Cardiovascular–kidney–metabolic (CKM) syndrome is driven by the interplay of visceral adiposity, insulin resistance, chronic inflammation, oxidative stress, and progressive kidney dysfunction. These mechanisms generate a distinct atherogenic dyslipidaemic phenotype characterised by elevated triglycerides (TG), reduced high-density lipoprotein-cholesterol (HDL-C), increased apolipoprotein B (apoB)-containing lipoproteins, remnant cholesterol (RC) accumulation, small dense low-density lipoprotein (LDL) particles, and frequently elevated lipoprotein(a) [Lp(a)]. Such lipid abnormalities contribute to accelerated atherosclerosis and early renal deterioration. In turn, kidney dysfunction further amplifies lipid abnormalities. These pathways underscore the need for a timely and comprehensive lipid assessment using apoB, non-HDL-C, RC, and Lp(a) within the CKM framework. Effective lipid management is crucial for CKM syndrome treatment, with the potential to reduce residual cardiovascular and renal risk and improve long-term clinical outcomes. In this narrative review, we examine current evidence on the pathophysiological mechanisms underlying CKM-related dyslipidaemia and provide a practical framework for its assessment and management. Management requires a multimodal approach tailored to the patient’s lipid phenotype and overall cardiovascular risk, incorporating a range of lipid-lowering strategies including statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, fibrates, icosapent ethyl, and emerging therapies targeting apoC-III, ANGPTL3, and Lp(a). Beyond lipid lowering, lifestyle interventions and cardiometabolic therapies such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and finerenone may provide complementary cardiometabolic and renal protection.

The composition of the growing medium is a key factor in the long-term functionality of green roofs, and in recent years, increasing attention has been paid to the use of biochar and other recycled organic materials. The use of biochar in green roof substrates represents an innovative way to improve their hydrological and nutritional properties in accordance with the principles of the circular economy. As part of this study, we incorporated 8.2% organic additives into the experimental substrates, including dried sewage sludge, biochar derived from sewage sludge, food waste biochar, wood biochar, and sewage sludge compost. The main hypothesis was that these additives would induce significant changes in the physicochemical properties of the substrate, nutrient content, and heavy metal concentrations, affecting plant growth. The study involved a three-year monitoring of six modules planted with a mixture of twelve Sedum species. The results showed that dried sewage sludge, food waste biochar, and sludge compost had a highly positive effect on vegetation growth, with coverage significantly higher compared to the control sample. The highest average coverage of plants (89%) was achieved by the substrate with dried sewage sludge due to its high content of available nitrogen and phosphorus. Wood biochar exhibited higher soil moisture content (mean 21.28%) and its stability throughout the year, but without a significant positive effect on plant growth. Dried sewage sludge applications improved soil quality the best with increase in the availability of essential nutrients NPK (an 87% increase compared to the control module). Several heavy metals (notably Cd, Cr, Zn, and Hg) exceeded regulatory thresholds, indicating a potential environmental risk that requires further investigation, particularly with respect to long-term accumulation and leaching.

Background: Dementia represents a major global public health challenge in aging populations, requiring effective primary care identification and prevention strategies. This study evaluated the prevalence and clinical significance of 11 modifiable risk factors among older adults within a primary healthcare setting. Methods: An observational, retrospective-analytical study was conducted in January 2025 within a family medicine team panel (N = 1122). Participants aged 65 and older were divided into two cohorts: patients with diagnosed dementia (n = 20) and a comparative group without dementia (n = 50). Data on 11 modifiable risk factors were extracted using medical records and clinical anamnesis. Continuous variables were analyzed using Student’s independent samples t-test, while categorical variables were evaluated using Pearson’s chi-square test or Fisher’s exact test (p < 0.05). Results: Patients with dementia were significantly older (85.50 ± 4.83 vs. 80.34 ± 4.10 years; p < 0.05). Lower educational level was frequent among dementia patients, with 55% (n = 11) having completed primary education compared to 32% (n = 16) in controls (p = 0.160). Obesity (BMI > 30 kg/m²) was significantly less frequent in the dementia group (5%, n = 1 vs. 48%, n = 24; p < 0.05). Arterial hypertension showed a lower prevalence in dementia patients (85%, n = 17 vs. 98%, n = 49; p = 0.038). Hearing impairment was present in all participants (100%). In late life, physical inactivity (90%, n = 18 vs. 74%, n = 37; p = 0.141), social isolation (60%, n = 12 vs. 66%, n = 33; p = 0.636), and depression (55%, n = 11 vs. 64%, n = 32; p = 0.485) showed high overall prevalence across both cohorts without statistically significant group differences. Conclusion: Modifiable risk factors for dementia are highly prevalent among geriatric primary care patients, representing a widespread cumulative burden. Early identification and systematic screening in family medicine are essential to optimize cognitive health management.

