since 2000. (2) While most regions demonstrated persistence with stability, areas with non-significant slight degradation trends were identified in parts of the eastern Inner Mongolia, Songnen, and Sanjiang subregions. (3) Slope and altitude emerged as the dominant factors influencing SEM patterns, with their effects substantially enhanced through interactions with other variables. Temporally, from the 2000 baseline to the 2001–2010 and 2011–2020 periods, the explanatory power of GDP consistently increased, contributing to an overall rise in anthropogenic influence that surpassed climatic factors. This trend indicated that human activities had increasingly impacted SEM patterns relative to climatic effects. (4) High-risk zones were identified at slopes of 6~8° and elevations of 1230~1430 m (approximately 0.2% of the region). These zones often overlap with ecologically fragile grassland situated in areas characterized by low socio-economic development. These findings underscore the nonlinear coupling mechanisms connecting human activities, land use, and climate systems, providing a scientific basis for targeted erosion mitigation and sustainable farmland management. Full article

Background/Objectives: Congenital uterine anomalies (CUAs) are associated with adverse pregnancy outcomes, but large-scale data, particularly in Asian populations, remain limited. We evaluated obstetric and neonatal outcomes in women with CUAs using a large national Korean cohort. Methods: This population-based retrospective cohort study used the Korean National Health Insurance Service database and included 878,000 singleton deliveries between 2018 and 2023. CUAs were identified using International Classification of Disease, 10th Revision (ICD-10) codes and categorized as double, septate, bicornuate, or unicornuate uterus. Outcomes were compared with women without CUA using multivariable logistic regression adjusted for maternal age, parity, chronic hypertension, and pregestational diabetes mellitus. Results: CUAs were identified in 6038 women (0.68%), most commonly double uterus. Risks were higher for Cesarean delivery (adjusted odds ratio [aOR] 2.57, 95% confident interval [CI] 2.38–2.77), breech presentation (6.42, 5.91–6.99), placenta previa (1.79, 1.45–2.22), and placental abruption (3.01, 2.26–4.01). Neonates were more likely to be preterm (2.43, 2.10–2.80), small for gestational age (1.90, 1.70–2.10), and to experience respiratory distress syndrome (2.04, 1.63–2.55) and intraventricular hemorrhage (3.04, 2.00–4.62). Conclusions: CUAs are associated with increased risks of adverse obstetric and neonatal outcomes, with subtype-specific variations, warranting tailored prenatal counseling and management. Full article

Background/Objectives: Chimeric antigen receptor T-cell (CAR-T) therapy has been approved for the management of relapsed and refractory hematologic malignancies, transforming the oncologic landscape and producing durable remissions in patient populations with limited alternatives. The systemic adverse events of CAR-T are well characterized; however, the orofacial adverse events have not been well described. The objective of this study is to leverage a large, de-identified, real-world dataset to (1) estimate the prevalence of orofacial adverse events following CAR-T, (2) compare event rates with the general population, and (3) directly contrast the orofacial toxicity burden of CAR-T with that observed after hemopoietic stem cell transplant (HSCT). Methods: We performed a retrospective cohort study using de-identified electronic health record data from TriNetX. CAR-T and HSCT cohorts were identified via RxNorm and procedure codes; a non-exposed control cohort was included. Patients with prior orofacial conditions or confounding therapies were excluded. New adverse orofacial events within one year were identified by International Classification of Diseases, 10th Revision (ICD-10) codes. Cohorts were 1:1 propensity-matched by age and sex; associations were estimated as odds ratios with two-sided 95% CIs. Results: In 1142 CAR-T recipients (mean age of 62), gastroesophageal reflux disease (GERD) was most frequent (5.18%). Oral mucosal events included stomatitis in 1.52%, mucositis in 1.31%, and lichenoid reactions in 1.03%. Dysphagia occurred in 1.8% and oral candidiasis in 1.6%. Several severe oral conditions were absent. Compared with the general population (CART vs. general population): mucositis—[12/995 vs. 0/1112] (OR 28.3)—and stomatitis—[16/987 vs. 0/1119] (OR 38)—risks were significantly increased, while CAR-T patients had significant lower risks of mucosal complications than HSCT recipients in this analysis (CART vs. HSCT): mucositis—[1.21% vs. 3.72%] (OR 0.316) and stomatitis—[1.42% vs. 3.91%] (OR 0.354). Conclusions: CAR-T therapy carries a distinct and generally lower orofacial toxicity burden than HSCT, but targeted dental assessment and prospective surveillance remain important to optimize supportive care for cellular therapy recipients. Full article

