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Osteogenesis imperfecta (OI) is characterized by substantial genetic and functional heterogeneity, yet low-burden objective tools for repeated gait monitoring in routine outpatient care remain limited. This study investigated whether routine smartphone videos combined with markerless pose estimation could capture genotype-associated gait patterns in children with IFITM5- and WNT1-related OI, with COL1-related OI included as a cross-sectional reference cohort. This single-center retrospective cohort study screened 237 pediatric patients with genetically confirmed IFITM5- or WNT1-related OI between 2014 and 2024. The main analytic cohort included 71 patients: 48 with IFITM5 mutations and 23 with WNT1 mutations. During the same period, 107 patients with COL1-related OI were screened, of whom 26 were included as a cross-sectional reference cohort. MediaPipe Pose was used to extract spatiotemporal and postural gait parameters from outpatient walking videos. Algorithmic consistency under simulated video perturbations was assessed, and gait phenotypes were evaluated using multivariable models, linear mixed-effects models, Kaplan-Meier analysis, and exploratory machine-learning analysis. Step_Width and Trunk_Lean showed high algorithmic consistency under perturbation testing, with ICC ranges of 0.966-0.980 and 0.923-0.983, respectively. At baseline, WNT1 patients showed greater Step_Width (0.265&#x2009;&#xb1;&#x2009;0.073 vs. 0.203&#x2009;&#xb1;&#x2009;0.062&#xa0;m), Trunk_Lean (4.53&#xb0; &#xb1; 2.10&#xb0; vs. 2.72&#xb0; &#xb1; 1.63&#xb0;), and Normalized_Step_Width (0.377&#x2009;&#xb1;&#x2009;0.103 vs. 0.270&#x2009;&#xb1;&#x2009;0.083) than IFITM5 patients (all P&#x2009;<&#x2009;0.001). These differences remained after adjustment for age, sex, documented medication exposure, and surgical history, with adjusted differences of 0.046&#xa0;m for Step_Width, 1.612&#xb0; for Trunk_Lean, and 0.087 for Normalized_Step_Width. In the COL1-related reference analysis, WNT1 patients retained higher Step_Width and Normalized_Step_Width than COL1-related OI patients, whereas Trunk_Lean did not differ significantly between these groups. Longitudinal analysis showed no significant age-related gait changes in the WNT1 group, whereas IFITM5 patients showed mild annual decreases in Step_Width (-&#x2009;0.0026&#xa0;m/year) and Normalized_Step_Width (-&#x2009;0.0046/year). Surgery-free survival declined earlier in the WNT1 group than in the IFITM5 group (log-rank P&#x2009;=&#x2009;0.007). The exploratory genotype classification model achieved an AUC of 0.804 (95% CI, 0.678-0.914). Routine outpatient smartphone videos combined with markerless pose estimation can capture genotype-associated gait patterns in pediatric OI. WNT1-related OI was characterized by a wider base of support and coronal-plane compensation, whereas IFITM5-related OI showed mild longitudinal changes in spatial gait metrics. Video-derived gait parameters may provide low-burden adjunctive measures for outpatient functional monitoring, although prospective reference-standard validation and larger multi-genotype cohorts are needed.