Cell therapies are increasingly manufactured in closed, automated culture systems, yet decisions about cell quality, safety, and release still rely largely on sparsely executed, destructive, and offline assays. Over the past 5 years, significant progress has been made in developing biosensors capable of real-time measurement of key biochemical and physicochemical indicators including metabolites, ionic species, and protein-associated stress indicators within cell culture environments. However, most systems remain disconnected from manufacturing workflows and fail to support actionable process control. This opinion article discusses the next phase of innovation and the need to reposition biosensors as process analytical technology, shifting the field from descriptive monitoring toward integrated, decision-driven control of cell therapy manufacturing.

The development of grade-level or age-level reading proficiency continues to be a challenge for a number of d/Deaf and hard of hearing (d/Dhh) children and adolescents. There have also been ongoing research debates on recommending evidence-based or effective practices to facilitate the acquisition of reading skills. These debates are fueled, in part, by the major principles of three broad frameworks: Paul’s Qualitative Similarity Hypothesis, Marschark’s Cognitive “Qualitative Difference” Hypothesis, and Mayberry’s L1-Timing Hypothesis. These frameworks highlight the tension between developmental similarity (continuity) and emerging neurocognitive reading research on d/Dhh individuals. The present commentary discusses the three frameworks, highlighting strengths and criticisms as well as similarities and differences, and concludes with a proposed integrative perspective with implications for classroom practices. This integration provides recommendations for further research, necessary for improving the reading levels of d/Deaf and hard of hearing students.

CardioPharmaGENET COST Action network aims to advance personalized medicine in cardiovascular care by leveraging pharmacogenomics (PGx) to optimize drug therapies. In cardiovascular medicine, this approach is especially critical, given the significant patient variability in drug responses to therapies. The main goal is to establish a pan-European network that addresses several key challenges that hinder the widespread adoption of PGx in cardiovascular care. These challenges include the lack of a centralized knowledge hub for clinicians and policymakers, insufficient integration of PGx into clinical practice, and inconsistent policy frameworks across Europe. The project also seeks to utilize AI and machine learning to streamline the analysis of large-scale genomic data and enhance clinical decision-making. The network includes five working groups (WG) to tackle these issues: WG1 evaluates the current landscape of cardiovascular PGx, identifying key gaps in research, clinical integration, and available resources; WG2 develops optimized guidelines for applying PGx in cardiovascular therapies, focusing on patient stratification based on genetic and demographic profiles; WG3 focuses on advancing digital and AI tools to improve PGx data analysis and implementation in clinical settings; WG4 analyzes regulatory frameworks across Europe, proposing policy changes to facilitate seamless integration of PGx into healthcare systems; WG5 handles communication, dissemination, and stakeholder engagement, ensuring that findings and guidelines are accessible to all stakeholders, including clinicians, researchers, and policymakers. By addressing these challenges, the network will help bridge the gap between PGx research and clinical practice, improving cardiovascular patient outcomes and promoting equitable healthcare access across Europe. This manuscript represents the COST Association-approved Memorandum of Understanding of COST Action CA24165 CardioPharmaGENET.