Background/Objectives: Self-management for adults living with intestinal stomas secondary to colorectal cancer encompasses technical ostomy care, physical symptom control, psychological adjustment, and social participation, creating demand for standardised assessment instruments to identify unmet rehabilitation needs. Definitions of generic self-care and stoma-specific self-management remain inconsistent across published literature, and psychometric indicators are incompletely reported across available measurement instruments. This review includes both stoma-specific instruments and generic self-care scales that have been validated or widely applied specifically in colorectal cancer ostomy cohorts. Following JBI scoping review methodology, this work systematically maps all published self-management assessment instruments developed for adults with intestinal stomas secondary to colorectal cancer, summarises their core measurement domains and documented psychometric properties, and identifies prevailing gaps in scale development and validation research. Methods: This scoping review was conducted in accordance with Joanna Briggs Institute methodological guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting checklist. Ten electronic databases were searched from inception to 31 December 2025, with supplementary manual screening of reference lists. Eligible sources were peer-reviewed English or Chinese articles focusing exclusively on adults with colorectal cancer–related intestinal stomas. Two independent researchers completed title/abstract and full-text screening, followed by data extraction using a piloted standardised form. Consistent with descriptive scoping review design, no formal methodological quality evaluation or risk-of-bias assessment was performed. Results: Thirty-two studies involving 12 self-management assessment instruments were finally included. All tools documented Cronbach’s α coefficients ranging from 0.805 to 0.977. Content validity indicators were documented for eight instruments, whereas construct validity verified via factor analysis or structural equation modelling was only available for three tools. Criterion-related validity, cross-cultural validity and responsiveness were scarcely reported across most instruments. Only three instruments were fully developed based on complete and clearly articulated theoretical frameworks. Four consistent core measurement domains were identified across scales: stoma technical care, symptom and complication management, psychological adaptation, and family-social interaction. Conclusions: Although internal consistency metrics are universally reported, comprehensive multi-faceted validity testing and responsiveness evaluation are largely absent from existing published evidence. Cross-cultural measurement invariance between original and locally adapted versions (such as the ESCA and its Chinese revised forms) has rarely been examined. Future research priorities include rigorous cross-cultural adaptation following International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) protocols, full psychometric verification of currently available instruments, and development of brief validated short forms for clinical screening. New instrument development should only be initiated if existing tools fail to capture core rehabilitation priorities identified by patients, caregivers, and clinical staff. No responsiveness metrics were identified across the 32 included colorectal cancer-specific clinical studies. The absence of relevant evidence in this literature pool does not prove that these instruments cannot detect longitudinal changes; formal responsiveness testing is required before applying these tools for long-term outcome monitoring. Full article

Background: Malnutrition causes complications and adverse effects in older people and is a burden on healthcare systems. Older people with, or at risk of malnutrition who receive nutrition care in hospitals do not appear to be adequately engaged with post-discharge nutrition care processes. Food-based approaches (exclusive of oral nutritional supplements) are commonly considered the ‘first’ or frontline approach by dietetic professionals in the community setting. The aim of this scoping review is therefore to identify and synthesise the literature on food-based nutrition care provided to older community-dwelling adults who have been identified as malnourished or at risk of malnutrition during a recent hospital admission. Methods: This scoping review follows the methodological framework by Arskey and O’Malley, revised by the Joanna Briggs Institute. Results are reported according to the PRISMA-ScR guideline. Studies evaluating food-based nutrition care interventions provided to patients post-discharge from a hospital admission returning to a community setting were included in this review. Results: A total of 4086 records were screened, and eleven articles from seven independent studies were included. Highly heterogeneous findings may suggest improvements in weight, dietary intake, quality of life, physical function, anxiety and/or depressive symptoms, and reduction in readmissions associated with interventions including food-based nutrition care. However, sample sizes were generally small and evaluated as part of multicomponent care. Conclusions: Additional research is required to support frontline, food-based approaches for older community-dwelling adults, with or at risk of malnutrition, who are recently discharged from hospital. In the interim, multi-component nutrition interventions may be considered to improve nutritional intake. Full article

