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Weight reduction and metabolic changes have been associated with the development of compressive peripheral neuropathies. We present the case of a right-handed 60-year-old man who had a medical history of hypertension and hypercholesterolemia and developed neuromuscular symptoms after being treated with tirzepatide. During a 6-month course of tirzepatide use, the patient lost 60 pounds. However, the treatment was complicated by right-sided brachial plexopathy symptoms, including scapular pain, paresthesia, and progressive triceps weakness. Electromyography and nerve conduction studies confirmed denervation potentials at the right C5-C7 roots. Imaging studies were unremarkable. Symptoms persisted despite conservative interventions but improved gradually after the tirzepatide regimen was ended. At 2 months after the cessation, the patient's pain decreased from a 5/10 score to a score of one-2/10, and his strength improved. The follow-up EMG/NCV demonstrated the resolution of the denervation-caused changes. This case highlights a possible association between the rapid weight loss caused by GLP-1 RAs and the development of brachial plexopathy. In this patient's case, the latter condition improved after his medication was discontinued.

Duchenne muscular dystrophy (DMD) is a lethal pediatric striated muscle disease caused by loss of dystrophin for which there is no cure. Cardiomyopathy is the leading cause of death amongst individuals with DMD, and effective therapeutics to treat DMD cardiomyopathy are a major unmet clinical need. This work investigated adeno-associated viral (AAV) gene therapy approaches to treat DMD cardiomyopathy by overexpression of the calcium binding proteins S100A1 and apoptosis repressor with caspase recruitment domains (ARC). Using the severe D2.mdx mouse model of DMD, we identified that S100A1 gene therapy improves the diastolic dysfunction associated with DMD cardiomyopathy, whereas ARC gene therapy prolongs survival. The combination of both S100A1 and ARC in a single bicistronic vector improves the long-term cardiac outcome and histopathology of D2.mdx mice, development of heart failure caused by micro-dystrophin expression, and exhibits safety via intracoronary delivery in a canine model of DMD. In addition to robust cardiac benefits, S100A1-ARC gene therapy benefits D2.mdx skeletal muscle function and histopathology when driven by a striated muscle promoter. Together, these findings indicate that S100A1-ARC gene therapy represents an effective treatment for DMD cardiomyopathy and may have therapeutic benefits in treating other forms of cardiomyopathy and muscle pathologies.

Multilayer structures are widely used in energy, aerospace, and microelectronic packaging owing to their high structural efficiency and functional integration. However, their reliability is often compromised by planar interfacial defects such as delaminations. Reliable nondestructive detection of these defects remains challenging, particularly under all-optical conditions, because conventional laser ultrasonic inspections typically rely on point-like thermoelastic excitation. This generates highly divergent bulk waves with oblique incidence, leading to weak interfacial reflections and complicated echo interpretation. In this work, a plane-wave-like laser ultrasonic inspection strategy enabled by beam-expanded excitation and migration-based reconstruction is proposed. To overcome the reduced optical energy density inherent in beam expansion, a reflective photoacoustic transducer is introduced to significantly enhance the optical-to-acoustic conversion efficiency while maintaining thermoelastic operation. The resulting near-plane longitudinal-wave illumination ensures stable, high-contrast reflections from planar interfaces. Subsequently, to compensate for the degradation of lateral resolution caused by the spatially extended excitation source, phase-shift migration (PSM) is employed to reconstruct the ultrasonic wavefield. Experimental validation on multilayer chip-like Cu-TIM-Si specimens containing circular and square delaminations demonstrates reliable reflection-mode defect detectability across different defect geometries. After PSM reconstruction, contrast-to-noise ratio (CNR) values above 12 dB and sizing errors within 0.2 mm are achieved. By synergizing physical wavefront control with reconstruction-based signal processing, this work provides a robust, all-optical solution for the reflection-mode inspection of layered structures.