Background: Surgical operations are an integral part of healthcare delivery and impose a substantial clinical and operational burden. Understanding how the operation- and process-management literature in healthcare reflects the intensity of surgical services and how this may affect the specialization preferences of healthcare professionals is important for strategic workforce planning. Methods: A bibliometric analysis was conducted on 272 academic publications obtained from the Web of Science Core Collection with the keywords "lean philosophy", "health" and "process" to capture the operational and process-improvement perspective of healthcare services. In this work, the "lean philosophy" keyword was taken to denote the operation- and process-management view of healthcare services, not to reflect the whole literature on surgical intensity. This selection was performed due to the multiple reasons, with an example being that lean-related studies often discuss complexities of workflow, efficiency, organizational responsiveness, and quality optimization, which are aspects also directly linked to surgical operational intensity. The data were analyzed using the bibliometrix R package, R-4.6.0 to construct the keyword co-occurrence network. Based on this network, a cognitive map was designed to visualize the conceptual relationships among the themes. Thematic clusters based on the co-occurrence network were then evaluated and prioritized by using the Analytic Network Process (ANP). Pairwise comparison data were derived from seven experts (surgeons and healthcare managers), and the model was implemented in Super Decisions with consistency ratios below 0.10. Results: The findings of the co-occurrence analysis are five main thematic clusters with surgical intensity themes including Healthcare Services, Quality, Care, Health and Outcomes. The cognitive map shows that Healthcare Services and Quality have the most central positions and structural hubs in the literature, whereas Outcomes is a dimension of great importance in terms of performance. The ANP results show that Quality (limiting weight &#x2248; 0.21), General Topics (&#x2248;0.14) and Management and Leadership (&#x2248;0.13) are the most influential sub-themes with regard to surgical operational intensity and, indirectly, to specialization preferences. Conclusions: The findings reveal that quality management, organizational leadership and larger health policy concerns are closely associated with the intensity of operations of surgical services as depicted in the operation- and process-management literature. Healthcare workers might be inclined to relocate to job positions related to quality improvement and leadership in lieu of places with a high direct clinical burden. Such insights can guide the policies of strategic human resource planning and specialization balancing in healthcare systems.

The clinical management of nutrition in acute and chronic diseases requires an integrated understanding of the interactions between energy intake, dietary protein, and amino acids (AAs). Many conditions (including sepsis, major trauma, cancer cachexia, chronic heart failure, chronic obstructive pulmonary disease, renal and liver failure, autoimmune diseases, and aging) share a common pathophysiological feature: the hypercatabolic state (HCS). HCS is characterized by systemic inflammation and neuroendocrine activation that increase basal metabolic rate, induce insulin resistance, and accelerate skeletal muscle proteolysis, leading to negative nitrogen balance, sarcopenia, and cachexia. Under these conditions, skeletal muscle acts as a metabolic reservoir of AAs mobilized to support energy production, gluconeogenesis, immune function, and vital organ metabolism, often at the expense of lean body mass and clinical outcomes. This narrative review examines the distinct and non-overlapping roles of calories, proteins, and AAs in metabolic regulation, with a particular focus on HCS. Calories primarily act as a permissive factor for protein utilization, whereas proteins and especially essential amino acids (EAAs) function not only as substrates for protein synthesis but also as signaling molecules (metabokines) regulating anabolic and catabolic pathways, including mTORC1 and AMPK. Energy provision alone is insufficient to prevent muscle loss when EAA availability is inadequate, while high protein intake without sufficient energy fails to sustain anabolism due to anabolic resistance. Evidence indicates that protein quality and the balanced availability of all EAAs are more critical for lean mass preservation than total caloric intake alone. Strategies based solely on calorie provision or protein quantity are therefore limited, whereas targeted EAA supplementation may partially overcome anabolic resistance in selected hypercatabolic conditions. Overall, this review supports a shift from calorie-centered nutrition toward a signal-based, quality-oriented approach, based on personalized needs, that integrates metabolic status, protein quality, and AA signaling to preserve lean body mass and improve clinical outcomes.

Tirzepatide induces substantial weight loss, but real-world data on early body composition changes remain limited. We evaluated short-term changes in body composition in 51 adults with obesity treated with tirzepatide for 12 weeks, using bioelectrical impedance analysis. Body weight decreased by 8.75 kg (-8.18%, P < 0.001), primarily driven by fat mass reduction (-6.87 kg, P < 0.001), with a smaller decrease in soft lean mass (-1.73 kg, P < 0.001). Despite this, the relative proportion of lean mass increased (+3.00 percentage points, P < 0.001), indicating preferential fat loss. Approximately 78% of total weight loss was attributable to fat mass. These findings suggest that short-term tirzepatide therapy leads to favorable body composition changes, characterized by predominant fat loss and relative preservation of lean mass, supporting its metabolic benefit in real-world clinical practice.