Background/Objectives: Psoriasis and atopic dermatitis have been conceived as opposite immunological poles, yet molecular overlap and clinically recognised coexistence challenge this dichotomy. We sought to adjudicate among three architectures: overlap with no discriminating systemic signature, a shared inflammatory and metabolic continuum with additive coexistence, and distinct phenotypes with synergy. Methods: Cross-sectional analysis of a selected UK Biobank subsample of 160,782 participants, classified by International Classification of Diseases, 10th revision codes L40 and L20 as control, isolated atopic dermatitis (n = 12,859), isolated psoriasis (n = 15,146) and coexistence (n = 1068). Haematological indices, a biochemical and metabolomic panel including glycoprotein acetyls, and circulating inflammatory proteins were evaluated through converging evidence from ordinal effect sizes, equivalence testing at a margin equivalent to an area under the receiver operating characteristic curve of 0.574, quantile regression with interaction terms, permutational multivariate analysis of variance, supervised classification and mixture modelling. Results: Effect sizes were negligible for 46 of 48 contrasts against a comorbidity-free comparator, and 38 of 48 met formal equivalence. None of the 16 interaction terms survived false discovery rate control. Multivariate separation was detectable but explained 0.6% of dispersion, classification reached an area under the curve of 0.57, and latent classes bore no correspondence to clinical diagnosis. When cardiometabolic exclusions were applied symmetrically to all four groups, every contrast met equivalence, and the ordering of the dominant factor did not persist. Polygenic risk scores confirmed that the coded groups carry the expected genetic architecture. Conclusions: Within the systemic biomarkers evaluated these conditions are not discriminable, and coexistence is not an emergent phenotype. Full article

Background: Total trapeziometacarpal (TMC) joint arthroplasty has emerged as a surgical option for selected patients with TMC osteoarthritis. The HORUS^® prosthesis (Evolutis, France) is a novel uncemented modular implant featuring a threaded screw-in trapezial cup coated with porous titanium and a PEXEL-E liner (vitamin E-infused cross-linked polyethylene) with a semi-retentive articulation. The purpose of this study was to report preliminary clinical and radiographic outcomes of total TMC joint arthroplasty using the uncemented HORUS^® prosthesis at 6-month follow-up. Methods: Eleven patients (8 women, 3 men; mean age 63.6 ± 10.1 years) with Eaton-Littler stage II–III TMC osteoarthritis and at least 6 months of unsuccessful conservative treatment underwent total TMC joint arthroplasty using the HORUS^® prosthesis. All procedures were performed by a single surgeon through a dorso-radial approach. Clinical outcomes were assessed preoperatively and at 15 days, 1, 3, and 6 months postoperatively using the Visual Analogue Scale (VAS), QuickDASH questionnaire, and Kapandji opposition score. Standardized radiographs were assessed at 1, 3, and 6 months for component position, periprosthetic radiolucency, cup migration/loosening, and stem subsidence. Results: One intraoperative trapezial fracture (1/11; 9.1%) required conversion to trapeziectomy with suspension arthroplasty; this patient was excluded from the prosthetic outcome analysis. In the remaining 10 patients, mean VAS decreased from 8.7 ± 1.1 preoperatively to 0.3 ± 0.7 at 6 months, mean QuickDASH decreased from 66.2 ± 11.3 to 14.5 ± 7.6, and mean Kapandji score increased from 5.8 ± 0.8 to 9.2 ± 0.6. One minor postoperative complication occurred (flexor tendinopathy of the third and fourth digits at 4 weeks). No dislocation, infection, or radiographic evidence of component migration, stem subsidence, or periprosthetic radiolucency was detected during the 6-month observation period. Conclusions: In this small preliminary series, the HORUS^® prosthesis was associated with marked short-term improvements in pain, disability, and thumb opposition. These data should not be interpreted as evidence of long-term implant survival or a reduced risk of loosening because the cohort was small and follow-up was limited to 6 months. Larger comparative studies with longer follow-up are required to assess durability, implant-related complications, and revision risk. Full article