Movement differences in autism have attracted growing attention in recent years. Anecdotally, autistic movement has been likened to that of Parkinson's Disease (PD). Given that PD assessments are primarily movement-based, it is important to ensure that autistic individuals are not scoring highly on PD diagnostic criteria due to autism-related movement differences. Quantifying overlap in movement profiles and identifying distinguishing features is essential, particularly given increased PD diagnosis rates in the autistic population.

We conducted the first direct comparison study of autistic and parkinsonian movement. Autistic individuals (N = 31), individuals with PD (N = 32) and control participants (N = 31) completed a Shapes Tracing Task and a Reaction Time Task. Kinematic features were compared between groups and classification algorithms were run to distinguish between groups.

Groups were distinguishable based on kinematic features. The autistic group differed from both PD and control groups in speed modulation and sub-movements, and from the PD group in reaction time. Classification algorithms for clinical (autism and PD) versus non-clinical groups, and for autism versus PD, were most accurate when combining kinematic and questionnaire data. There were no kinematic similarities between autism and PD that were also distinct from controls.

Whilst kinematic features did not appear similar between autism and PD, they were informative for group classification. This proof-of-concept study highlights that movement-based metrics may aid in identifying whether someone belongs to a clinical group, and which one - suggesting potential for refining diagnostic approaches for both autism and PD.

Background and Objectives: Oral nicotine pouches (ONPs) are rapidly expanding nicotine products with limited evidence from the Middle East, particularly among young adults. This study assessed the awareness, perceptions, and use of ONPs among university students in Jazan, Saudi Arabia. Materials and Methods: A cross-sectional survey (November 2024-April 2025) used multistage stratified random sampling across six colleges at Jazan University. A self-administered questionnaire captured sociodemographic characteristics, tobacco-use history, ONPs awareness (aided), ever use and current use (past 30 days), and self-reported perceptions items across nine domains. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Among 624 students (mean age = 20.9 ± 1.7 years; 50.5% female), ONPs awareness was 69.7%, ever use 11.5%, and current use 7.5%. Awareness and use were higher among males and other tobacco users (p < 0.001). In multivariable models, male sex predicted awareness, ever use, and current use; rural residence was linked to lower awareness (aOR = 0.67; 95% CI 0.45-0.98), and being a medical student was linked to lower current use (aOR = 0.08; 95% CI 0.003-0.51) Most students perceived ONPs as addictive (80%) and harmful (68%), yet accessible (61%) and attractive (55%). Conclusions: ONPs awareness and use were high, particularly among males and tobacco users. Despite recognizing potential harm, students viewed ONPs as accessible and attractive. Ongoing surveillance, education, and balanced regulation are needed to guide harm-reduction policy and prevent unintended nicotine uptake.

Background/Objectives: Incarcerated people experience high rates of trauma, psychological distress, and social marginalization. Yoga has been introduced in prisons as a trauma-sensitive mind-body practice, yet its rehabilitative contribution remains uncertain. This systematic review aimed to synthesize evidence on the feasibility and effectiveness of yoga interventions delivered in correctional settings. Methods: Following PRISMA guidelines and a preregistered PROSPERO protocol, we searched PubMed, PsycINFO, Cochrane CENTRAL, and Scopus for peer-reviewed publications from May 2012 to November 2025. Eligible studies involved structured yoga interventions for incarcerated populations and reported psychological, behavioral, or institutional outcomes. Two reviewers independently performed screening, data extraction, and quality appraisal using the Mixed-Methods Appraisal Tool (MMAT). Results: Ten studies reported in twelve publications and involving 1815 incarcerated individuals met the inclusion criteria. Interventions included Hatha-based protocols, Krimyoga, trauma-informed approaches, and multicomponent programs. Across randomized, quasi-experimental, and pre-post designs, yoga was feasible and acceptable. Reported benefits included reduced psychological distress, negative affect, anger, and trauma-related symptoms, as well as improved mood, self-regulation, and mindfulness. Evidence specific to women and girls was limited, but the available trauma-informed and gender-responsive studies suggested potential reductions in post-traumatic stress, depression, and anxiety, alongside increases in self-compassion. One large quasi-experimental cohort found lower reincarceration rates among yoga participants, although institutional outcomes were otherwise limited. Evidence was constrained by small samples, heterogeneous intervention formats, short follow-up, and variable outcome measures. Conclusions: Yoga appears to be a promising adjunct to rehabilitation in correctional settings. However, methodological limitations prevent firm conclusions. Larger, well-controlled studies with standardized outcomes and longer follow-up are needed to clarify effectiveness and support integration into correctional health and rehabilitation policy.

