Dietary guidelines shape food policy, education, and food systems worldwide. Recent controversies in dietary guideline development, together with rising burdens of diet-related chronic disease and increasing environmental pressures, highlight the need for globally relevant dietary guidance aligned with both human and planetary health. We developed an evidence-informed International Food Guide Pyramid emphasizing optimal carbohydrate-containing staple foods. The International Carbohydrate Quality Consortium (ICQC) developed the proposed framework using a four-step evidence-review process involving comparison of major national and regional dietary guideline systems, integration of evidence syntheses and selected primary studies, and expert consensus. Quantitative intake ranges from the EAT-Lancet Commission reference diet informed the relative visual proportions of food groups, while the guiding principles were derived from convergence across dietary guideline systems and complementary evidence syntheses. The resulting pyramid depicts a plant-forward omnivorous dietary pattern supported by epidemiological and clinical evidence indicating benefits for cardiometabolic health and chronic disease prevention. Vegetables, fruits, whole grains, and legumes constitute foundational components of the pyramid. Nuts, seeds, and unsaturated plant oils are emphasized as primary fat sources, while foods high in saturated fat are generally limited. Animal-source foods are included in modest amounts, with plant protein sources emphasized, poultry and fish preferred over red meat, and dairy incorporated in modest amounts, consistent with dietary patterns associated with lower environmental impacts. Carbohydrate quality is emphasized through prioritization of whole-grain foods alongside traditional low-glycemic index grain staples, favoring carbohydrate sources rich in dietary fiber, intact plant cells, and micronutrients while limiting sugars consumed in low-nutrient forms, particularly sugar-sweetened beverages. The framework also accommodates vegan and other primarily plant-based dietary patterns. This evidence-informed International Food Guide Pyramid integrates quantitative modeling and qualitative evidence synthesis to provide a coherent, flexible, and globally adaptable dietary framework aligned with both human and planetary health. STATEMENT OF SIGNIFICANCE: This work presents an evidence-informed International Food Guide Pyramid developed through a structured synthesis of major national and regional dietary guideline systems, quantitative modeling from the EAT-Lancet Commission, and complementary evidence syntheses. By translating areas of convergence across these independent evidence-based sources into a practical visual framework, it provides a globally adaptable approach to dietary guidance that explicitly incorporates carbohydrate quality and both human and planetary health.

Accurately assessing pain remains challenging due to its inherently subjective nature, highlighting the need for normative and objective neural indicators to support pain diagnosis. Using large-scale electroencephalography (EEG) datasets (N = 936), the present study establishes normative values for laser-evoked brain responses (LEP) and develops a predictive model of perceived pain intensity. Three major findings emerged. First, we characterized the typical EEG features elicited by nociceptive laser stimuli and constructed their normative reference ranges using normative modeling. Second, within a linear mixed-effects model framework, subjective pain ratings were reliably predicted by LEP features, each of which demonstrated distinct predictive contributions. Third, multilevel parallel mediation analyses demonstrated that N1, N2, and P2 amplitudes, N2 latency, as well as the magnitude of γ-band event-related synchronization (γ-ERS) serve as key neural mediators linking stimulus intensity to subjective pain perception. Collectively, these results elucidate how different EEG features encode variability in pain perception and provide a normative neurophysiological foundation for future pain research and clinical applications.

Epstein-Barr virus(EBV) is recognized as the principal environmental risk factor for Multiple Sclerosis(MS).Given the distinctive clinical characteristics of Tunisian MS patients, investigating the role of EBV may provide insights into disease heterogeneity and progression.

Evaluate EBV seroprevalence and its association with clinical characteristics in Tunisian patients with MS.

A prospective cross-sectional study was conducted in MS Tunisian patients at the MS center of the Neurology Department,Razi University Hospital.Patients were diagnosed according to the 2017-McDonald criteria.EBV serology was assessed by electrochemiluminescence immunoassay, and its associations with clinical characteristics were analyzed.

A total of 188 MS patients and 42-healthy controls(HC) were included.The mean age at disease onset was 29.8 years.The mean Expanded Disability Status Scale score was 3.49,and the annualized relapse rate was 0.67.EBV serology was positive in 88% of MS patients,while 12% exhibited an atypical EBV profile,compared with 75% EBV seropositivity among HC.VCA-IgG intensity was significantly higher in patients experiencing a relapse at the time of sampling(p = 0.016) and in those with the relapsing-remitting MS phenotype (p = 0.027).Female patients with atypical EBV profiles exhibited lower EDSS scores than seropositive females(p = 0.038).Visual system impairment was more frequent among patients with atypical EBV profiles(40.9%vs. 22.3%,p = 0.048).Significant differences were also observed in cognitive performance, with seropositive patients demonstrating greater impairment across BICAMS,FAB,and Beck Depression Inventory assessments (p < 0.05).