Summary Background Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among non-smokers. This study presents the first dedicated Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) publication to systematically quantify SHS prevalence and evaluate its effect as a global risk factor across a broader range of outcomes. Methods Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence and attributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposure estimates were derived by synthesising population-based surveys and household composition data through spatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, were estimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjusted life-years (DALYs). Findings In 2023, an estimated 2·71 billion (95% UI 2·44–3·02) people worldwide were exposed to SHS, including 767 million (687–858) children aged 0–14 years. Age-standardised prevalence was highest in southeast Asia, east Asia, and Oceania (48·4% [44·0–53·4]), with female individuals in some countries experiencing nearly 1·8 times the exposure prevalence of male individuals. Despite a 22·2% (10·6–32·4) decline in global age-standardised prevalence since 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which has remained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0–144·4] increase) and North Africa and the Middle East (72·1% [47·8–101·8] increase). In 2023, SHS exposure accounted for 1·66 million (1·33–2·07) deaths and 44·8 million (35·8–54·3) DALYs globally. Ischaemic heart disease was the leading contributor to SHS-attributable DALYs (12·0 million [9·31–15·2]) overall, while lower respiratory infections predominated among children (5·16 million [3·48–7·12]). Interpretation We estimated that SHS remains a substantial driver of global health loss, particularly through cardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbers of exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcement of comprehensive tobacco control measures, particularly to protect women and children in both public and domestic environments. Funding Bloomberg Philanthropies and the Gates Foundation.

Simple Summary This paper presents a narrative review of the legal and policy framework for the use of animals in scientific procedures in Bosnia and Herzegovina, focusing on the 3Rs principles (Replacement, Reduction, Refinement). Although the country has made progress in aligning its laws with European standards, important gaps remain in practice, including limited national coordination, lack of detailed guidance, insufficient training, and limited support for alternative methods that do not use animals. The review highlights the need for stronger coordination, clearer rules, better training, and more investment in alternative methods to improve animal welfare and research quality. It also discusses policy options, such as enhanced regional cooperation and a potential joint centre to promote humane and modern research methods, which could help Bosnia and Herzegovina and neighbouring countries move closer to European standards. Overall, improving the ethical use of animals in research is important not only for animal protection, but also for scientific quality, reproducibility, and public trust.

A discrete, anomaly-free $\mathbb Z_9$ gauge symmetry may persist to the deep infrared, exactly forbidding proton decay. This $\mathbb Z_9$ can emerge from Higgsing a lepton-flavour non-universal $U(1)_X$ that generates realistic neutrino masses and mixings through a high-scale seesaw and predicts an additional light Goldstone. Adding an anomaly-free chiral heavy-quark sector turns this mode into the QCD axion. The same selection rules that ban proton decay also forbid PQ-violating operators below a suitably high dimension, $d_{\rm PQ}\gtrsim10$, including operators involving the heavy quarks that radiatively match onto the scalar potential. We construct explicit models viable when PQ breaking occurs before or after inflation; in the latter case, avoiding stable heavy relics and eliminating the string-wall network tightly constrain the heavy-quark spectrum. We identify restricted regions of parameter space where thermal leptogenesis remains viable and, for $d_{\rm PQ}\geq13$, can coexist with a high-quality axion constituting all of the dark matter.

Objective. To analyze the ethical, psychological, and social dimensions of contemporary aesthetic surgery, with particular emphasis on empathy in clinical decision-making, patient autonomy, body image disturbance, and the risks associated with unregulated practice. Narrative review. This manuscript is based on a qualitative narrative review of the literature in plastic surgery, bioethics, psychology, and public health, including professional guidance documents and selected epidemiological reports. Available evidence was examined through the core principles of medical ethics: beneficence, non-maleficence, autonomy, and justice. Aesthetic surgery increasingly operates at the intersection of medicine, consumer culture, and digitally mediated beauty ideals. The literature indicates that requests for aesthetic procedures may be shaped by social media exposure, unrealistic expectations, and, in some patients, body dysmorphic disorder or other psychological vulnerabilities. Ethical practice, therefore, requires empathic communication, careful assessment of indications, and willingness to decline procedures that are unlikely to benefit the patient. The growing presence of unlicensed providers further underlines the need for stronger regulation and public education. Conclusion. Aesthetic surgery should remain grounded in medical professionalism, with empathic ethical judgment, psychological vigilance, and patient safety at the center of care.