We address a critical clinical gap in real-world kidney transplantation (KT), the long-standing disconnect between structured longitudinal follow-up and text-defined clinical rules, which often leads to inconsistent reporting, poor policy compliance, and non-reproducible outcomes across centers. To resolve this, we introduce KT-LLM, a verifiable orchestration layer that bridges sequence modeling with policy and terminology-aware reasoning, tailoring explicitly to KT clinical workflows. KT-LLM ensures clinical decision-making is grounded in authority by constraining knowledge access to Banff kidney allograft pathology references, OPTN, and SRTR policy documents via retrieval-augmented generation. This design anchors answers and computable checklists to versioned sources, enabling full auditability and reducing subjective interpretation errors. The system coordinates three clinically focused, auditable agents: (i) Agent-A (SRTR-MambaSurv): Optimizes discrete-time survival and competing risk prediction from TRF-aligned trajectories via a linear-time inference backbone to personalize follow-up scheduling; (ii) Agent-B (OPTN-BlackClust): identifies clinically distinct population subtypes using stable deep embedded clustering, supporting individualized treatment stratification; (iii) Agent-C (Policy-Ops): encodes OPTN and UNOS submission timelines, SRTR reporting cadence, and Banff terminology into executable rules, returning pass, warn and fail outcomes with versioned evidence to ensure policy compliance. On de-identified OPTN and UNOS cohorts, KT-LLM outperformed strong baselines in evidence attribution and predictive calibration. Critically, it retained the ability to surface clinically distinct subgroups among Black recipients, which aligns with prior reports of outcome heterogeneity, while avoiding overgeneralization of claims beyond the analyzed window. This supports equitable subgroup analysis while avoiding clinical overreach. By anchoring reasoning and outputs to versioned policies and terminology, KT-LLM transforms the model to govern KT workflows into an auditable, clock-synchronized process. This offers a practical solution to enhance reproducibility, monitor fairness across centers and eras, and standardize clinical practice, addressing unmet needs for scalable, reliable KT care in real-world settings.

Preserved ratio impaired spirometry (PRISm) is associated with elevated cardiovascular disease (CVD) risk and progression to COPD, but the underlying mechanisms remain unclear. Frailty is known to worsen outcomes in COPD; however, its role in PRISm has not been well defined. This study examined factors associated with cardiovascular events and mortality in PRISm and developed risk models.

We analyzed 8882 adults (aged 20-79 years) from NHANES 2007-2012, identifying 763 (8.6%) with PRISm (FEV₁/FVC ≥ 0.70 and FEV₁ < 80% predicted). Frailty was assessed using the 23-item laboratory frailty index (FI-LAB; cut-off ≥ 0.23). The primary outcome was all-cause mortality, obtained from linked National Death Index records; the secondary outcome was major adverse cardiovascular events (MACEs: myocardial infarction, stroke, heart failure, or angina), assessed cross-sectionally. LASSO regression and multivariable logistic/Cox models were used to identify variables independently associated with the outcomes, and nomograms were constructed.

PRISm participants had higher frailty prevalence (53.9% vs. 45.5%) and more MACEs (16.2% vs. 6.0%) than those with normal spirometry (both p < 0.0001). Frailty was independently associated with prevalent MACEs (adjusted OR = 18.87, p < 0.001) and was bidirectionally associated with PRISm (OR = 1.40, p < 0.001). Key factors independently associated with MACEs included frailty index, age, sex, anemia, and emphysema (AUC = 0.786). Over 9.9 years, mortality was higher in frail vs. non-frail PRISm individuals (15.2% vs. 7.0%; adjusted HR = 30.66). Frailty severity demonstrated a clear mortality gradient, and a mortality nomogram integrating age and frailty achieved an AUC of 0.81.

Frailty is strongly and independently associated with cardiovascular morbidity and mortality. FI-LAB offers a practical tool for risk stratification and may help guide targeted preventive strategies.

CD73 is a key immunosuppressive ectoenzyme overexpressed in colorectal cancer (CRC), facilitating tumor immune evasion by generating adenosine. While monoclonal antibodies have shown promise, their limited tissue penetration restricts efficacy. Nanobodies, due to their small size and high stability, provide a novel therapeutic platform. This study aimed to design, produce, and functionally evaluate a recombinant anti-CD73 nanobody-based protein capable of stimulating anti-tumor immunity in a tumor cell line.

We engineered heavy-light nanobody (HeLiNa-73), a novel anti-CD73 nanobody, through CDR grafting from the clinical antibody IPH5301 onto a nanobody scaffold. HeLiNa-73 was expressed in E. coli, purified, and characterized for binding affinity, cytotoxicity, and induction of immunogenic cell death (ICD) markers. Functional assays assessed calreticulin (CALR) exposure, HMGB1 release, ATP secretion, apoptosis, and dendritic cell (DC) maturation.