EBV serological markers were associated with disease activity,functional impairment, and cognitive dysfunction in Tunisian patients with MS supporting a potential role for EBV-related immune dysregulation in disease expression.Further molecular studies are needed to clarify their role in disease progression.

Although myoclonus is known to be linked to genetic etiologies, its characterization in conditions associated with pathogenic copy number variation (CNV) remains limited.

This study systematically characterized myoclonus in 22q11.2 microdeletion, the most common pathogenic CNV in humans.

We identified individuals with neurophysiologically confirmed myoclonus from a large cohort of adults with 22q11.2 deletion syndrome (22q11.2DS) assessed between January 1996 and December 2025. We estimated prevalence, and analyzed clinical and neurophysiological features.

Among 295 neurologically assessed patients, 16 of the 42 unrelated individuals with clinically suspected myoclonus had neurophysiological data available for characterization. All 16 met predefined criteria for highly probable cortical myoclonus (minimum observed prevalence: 5.4%; 95% CI 3.4 - 8.6%), with eight meeting criteria for definite cortical myoclonus (minimum observed prevalence: 2.7%, 95% CI 1.4 - 5.3%). In 9 of the 12 patients with available follow-up clinical data, neurophysiological evaluation has led to changes in management.

The findings support cortical myoclonus as a relatively common and clinically actionable movement disorder in 22q11.2DS. As for Parkinson's disease, the results provide preliminary evidence supporting the chromosome 22q11.2 microdeletion as a potential risk-conferring CNV for cortical myoclonus, adding to the genetic heterogeneity associated with this movement disorder.

Negative mental imagery in social anxiety is common and can involve memories of adverse events or catastrophic future anticipations (i.e., "flashforwards"). Laboratory research has shown that such imagery can be modulated by dual-tasking interventions, which is used in Eye Movement Desensitization and Reprocessing (EMDR) therapy.

Using a replicated sequential single-case experimental design, we examined whether EMDR therapy for flashforwards reduces social anxiety and avoidance of fear-related situations, relative to baseline, in eight individuals with social anxiety disorder. Participants were recruited from a specialized treatment center after unsuccessful CBT or because of treatment complexity (e.g., comorbidity) and were randomly assigned to varying baseline durations before EMDR therapy. Outcome variables were daily social anxiety and avoidance. Randomization tests were conducted for each case separately to test whether EMDR therapy compared to a baseline phase resulted in less daily 1) social anxiety and 2) social avoidance for individual participants and for the total sample.

The preregistered randomization tests did not show statistically significant between-phase differences in daily social anxiety, daily social avoidance, or weekly social anxiety severity. Exploratory, unplanned permutation distancing tests, conducted to examine the possible influence of serial dependency, indicated lower scores during the intervention phase across all three outcomes. At the individual level, these exploratory analyses indicated reductions in daily social anxiety for six participants, in daily social avoidance for three participants, and in weekly social anxiety severity for five participants. Aggregated effect-size estimates were medium for daily social anxiety, small for daily social avoidance, and small to medium for weekly social anxiety severity.

Limitations include modest serial dependency, absence of an active treatment control condition, absence of long-term follow-up measurements, and inclusion of one participant without a clearly identifiable flashforward, although treatment adhered to the prespecified Stage 1 treatment protocol.

The preregistered analyses did not provide confirmatory evidence that EMDR therapy for flashforwards reduced social anxiety or avoidance. However, the descriptive findings, effect-size estimates, and exploratory analyses showed a pattern consistent with possible reductions in social anxiety, while findings for avoidance were weaker and less consistent. These results should be considered hypothesis-generating and require confirmation in adequately powered controlled studies. TRIAL REGISTRATION PRE-REGISTRATION: https://osf.io/f9hw8/?view_only=dec61cab812d4093bf98842eec7cefd6.

A mother's childhood traumatic events (CTEs) and stressful life events (SLEs) during pregnancy independently have been associated with offspring wheeze and asthma. However, their combined influence on childhood airway outcomes, including lung function, remains unclear.