Background: Obesity is associated with impaired health-related quality of life, including reduced sexual satisfaction. Metabolic and bariatric surgery leads to substantial weight loss and favorable changes in body composition; however, its association with sexual satisfaction as a health-related outcome remains insufficiently explored. The aim of this study was to examine changes in body composition and sexual satisfaction six months following metabolic and bariatric surgery. Methods: This prospective study included 40 women with obesity who underwent metabolic and bariatric surgery performed according to standard clinical indications and multidisciplinary team recommendations. Body composition parameters were assessed using bioelectrical impedance analysis, and sexual satisfaction was evaluated using the New Sexual Satisfaction Scale at baseline and six months postoperatively. Changes in anthropometric, body composition, and sexual satisfaction measures were analyzed using nonparametric statistical tests. Results: Six months after surgery, significant changes were observed in body composition and sexual satisfaction. Median body weight decreased from 119.55 to 100.80 kg, BMI from 42.15 to 35.65 kg/m2, and visceral fat level from 14.50 to 11.00 (all p < 0.001). Although absolute skeletal muscle mass decreased significantly (28.40 to 26.30 kg, p < 0.001), its relative proportion increased (25.35% to 25.90%, p = 0.002). Median total NSSS score increased from 62.50 to 69.50, with significant improvements in both NSSS subscales (all p < 0.001). Conclusions: Metabolic and bariatric surgery was associated with significant improvements in body composition and sexual satisfaction six months postoperatively. These findings suggest that improvements in physical health following metabolic and bariatric surgery may be accompanied by enhancements in sexual well-being.

Emergency procedures are an important domain for safety education. Modern multimedia technologies aim to aid this process by replacing real‐life drills and hazard procedures with virtual simulations. However, there is a limited amount of existing research on this topic, especially focusing on the Western Balkans region. This paper presents a 3D virtual learning environment for emergency procedures in the form of a serious game. The virtual user manual uses the 2D fire evacuation plan of a university building in Ohrid, North Macedonia, for teaching civilians about multiple emergency procedures emergency exits, fire alarms, fire extinguishers, and wall hydrants. A case study was performed on 90 participants from Bosnia and Herzegovina and North Macedonia. Four different scenarios of interest were utilized, general knowledge about emergency procedures, emergency exit simulation, virtual user manual simulation, and emergency procedures involving a cultural heritage site. The achieved results indicate that participants are open to the usage of modern multimedia technologies, that familiarity with the presented location affects the success of learning, and that there is a strong potential for successful usage of virtual user manuals in the region of the Western Balkans in the future.

Abstract Background: The total number of platelets (PLT), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) are utilized as markers of platelet activation in assessing thrombotic vascular events. Given the critical importance of maintaining adequate vascular access, i.e., arteriovenous (AV) fistula, for the survival of hemodialysis (HD) patients, the question arises: Is it possible to detect changes in platelet parameters that indicate a connection to occurrences of thrombotic complications with AV fistula? Materials and methods: The study involved 100 patients diagnosed with end-stace renal disease, admitted to the Clinic of Hemodialysis at the University Clinical Center Sarajevo (UCCS). All patients underwent standard bicarbonate HD three times a week, utilizing a native AV fistula for access. The study group was divided into two subgroups: patients without confirmed AV fistula thmmbosis (AVF-nonT; n = 66) and patients with confirmed AV fistula thrombosis (AVF-T; n = 34). Anamnestic data and platelet parameter values were collected during the surveyed period. Results: The average value of the PLT was significantly lower (p = 0.001), while the average value of the MPV was significantly higher (p = 0.0001) in patients of the AVF-T group in relation to the patients in the AVF-nonT group. In differentiating patients of the AVF-T group and patients of the AVF-nonT group, PLT in peripheral blood had a moderately good diagnostic accuracy (AUC = 0.704; p = 0.001), and MPV had an excellent diagnostic accuracy (AUC = 0.991; p < 0.001). Conclusion: PLT and MPV can be used as effective biomarkers ofAV fistula thrombosis in patients undergoing chronic HD treatment.