Pierce's disease (PD) of grapevines, caused by the bacterium Xylella fastidiosa, is a major constraint on viticulture in various regions of the world. An unusual and understudied feature of PD is the capacity of some grapevines to recover after winter dormancy, becoming asymptomatic and the bacterium is no longer detected in the plant. Ovewinter recovery has been documented for over four decades and is reproducible under both field and controlled conditions, yet outcomes vary across cultivars, environments, and pathogen strains. Similar phenomena have been reported in related pathosystems, including X. fastidiosa infections of almond and phytoplasma-associated diseases of grapevine, providing comparative insights. We review ecological and biological factors that influence overwinter recovery, highlighting the role of winter climate, timing of infection, host cultivar differences, pathogen population dynamics, and vector activity. Evidence suggests that overwinter recovery is not solely attributable to cold-induced pathogen mortality but also involves host-mediated processes, potentially including an immune reset during dormancy. These findings link recovery to broader ecological consequences, influencing pathogen persistence, disease epidemiology, and the geographical distribution of PD under current and future climate conditions. Despite decades of observation, the mechanistic basis of recovery remains unresolved. Key gaps include the identification of host traits underlying recovery, the contribution of pathogen genotype, and the integration of climate variables into predictive models. Addressing these gaps will be essential not only for understanding disease ecology but also for anticipating the impact of climate change and informing management strategies for PD and related vector-borne vascular diseases.

Abnormal accumulation of reactive oxygen species (ROS) induces oxidative stress, a central pathological factor in many human diseases. Traditionally, antioxidants are suggested to relieve oxidative stress in the body; however, their efficacy is limited by poor stability in vivo and inadequate tissue targeting in clinical practice. Therefore, there is a great need for an effective, safe, biocompatible, and environmentally friendly antioxidant strategy to reduce damage caused by oxidative stress. Previous work has demonstrated that nanobubbles (NBs) can regulate hydroxyl radical (•OH)-mediated redox reactions. However, it remains unclear whether NBs can exert similar regulatory control on singlet oxygen (1O2), and the molecular mechanisms that control this interaction need to be elucidated. In this work, we employed photodynamic reactions to generate 1O2 and systematically investigated the effects of NBs of different particle sizes and different encapsulated gas compositions (N2 or O2) on 1O2-mediated oxidation of selective fluorescent probes. Our findings indicate that ultrasmall NBs exhibit remarkable antioxidant activity across all test systems and that even NBs prepared with O2, a gas that typically enhances ROS-driven oxidation, inhibit 1O2-mediated substrate oxidation. These insights establish a basic framework for the rational design of NB-based antioxidant platforms, which hold significant promise for applications in biomedical antioxidant therapy, material protection, and food preservation.

Decompression sickness (DCS) is a pathology caused by the appearance of gas emboli in the bloodstream and tissues. However, the weak correlation between the amount of venous gas emboli (VGE) and the development of DCS, as well as the considerable inter-individual variability in DCS-susceptibility, suggest that a higher DCS resistance could be associated with a better management of VGE-induced stress. To study the effects of VGE independently of the hyperbaric stress induced by diving, Wistar and DCS-resistant male and female rats received 5 ml/kg of a NaCl solution 0.9 % filled with air microbubbles through the tail vein. After 120 minutes, the liver and lungs were harvested. Wet to dry weight ratio was determined in the lungs. Gene expression was quantified by RT-PCR in the liver. Compared to Standard Wistar, DCS-resistant rats exhibited a lower lung wet to dry weight ratio after air microbubble injection, suggesting lower pulmonary fluid accumulation. In the liver, DCS-resistant rats showed higher tissue factor (TF) transcription at basal state and post-air microbubble injection. Tissue factor pathway inhibitor (TFPI) was lower in DCS-resistant rats at basal state but higher following air microbubble injection. Levels of HSP70, HSP27, and Egr-1, were higher in DCS-resistant rats after air microbubble injection. At the basal state, only HSP27 was higher in DCS-resistant rats, with HSP70 lower and Egr-1 not different. These results help clarifying the pathways involved in the response to VGE and highlight potential mechanisms underlying resistance to DCS, including enhanced anticoagulant pathways and improved cellular stress responses.