Vascular cognitive impairment (VCI) shares major risk factors with heart failure with preserved ejection fraction (HFpEF), including obesity, diabetes and hypertension. Yet VCI research often relies on single-stimulus models, whereas patients experience combined risk factors. We therefore assessed cerebrovascular and cognitive phenotypes in an HFpEF model and investigated underlying mechanisms.Male Lean and Obese ZSF1 rats underwent longitudinal assessments of blood pressure, glucose, cardiac function, and behavioural performance. Cerebral blood flow and neurovascular coupling were assessed by laser speckle contrast imaging. White matter integrity, blood-brain barrier (BBB) permeability, and vascular density were analysed by (immuno)histochemistry. Cortical microvessels were isolated for transcriptomic profiling, and selected targets were validated using multiplex in-situ hybridization.Obese rats exhibited neurovascular uncoupling and impaired short- and long-term memory and spatial learning, accompanied by brain atrophy and reduced myelin. BBB permeability increased at 22-23 weeks and vascular density at 34-35 weeks in Obese vs Lean rats. Transcriptomic analysis of brain microvessels revealed altered processes related to angiogenesis, vasoreactivity, immune mechanisms and vascular remodelling, with consistent downregulation of Trpv4 and Klf2.Obese ZSF1 rats develop progressive neurovascular dysfunction associated with HFpEF onset and reduced Trpv4 and Klf2 expression in cerebral microvessels, two key vasoprotective genes.

The gut microbiome is increasingly being recognized as a regulator of cardiometabolic health; however, whether microbiome interventions can attenuate myocardial ischemia-reperfusion injury (IRI) in diabetic hearts remains unclear. Therefore, we tested whether fecal microbiota transplantation (FMT) from lean non-diabetic donors could mitigate myocardial IRI in type 2 diabetes mellitus (T2DM) db/db mice and explored candidate taxa associated with protection. Male db/db mice (T2DM model) received a 14-day course of FMT from lean db/m donors or a vehicle after antibiotic pretreatment. Myocardial IRI was induced, and infarct size was quantified. The gut microbiota was evaluated by 16S rRNA gene sequencing. FMT significantly reduced the infarct size as a percentage of the area at risk compared to the IRI group (38.7 &#xb1; 13.4% vs. 58.7 &#xb1; 4.3%, P = 0.003). Microbiome analysis revealed that among alpha-diversity metrics only the Simpson index differed between the donor and diabetic groups. In beta-diversity analyses, diabetic mice clustered separately from donor mice, and the microbiome intervention induced a modest but significant shift detected by the presence or absence of Unweighted UniFrac. Differential abundance analysis and exploratory LEfSe further suggested Akkermansia, particularly Akkermansia muciniphila, as a candidate taxon reduced in diabetic mice and partially restored after the FMT intervention. A donor-derived microbiome intervention attenuated myocardial IRI in db/db mice and was accompanied by partial remodeling of the gut microbiota. Akkermansia muciniphila emerged as a candidate taxon associated with a reduced susceptibility to IRI in diabetic hearts.

Skeletal muscles make up about 40% of the body mass, but the effects of skeletal muscle mass (SMM) on blood pressure (BP) and the heart remain unclear and were explored in this study. The study used cross-sectional and longitudinal cohort designs with data from 492&#x200a;498 UK Biobank (ID 54078) participants without a history of stroke [mean (SD) age 56.5 (8.1) years, 45% men, 94% white]. Muscle mass index (MMI) was measured by bioimpedance analysis, lean mass index by DEXA, and thigh MMI by MRI, fat mass index (FMI) by bioimpedance and DEXA, left ventricular mass index (LVMI) by MRI. Multivariable regression was used to relate muscle mass, BP, and LVMI. On cross-sectional analysis, people with hypertension have higher values of all muscle mass metrics, which were independently associated with higher SBP and DBP after adjustment for age, sex, use of BP-lowering drugs and their interactions. Each 1&#x200a;kg/m2 higher muscle mass was associated with higher SBP by 0.67 [95% confidence interval (CI) 0.63-0.71] mmHg for MMI, 0.82 (95% CI 0.68-0.97) mmHg for lean mass index and 4.7 (95% CI 4.3-5.1) mmHg for thigh MMI. On longitudinal cohort analyses, higher values of muscle mass changes were independently associated with higher SBP and DBP after adjustment for age, sex and FMI (for SBP per 1&#x200a;kg/m2 increase) MMI during first follow-up of 4.3&#x200a;years was independently associated with 2.2 (95% CI 1.9-2.5) mmHg increase in SBP, with consistent findings during longer follow-ups and MMI assessment by DEXA and MRI (P&#x200a;<&#x200a;0.001 for all). Similarly, higher values of muscle mass metrics and their follow-up changes were independently associated with higher LVMI on cross-sectional and cohort analysis. Higher SMM is associated with higher BP and LVMI, independently of adiposity. Further research is needed to establish whether the observed association is causal and to identify the optimal exercise modes for optimal BP and better health outcomes.