HeLiNa-73 exhibited favorable binding to CD73 and potent cytotoxicity in HT-29 CRC cells (IC₅₀ = 23.99 μg/mL). Treatment markedly increased CALR exposure (12.4 % vs. 1.2 % control, p < 0.05) and HMGB1 release (>10-fold, p < 0.001), though ATP release remained unchanged. HeLiNa-73 significantly promoted apoptosis and enhanced DC maturation, with CD80/CD86 upregulation upon coculture with treated tumor cells.

HeLiNa-73 combines CD73 inhibition with ICD induction, thereby overcoming adenosine-mediated immune suppression while enhancing tumor immunogenicity. These in vitro findings highlight HeLiNa-73 as a next-generation nanobody-based candidate for in vivo chemoresistant CRC studies and to synergize with checkpoint blockade.

Physical activity is widely recognised as effective in preventing and managing non-communicable diseases (NCDs). Digital health innovations can facilitate the delivery of physical exercise programs for this population. Digital therapeutics (DTx) could transform healthcare delivery, including how digital exercise therapy is provided. We aim to perform a scoping review to systematically explore whether and how exercise is provided by DTx for preventing and managing NCDs.

This protocol follows the Joanna Briggs Institute (JBI) methodology for scoping reviews and is reported according to JBI best practice guidance. A comprehensive search strategy will be performed in MEDLINE, CINAHL, Cochrane, PEDro and Google to identify existing DTx for preventing and treating NCDs, and which of those provide exercise therapy as intervention. Key data of the included studies will be charted descriptively and supplemented by summary tables.

This scoping review does not require ethics review and approval. Our target audience for this review will be DTx manufacturers, health policy makers, clinicians, researchers, patients and other relevant stakeholders, in order to highlight gaps and potential of physical exercise provided by DTx. Results will be disseminated through peer-reviewed publications, online platforms and conference presentations.

https://osf.io/fyqt8.

As people live longer after a cancer diagnosis, there is an increasing need to focus on chronic disease state management in the primary care setting. Particular attention to appropriate statin prescribing in cancer survivors is warranted given a heightened risk of atherosclerotic cardiovascular disease (ASCVD). The purpose of this study was to further understand cardiovascular care in cancer survivors by identifying the proportion of cancer survivors with a prescription for appropriate statin therapy and to identify associated factors.

A retrospective cohort study was conducted to identify cancer survivors aged 40-75 years with a diagnosis of breast, lung, colorectal, or lymphatic and hematopoietic cancers cared for within family medicine clinics in a large academic health system. Statin prescriptions were assessed to identify the percentage of statin candidates prescribed a statin based on a diagnosis of ASCVD or type 2 diabetes.

Data from 8763 cancer survivors were included in the final analysis. Among patients with ASCVD, 66% were prescribed a statin. In patients with type 2 diabetes without ASCVD, 58% were prescribed a statin. Female sex was negatively associated with statin prescribing (OR 0.88, 95% CI 0.80-0.97).

Statins are underutilized in cancer survivors, as they are in the general population. This may present an area of health disparity given the heightened risk of ASCVD in cancer survivors. Cancer survivors suffer from a heightened risk of death from CVD. As survivors enjoy longer lifespans after diagnosis, there is a need to optimize cardiometabolic disease state management in this high-risk population.

The incidence of women giving birth at advanced maternal age is increasing. Literature regarding the long-term implications of delivery at advanced maternal age is limited. This study aimed to investigate whether advanced maternal age at first delivery correlates with elevated long-term risk of endocrine morbidities.

This retrospective population-based study included women who gave birth between 1991 and 2021. Participants were categorized by age at first delivery: < 30, 30-35, 35-40, and > 40 years. Women with pre-existing endocrine disorders before pregnancy were excluded. Kaplan-Meier survival curves assessed cumulative incidence of endocrine disorders, while Cox proportional hazards models calculated adjusted hazard ratios (HR), accounting for confounders including fertility treatments, ethnicity, gestational diabetes mellitus, and hypertensive disorders.

A total of 77,746 women were included. Advanced maternal age at first delivery was significantly associated with increased risk for endocrine morbidity, particularly diabetes and hyperlipidemia, both showing a clear age-related progression. No significant differences were observed for thyroid, parathyroid disorders, or obesity. Kaplan-Meier curves showed the highest endocrine morbidity risk among women delivering after age 40 (log-rank p < 0.001). After adjustment, hazard ratios were: 30-35 years aHR 1.29 (95% CI 1.19-1.40, p < 0.001), 35-40 years aHR 1.27 (95% CI 1.10-1.47, p < 0.001), and > 40 years aHR 1.15 (95% CI 0.86-1.54, p = 0.339), compared to women < 30 years.

Advanced maternal age at first delivery is independently associated with an increased risk of long-term endocrine morbidity, particularly diabetes and hyperlipidemia. This graded association underscores the need for long-term follow-up and preventive care in these women.