Indigenous, mountain communities residing upstream of Bhumibol Dam, Thailand, rely on vulnerable natural water sources for their water supply, yet remain unaware of the associated health risks. This study assessed the water quality, usage patterns, and contamination pathways across six villages upstream of Bhumibol Dam to shed light on the obstacles to sustainable water security. Samples from 38 water sources of drinking and/or non-drinking water, soil, and the edible parts of crops were subjected to analyses of physical, chemical (NO3-N, pH), and qualitative pesticide-related variables, alongside a 6-month assessment of a community water filter system. Principal component analysis identified a "at-risk group" of preferred drinking water sources all exhibiting high NO3-N, highly alkaline pH, and substantial pesticide contamination, which was found to likely be caused by agricultural run-off. This was reinforced by the detection of pesticide residues in all soil samples and, critically, in the below-ground edible parts of crops (taro, lemongrass, arrowroot), confirming dietary exposure in the local communities. Further compounding the risks posed by the unsafe water supply, the community water filter was found to be ineffective throughout the 6-month analysis with there being no significant difference in water quality between before and after filtration. The residents' paradoxical preference for high-risk, still water (from sand-filtered puddles) for drinking, rather than water from flowing sources, which they used only for cooking and cleaning. Overall, these findings reveal compounded environmental health risks emerging from the convergence of mineral-rich hydrogeology, agrochemical runoff, and vulnerable water-collection behaviours. To mitigate these threats, the study suggests that decentralized water management strategies must prioritize both the implementation of advanced filtration technologies capable of mineral and chemical removal and targeted public health education to shift community reliance away from high-risk, stagnant water sources.

Lumbosacral radicular pain (LRP) results from the ectopic activation of nociceptive afferent fibers in a spinal nerve or its roots. Lumbar disc prolapse is the most prevalent cause of LRP. This condition significantly impacts patients' quality of life and is deemed a burden on communities and health care facilities alike. The utilization of pulsed radiofrequency (PRF) in dorsal root ganglion stimulation (DRG-S) has demonstrated efficacy with a wide applicability across various conditions. However, whether elevating the voltage of PRF to between 55-75 volts could augment its clinical efficacy remains uncertain. The primary measure of outcome was the Numeric Rating Scale (NRS) score between the 2 groups . The secondary outcomes included functional outcomes as evaluated on the Oswestry Low Back Disability Questionnaire and intra- or post-intervention complications. A prospective, double-blinded, randomized controlled study. The study was carried out at the Medical Research Institute of Alexandria University. The study included 96 patients with lumbosacral radicular pain caused by disc prolapse. They were randomly divided into 2 equal groups to receive high-voltage pulsed radiofrequency (HV-PRF) (Group I) or standard-voltage PRF (Group II) adjacent to the DRG corresponding to the affected dermatome. Scores on the NRS and Oswestry Low Back Disability Questionnaire were evaluated at one week and one, 2, 3, and 6 months after the intervention. The complications of the intervention were recorded. In both groups, NRS scores decreased significantly from the pre-intervention ratings at all post-intervention studied times (P ≤ 0.001). However, this decline was significantly more observable in Group I than in Group II (P ≤ 0.001). The percentage of patients reporting NRS reductions ≥ 50.0% was significantly higher in Group I than Group II at one, 2, 3, and 6 months after the intervention (P ≤ 0.001). Similarly, when compared to the pre-intervention ratings, Oswestry Low Back Disability scores decreased significantly in both groups at all studied post-intervention times (P ≤ 0.001), but this reduction was significantly greater in Group I than in Group II (P ≤ 0.001). The percentage of patients who reported Oswestry Low Back Disability score reductions ≥ 50.0% was also significantly higher in Group I (37.5%, 66.7%, 75% and 81.3% of patients at one, 2, 3, and 6 months, respectively, post-intervention) than in Group II (no patients at one and 2 months, 8.3% and 14.6% at 3 and 6 months, respectively, post-intervention) (P ≤ 0.001). No major complications were recorded for either of the studied groups. Short study period, single-centre study. High- and standard-voltage PRF administered in an area adjacent to the dorsal root ganglion provides significant improvements in radicular pain, as measured by the NRS, and function capacity, as measured by the Oswestry Disability Index, in patients with LRP associated with disc prolapse. However, of the 2 types of PRF procedures, HV-PRF yields superior pain relief and augments patients' functional status to a greater degree.