This study investigated glucose metabolism in the forearm during fasting and postprandial states, comparing overweight men with lean men. We sought to understand how glucose is metabolized to prevent hyperglycemia in insulin-resistant obese men and the implications of increased basal glucose uptake in this population. Our findings reveal that overweight men exhibit elevated basal glucose uptake in the face of increased insulin concentrations and, unlike lean men, very limited basal lactate output. The overweight group demonstrated increased alanine release, suggesting a pathway toward enhanced hepatic gluconeogenesis.

White adipose tissue (WAT) plays a central role in maintaining systemic metabolic homeostasis by buffering lipid flux throughout the body. Impairment of this lipid-buffering capacity is a hallmark of obesity and has also been observed during chronic viral infection. Such dysfunction is closely associated with ectopic fat accumulation, particularly in the liver. We hypothesized that the coexistence of obesity and chronic viral infection exacerbates WAT dysfunction, thereby promoting liver pathology. However, the specific response of obese WAT to chronic viral infection - and its downstream impact on liver health - remains to be explored. To investigate this interaction, we employed a model of chronic viral infection in mice using lymphocytic choriomeningitis virus (LCMV) clone 13. In obese hosts, chronic infection caused sustained WAT depletion and progressive weight loss, accompanied by a reduction of Tim-4+ eWAT-resident macrophages and features reminiscent of lipodystrophy and aggravated metabolic dysfunction-associated steatotic liver disease (MASLD). Depletion of CD8+ T cells, the key mediators of LCMV-driven weight loss in lean mice, only modestly attenuated weight loss and did not ameliorate liver pathology in obese mice. Likewise, therapeutic interventions including TNF-&#x3b1; blockade and glycemic control with metformin did not reverse infection-induced weight loss; moreover, TNF-&#x3b1; blockade failed to improve liver pathology. Collectively, these findings reveal a previously unrecognized crosstalk between WAT and the liver in infection-driven MASLD, highlight distinct responses in WAT of obese mice compared to their lean counterpart, and underscore the increased susceptibility to virus-induced metabolic complications in obesity.

Despite the widespread use of phytase in swine diets, there is a need to update the current evidence on its effects on performance, carcass traits, and economic outcomes. This meta-analysis evaluated the impact of phytase supplementation on growth performance, carcass traits, and economic returns in growing-finishing pigs, combining meta-analysis with economic modeling. A systematic review (Web of Science, ScienceDirect, PubMed, and Scopus) revealed 1049 studies, 17 of which met the inclusion criteria (PRISMA). Three treatments were considered: a basal diet (BD), a reduced-P diet without phytase (DRP), and a reduced-P diet with phytase (DRP + P), with effect sizes expressed as weighted mean differences (WMDs). The meta-analysis included performance traits (daily feed intake, DFI; daily weight gain, DWG; feed conversion, FC; and final weight, FW) and carcass traits (carcass weight, CW; carcass yield, CY; backfat thickness, BT; loin eye area, LEA; lean meat percentage, LMP; and lean meat yield, LMY). With respect to BD vs. DRP, P reduction impaired performance and decreased ADG, DFI, and final weight (p < 0.001), especially at reductions &#x2265;0.12%. In DRP + P vs. BD, phytase had no significant effects on performance (WMD = 0.008 kg/day) or carcass traits. In DRP + P vs. DRP, phytase improved performance (ADG: +0.068 kg/day; DFI: +0.106 kg/day; FW: +4.630 kg; FC: -0.115; p < 0.001), with stronger effects in males and at greater P reductions. In DRP + P vs. DB, carcass traits were not significantly affected, whereas DB vs. DRP reduced LEA (WMD = -1.820, p < 0.00), and DRP + P vs. DRP produced subgroup-dependent changes in CW, LEA, and LMY according to sex, phytase source, and diet composition. Economically, phytase increased profit by up to US$ 2.66 (vs. BD) and US$ 5.14 (vs. DRP), remaining advantageous even with enzyme price increases of up to 4&#xd7;. Overall, phytase supplementation improved performance and economic returns, representing an effective strategy for the development of swine production systems.

1. Indigenous poultry breeds, like Kadaknath and Aseel, represent invaluable genetic resources, combining unique nutritional and cultural traits. The Kadaknath breed is famed for its black, lean, iron-rich meat with high protein and antioxidant content, while Aseel is a muscular breed prized for endurance, stress tolerance and fighting abilities. Despite their economic and nutritional value, the genetic and metabolic underpinnings of their distinct traits remain underexplored.2. This study conducted a comparative transcriptomic analysis of liver tissue from Kadaknath and Aseel chickens using RNA sequencing (RNA-seq) to uncover the molecular mechanisms driving their phenotypic diversity. The results identified 435 differentially expressed genes (DEG) linked to key processes such as lipid metabolism, oxidative phosphorylation and stress response.3. In Kadaknath chickens, up-regulated genes, including CPT1A, PCK1, TXNRD3 and PPARGC1A, were associated with efficient triglyceride breakdown, strong antioxidant defence and optimised energy metabolism. This likely contributes to the characteristic lean, nutrient-rich meat with high protein and low fat content.4. In contrast, Aseel birds showed elevated expression of stress response genes (MRPL18 and RPL11) and mitochondrial genes (NDUFA1, NDUFA8, NDUFB9 and PTPMT1), supporting its high energy requirements and resilience to stress, crucial for its endurance as a fighter breed. Gene co-expression network analysis highlighted critical hub genes driving these breed-specific adaptations.

Assess the impact of different stance variations, body composition and use of shoes among healthy young men and women on postural sway during quiet stance. A repeated-measures study with 123 participants (40 males, 83 females) aged 18-39 years was conducted. Participants stood quietly without shoes on a force plate with hands on hips (also performed with shoes), hands by sides, arms across chest, hands behind head and while isometrically contracting. Postural sway metrics were assessed for each condition. Body composition was assessed using bioelectric impedance analysis. There were no significant differences found between stances involving hands on hips, arms across chest, hands behind head, or hands by sides in the measured variables. Postural sway was greatest during isometric contraction (p&#x202f;<&#x202f;0.05). Women had greater path length, sway frequency and greater anterior-posterior sample entropy (AP SampEn) compared to men (p&#x202f;<&#x202f;0.05). Quiet stance postural sway was not influenced by the use of shoes. Variables related to lean body mass are significantly associated with postural sway as assessed by principal component analysis. The assessment of quiet standing postural control in healthy young adults can use a variety of stance variations (with or without shoes) since they yield statistically similar measures of postural sway. Postural sway is significantly increased with muscle contraction. Young women exhibit greater path length, sway frequency and AP SampEn compared to young men. Lean body mass may represent a target for improved postural control since it is associated with postural sway.

One of the priority goals of sports medicine is maintaining athletes' health, both throughout their athletic careers and afterward. Identifying athletes with excess body fat under normal body mass index (BMI) is important for sports medicine, as excess body fat predicts the development of metabolic disorders, as well as the development of overweight and obesity after retirement. The aim of this study was to assess nutritional status using a method combining BMI and body fat percentage criteria, to identify the incidence and timing of the manifestation of excess body fat under normal BMI values in female rhythmic gymnasts. A total of 239 female rhythmic gymnasts aged 6-20 years were examined. Anthropometric measurements were performed using standard methods. Body composition was determined using bioelectrical impedance analysis using an ABC-02 MEDASS analyzer. Nutritional status was assessed using the WHO AnthroPlus program and a method combining BMI and body fat percentage evaluation, which allows for the detection of hidden conditions such as excess body fat with a normal BMI. Using the combined method of assessing BMI and body fat percentage, 14 (5.9%) gymnasts had elevated body fat with a normal BMI. These athletes had lower lean body mass and skeletal muscle mass than gymnasts with normal body fat. Thirty athletes were identified as having a body type characterized by normal lean body mass and BMI values with insufficient fat mass. Eight athletes (3.3% of those examined) were underweight; one of them was diagnosed with insufficient body height. Athletes involved in complex athletic disciplines, such as rhythmic gymnastics, are at risk of developing excess body fat despite normal BMI levels, true overweight, and true obesity, both after retirement and during puberty.