Building on our previous work on electrochemically synthesized anatase TiO2 nanoparticles (NPs), this study evaluates their environmental relevance by linking pharmaceutical photocatalytic degradation with transformation product identification and toxicity-oriented assessment. The incomplete removal of pharmaceuticals in wastewater treatment plants raises concerns about both parent compounds and transformation products formed during advanced treatments. Here, the synthesized TiO2 NPs were applied to the photocatalytic degradation of ibuprofen (IBU) and paracetamol (PCT) under ultraviolet A (UVA) irradiation. The TiO2 NPs showed higher degradation efficiency than commercial P25, with Kobs of 10.82 × 10-3 min-1 for IBU and 10.75 × 10-3 min-1 for PCT, and approximately 95% removal for both pollutants after 4 h of UVA irradiation. Liquid chromatography tandem mass spectrometry (LC-MS/MS) identified 8 transformation products for IBU and 9 for PCT, suggesting degradation pathways involving hydroxylation, decarboxylation, bond cleavage, and formation of smaller oxygenated products. In-vitro assays were performed using A549 lung cells and HepG2 liver cells. In A549 cells, TiO2 NPs caused no significant decrease in dehydrogenase activity at 1-100 µg/mL after 24 and 48 h. In HepG2 cells, TiO2 NPs showed lower cytotoxicity than P25, with viability remaining at approximately 68% after 48 h at 250 µg/mL, compared with about 60% for P25. IBU and PCT solutions before and after 4 h of photocatalytic treatment maintained HepG2 viability above 90%. The toxicity-oriented assessment, supplemented by Ecological Structure Activity Relationships (ECOSAR) software predictions, suggested that further transformation could reduce predicted ecological concern.

Computing molecular thermodynamic properties is instrumental in multiple scientific disciplines, such as statistical physics, N-body simulations, and molecular docking. However, exact thermodynamic calculations are almost always not feasible. In this work, we introduce a versatile algorithm designed to rapidly compute the two-body partition function, its related thermodynamic properties, and the second virial coefficient for anisotropic nanoparticles and proteins under the rigid-body approximation. Our method involves constructing a quasi-regular grid in the 5D angular space between pairs of arbitrary objects and efficiently scanning the radial-angular space between the rigid molecules. Where available, we find excellent agreement with light and X-ray scattering experiments, as well as with Monte Carlo simulations. Our results suggest a correction to current coarse-grained protein force fields, and we further discover a new, counterintuitive effect of temperature on virial coefficients, caused by a population shift in angular space due to the dielectric response of water. Finally, the grid can serve as an interpolation table for N-body simulations, increasing their performance by orders of magnitude.

Myiasis is a rare disease primarily caused by the invasion of tissue by larvae of certain dipteran flies. Common predisposing factors are poor oral hygiene, halitosis, trauma, senility, learning disabilities, physically and mentally challenged conditions. A 40-year-old female patient reported with pain in the maxillary anterior region with difficulty in chewing since 1 month.The clinical examination revealed the presence of maggots which helped in arriving at the diagnosis.The possible causes, clinical features and treatment has been discussed.

Foodborne illnesses are infections or intoxications caused by consuming contaminated food or beverages. This study aims to find the prevalence of diarrheal cases and deaths associated with food-borne illnesses in India. A Search was performed on PubMed and other platforms from 2011 to 2022. Sensitivity and quality analyses were also performed. The pooled prevalence was reported with effect sizes, considering the random-effects and quality-effects models. A subgroup analysis was also performed based on the regions and age groups. The prevalence of diarrheal cases due to foodborne illnesses in India was 18%. The prevalence was 22% in the North Eastern region, 20% in the Eastern region, 18% in the Southern region, 16% in the Western region, and 13% in the Northern region. Among the age groups, prevalence was 34% for 5-10 years, 22% for under 5, 13% for 20-60 years, 14% for 10-19 years, and 10% for more than 60 years. The prevalence of diarrhea is still on the higher side in India. Although programs like Intensified Diarrhea Control Fortnight are running, interventions and awareness, ensuring intake of safe food and water are necessary.

Rugged terrain and abnormal signal transmission in mining areas threaten the stability and reliability of minecart suspension systems. To address this challenge, the reliable control of minecart suspension systems is explored in this article. Different from general vehicle suspension systems, time-varying minecart body mass caused by road-induced vibration and ore loading or unloading is captured by a Markov process. To mitigate the adverse effects of packet dropouts, a redundant-channel compensator based on multisensor data is designed. Furthermore, accounting for the unavailability of partial states, an adjustable partition-dependent switching (APDS) mechanism is developed with observer assistance to achieve desired control performance. Notably, the proposed mechanism removes the crucial requirement of online matrix inversion in nonparallel distributed compensation (non-PDC) controllers, while simultaneously improving the control flexibility and gain-scheduling precision through generalized membership function (MF) partitioning. Moreover, based on a relaxation variable approach, time-varying balanced matrices adapted to the working mode properties are incorporated into the stability conditions. Finally, numerical and hardware-in-the-loop (HIL) experiments demonstrate that the proposed mechanism enhances crucial ride comfort while maintaining strong robustness against both road disturbances and channel noise.