This prospective study compared the Marsh and Schnider pharmacokinetic models for propofol target-controlled infusion (TCI) during anesthetic induction in obese patients undergoing elective cardiac surgery. A total of 118 patients were randomly assigned to either the Marsh or Schnider group (n&#x2009;=&#x2009;59 each). The primary outcome was the performance error (&#x394;C&#x2009;=&#x2009;measured minus predicted plasma concentration) during and after TCI. Secondary outcomes included hemodynamic pharmacokinetic-pharmacodynamic (PK-PD) model, anesthetic depth (BIS), cardiac function (LVEF, SV), electrocardiographic PK-PD model (QTc, QTcd), and recovery profiles. While no significant differences in &#x394;C were observed during TCI, the Marsh model demonstrated significantly lower &#x394;C at all time points after TCI cessation (p&#x2009;<&#x2009;0.05). Compared to the Schnider group, the Marsh group also showed higher BIS values, better preserved LVEF and SV, shorter QTc/QTcd intervals, reduced propofol requirements, and shorter recovery times (all p&#x2009;<&#x2009;0.05). In conclusion, under the conditions of this study, in which propofol TCI was configured using total body weight for the Marsh model and lean body weight for the Schnider model, the Marsh model provided more accurate plasma concentration control, better hemodynamic stability, and improved recovery profiles compared with the Schnider model for anesthetic induction in obese cardiac surgery patients.

Background: Intermittent fasting (IF) is a popular dietary strategy for improving weight and cardiometabolic health. However, its effectiveness and potential risks across different adult age trajectories remain unclear. This systematic review and meta-analysis evaluated the age-specific effects of IF on body composition and cardiometabolic markers. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) up to September 2025. Participants were stratified into three cohorts: <30 years, 30-44 years, and &#x2265;45 years. Random-effects meta-analyses and leave-one-out sensitivity analyses were conducted on body composition, lipid profiles, glycemic markers, and blood pressure. Additionally, a conservative methodological sensitivity analysis (imputed correlation r = 0.5) and subgroup analyses by fasting modality (TRF vs. intermittent energy restriction) were performed. Risk of bias was assessed using the RoB 2 tool. Results: Analysis of 28 RCTs (N = 1833) demonstrated that IF significantly reduced body weight and BMI across all age groups. Notably, subgroup analyses revealed comparable physiological responses between TRF and intermittent energy restriction modalities. Cardiometabolic adaptations were highly age-dependent. Young adults exhibited significant reductions in fasting insulin and HOMA-IR, alongside a robust reduction in fat mass. However, a significant loss of fat-free mass (FFM) was observed in both young and older cohorts. While middle-aged and older adults experienced the most pronounced improvements in triglycerides, systolic blood pressure, and insulin sensitivity, our conservative sensitivity analysis unmasked a significant elevation in low-density lipoprotein cholesterol (LDL-C) in this group, mirroring the robust LDL-C increase observed in young adults. Early middle-aged adults exhibited highly variable responses with no significant overall improvements in cardiometabolic parameters. Conclusions: IF is an effective weight-management tool, but elicits distinct, age-specific metabolic trajectories. While middle-aged and older adults derive pronounced cardiometabolic benefits, they face critical risks of lean mass depletion, necessitating a combined "IF+" strategy (adequate protein and resistance training). Crucially, the age-specific risk of LDL-C elevation dictates a mandate for vigilant lipid monitoring. Given that the certainty of evidence was rated as low to very low per GRADE criteria, these age-specific patterns should be interpreted as hypothesis-generating, warranting validation in future large-scale trials.