Introduction. Tuberculosis (TB) remains a major global health threat, and its control is hindered by prolonged treatment and increasing drug resistance. Helicase with zinc finger 2 (HELZ2) has recently been identified as an RNA-binding protein up-regulated after Mycobacterium tuberculosis (Mtb) infection, yet its functional contribution to host defence is not fully understood.Hypothesis/Gap Statement. Although HELZ2 expression increases following Mtb infection, the molecular mechanism by which HELZ2 regulates macrophage immunity, particularly autophagy-mediated bacterial clearance, remains unclear.Aim. This study aimed to elucidate the role and underlying mechanism of HELZ2 in macrophage-mediated elimination of Mtb, with a specific focus on its regulation of autophagy.Methodology. HELZ2 expression was quantified in the peripheral blood of TB patients and in Mtb-infected monocyte-derived macrophages. By knocking out and overexpressing genes, phagocytosis, intracellular bacterial survival and autophagy were analysed. Co-immunoprecipitation, chromatin immunoprecipitation and dual-luciferase assays were employed to identify HELZ2-interacting proteins and downstream transcriptional targets.Results. HELZ2 was significantly up-regulated in patient samples and infected macrophages. HELZ2 silencing impaired phagocytosis, reduced autophagic flux and increased intracellular Mtb survival. Mechanistically, HELZ2 bound to and stabilized the MYC proto-oncogene, bHLH transcription factor (MYC), which directly activated transcription of the autophagy-related gene ATG16L1. Overexpression of MYC or ATG16L1 restored the autophagy disorder caused by HELZ2 deficiency and enhanced bacterial clearance.Conclusion. HELZ2 enhances macrophage autophagy and promotes intracellular Mtb elimination by interacting with MYC and up-regulating ATG16L1. This newly identified HELZ2-MYC-ATG16L1 regulatory axis provides mechanistic insight into host defence and suggests a potential target for host-directed TB therapies.

Human metapneumovirus (HMPV) is a leading cause of acute respiratory infection worldwide, and most people over the age of 10 have been infected. Despite its high prevalence, its pathogenesis is not yet fully elucidated. Many cell types, including stem cells, are susceptible to HMPV infection. Our previous results suggested that mesenchymal stem cells (MSCs) are susceptible and permissive to HMPV infection. This study aimed to understand the effects of HMPV on stem cell biology. Specifically, we focused on the expression and localization of cytoskeletal proteins and their role during syncytium formation. To this end, we evaluated the surface markers CD90, CD73, and CD105 in infected and non-infected cells using flow cytometry; assessed infection-induced modifications in cytoskeletal proteins using immunofluorescence, and analyzed changes in the secretion pattern of the growth factors including Ang-2, EGF, EPO, FGF-basic, G-CSF, GM-CSF, HGF, M-CSF, PDGF-AA, PDGF-BB, SCF, TGF-α, and VEGF. We observed changes in the distribution of tubulin and actin. Annexin V levels were also increased following HMPV infection, likely due to membrane modifications associated with viral fusion during entry and/or viral exit by budding. HMPV infection induced a significant decrease in EGF and VEGF secretion compared with mock-infected cultures. In contrast, Ang-2 and PDGF-AA levels were significantly elevated in infected MSCs. HMPV infection alters the structure and surface marker expression of PL-MSCs; however, these cells retain their ability to differentiate into various tissue types. Nevertheless, the virus disrupts growth factor production, creating a complex balance between cellular damage and the remaining potential for tissue repair.

Extended-view totally extraperitoneal repair (eTEP) is one of the recently introduced, advanced minimal access approaches for the repair of ventral hernias. Posterior sheath rupture (PRSR), though rare, is a lethal complication of eTEP, exposing the polypropylene mesh to the viscera. Few cases of PRSR have been reported following eTEP ventral hernia; however, delayed presentations as acute small bowel obstruction, has not been reported so far. We present the case of acute intestinal obstruction following eTEP ventral hernia repair after 10 months following the primary surgery. A 67-year-old female underwent laparoscopic eTEP repair for an incisional hernia using a polypropylene mesh of 20 cm × 15 cm without mesh fixation, along with anterior and posterior rectus sheath re-approximation 10 months ago. She presented in emergency with abdominal pain and constipation and obstipation for 2 days. Contrast-enhanced computed tomography of the abdomen and pelvis revealed interstitial hernia with dilated small bowel herniating till anterior rectus sheath with adhesions to the mesh through the posterior rectus sheath dehiscence. She was subjected for an emergency laparoscopic surgery. She had an uneventful recovery. Ventral hernia repair with mesh reinforcement in retrorectus plane is considered safer with maintained peritoneal integrity, reducing the risk of bowel obstruction and fistula formation as with an intraperitoneal mesh. There are few documented cases of posterior rectus sheath rupture as an early complication of eTEP, which exposes to similar risks of bowel obstructions. However, PRS rupture as delayed complication with bowel obstructions has not been documented. A high degree of clinical suspicion of PRS rupture must be kept post-ventral hernia repair in patients presenting with obstructive symptoms. We consider that poor muscle tone, strenuous activity and deep bending may cause PRS rupture.

Developmental prosopagnosia (DP) causes difficulty recognizing familiar faces, but little is known about which stage(s) of the face-processing system difficulties occur, or whether these are identical in all DP cases. Twenty DPs and matched controls completed six face perception tasks. The DP group performed significantly poorer than controls on face detection and gender categorization tasks and on a global (averaged) face perception measure. 40% of individual DPs showed significant impairments on tasks not involving identity perception (face detection and categorization, age and gender categorization). By contrast, 50% showed broadly typical face perception and thus support for the idea of apperceptive (affecting both face perception and face memory) and mnemonic (affecting only face memory) subtypes of DP. Intraclass correlations revealed clear inter- and intra-individual differences, confirming that data from a single perceptual task cannot be taken as evidence of broader face-perception ability spanning beyond the results of that test..

The European Kidney Function Consortium (EKFC) has introduced equations for estimating glomerular filtration rate (eGFR) using serum creatinine (Cr) and cystatin C (Cys). While their diagnostic accuracy is established, their comparative prognostic value for long-term mortality in the general population is not well-defined. This study compared the prognostic performance of three EKFC equations-creatinine-based (EKFC-eGFRcr), cystatin C-based (EKFC-eGFRcys), and the combined (EKFC-eGFRcrcys) model-for predicting all-cause and cardiovascular (CV) mortality. We analyzed a population-based cohort of 4519 participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. eGFR was calculated using all three EKFC variations (EKFC-eGFRcr, EKFC-eGFRcys, and EKFC-eGFRcrcys). The primary and secondary endpoints were all-cause and CV mortality, respectively, through December 31, 2019. Predictive improvements were evaluated using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and number needed to measure (NNM). The eGFR value calculated by the EKFC-eGFRcys, EKFC-eGFRcr, and EKFC-eGFRcrcys was 78.92&#xb1;22.98, 84.45&#xb1;23.21, and 81.68&#xb1;22.13 ml/min/1.73m2, respectively. Over a median follow-up of 211 months, all three eGFR models were independent predictors of mortality (all P <0.001). Restricted cubic spline regression revealed significant non-linear, inverse associations between all eGFR measures and adjusted mortality risks (all P for non-linearity < 0.001). Compared to EKFC-eGFRcr, EKFC-eGFRcys significantly improved risk reclassification for all-cause mortality (categorical NRI = 15.9%; 95% CI: 14.1-17.8%; NNM = 7). The combined EKFC-eGFRcrcys also outperformed the creatinine-only model (NRI = 8.9%; NNM = 12). However, EKFC-eGFRcys demonstrated modestly better performance than the combined equation (NRI = 7.0%; NNM = 15), suggesting limited incremental value in adding creatinine to cystatin C. The superiority of EKFC-eGFRcys was primarily driven by improved classification of non-events. The EKFC-eGFRcys equation provides superior prognostic value for all-cause and CV mortality compared to both creatinine-based and combined EKFC equations. Notably, the combined model offered no prognostic advantage over cystatin C alone. These findings highlight the clinical importance of cystatin C-based eGFR for accurate risk stratification in the general population.