Participants included 341 mother-child dyads from The Infant Development and the Environment Study. Mothers retrospectively reported CTEs and SLEs. At age 12, children completed spirometry and respiratory questionnaires. We estimated risk ratios for ever asthma, ever wheeze, and wheeze in the last 12 months, and linear regression coefficients for FEV₁/FVC and FEF_25-75. Models included CTEs and SLEs simultaneously and CTE × SLE and stress×sex interactions.

CTEs and SLEs were not individually associated with ever wheeze (RR = 1.27 [0.98-1.64] and 1.04 [0.91-1.20], respectively), wheeze in the last 12 months (RR = 1.00 [0.56-1.76] and 1.17 [0.98-1.39], respectively), or ever asthma (RR = 0.99 [0.71-1.39] and 1.15 [1.00 to 1.32], respectively). An antagonistic interaction was observed for ever wheeze (p = 0.03) and wheeze in the last 12 months (p = 0.04) with the greatest risk among those with either high stress or trauma measures during childhood (CTE) or pregnancy (SLE), but not both. Neither exposure was associated with lung function, and no interactions by sex were observed.

Maternal childhood trauma and prenatal stress independently were not associated with airway outcomes at age 12. An antagonistic interaction of stress during both periods suggests that mismatches in stress exposures across maternal life stages may shape offspring respiratory health. Given small event counts and limited adversity range, replication is needed before clinical implications can be drawn.

Depression is a common mental illness worldwide and has a bidirectional relationship with cardiovascular disease. However, research on the link between adolescent depression and cardiac structure/function remains limited and partly controversial. This study aims to investigate whether depression and its severity affect cardiac structure and function in adolescents.

We enrolled 181 adolescents aged 13-19, newly diagnosed with depression at our Mental Health Center (December 2024-December 2025), and 45 healthy controls. Conventional echocardiography and two-dimensional speckle-tracking (2D- STE) assessed cardiac anatomy, systolic/diastolic function, and strain parameters. Differences between groups and correlations with depression severity were analyzed.

The depression group showed significant differences in left ventricular ejection fraction (LVEF), left ventricular fractional shortening (FS), and left ventricular end-systolic volume (LVESV) compared to controls (all p < 0.05). LVEF, FS, tricuspid annular systolic velocity (S'), E/e' ratio, and left atrial strain all correlated with depression severity (all p < 0.05). The S' values in the mild depression group were significantly higher than those in the control group, as well as those in the moderate and severe depression groups (p < 0.05). E/e' was higher in moderate depression than in mild and severe cases (p < 0.05).

Adolescents who are depressed may see changes in heart contractile function at an early period. In patients with depression, echocardiography provides a non-invasive examination of heart structure and function. It provides an image reference for real-time clinical monitoring and risk prediction by performing objective analysis using quantitative parameters.

Parent-child conflicts are implicated in adolescents' suicide risk, while positive parent-child interactions appear protective. Understanding how adolescents at elevated risk respond to parent-child interactions could inform suicide prevention. Parent-child contexts provoke intricately patterned, parasympathetic and sympathetic autonomic responses, which are thought to facilitate situationally appropriate self-regulation but may be maladaptive when atypical. Examining interactions of baseline and task-related autonomic components has promise for identifying clinically relevant response profiles.

Participants were clinically referred adolescents (N = 162; M_age=12.03 yrs; 47% female; 60% minoritized race/ethnicity). Over half (61%; n = 99) were considered at elevated suicide risk based on suicide/self-harm thoughts/behaviors on any measure (self-report, interview, ecological momentary assessment). Adolescents completed three parent-child interaction tasks with differing self-regulation demands: a conflict discussion, a positive discussion, and a reading challenge. Autonomic responses were measured using respiratory sinus arrhythmia (RSA), cardiac pre-ejection period (PEP), and skin conductance level (SCL). Multivariate logistic regressions for each parent-child context predicted suicide risk status using task-related change in all autonomic indices in the context of (i.e., as moderated by) baseline autonomic activity.

Elevated suicide risk status was associated with context-specific, sympathetic patterns: pronounced threat-like (PEP) response to the conflict discussion, pronounced disengagement-like (SCL) response to the positive discussion, and an amotivation-like (PEP) response to the reading challenge. Results were independent of subjective affect covariates.

Autonomic dysregulation may help explain suicide risk. Findings are consistent with interpersonal suicide theories and may help pinpoint contextually bound interpersonal affective processes associated with youths' suicide risk.

The evolution of blood glucose assays reflects the constant progress in laboratory medicine toward increasing analytical precision, serving both diagnosis and patient management. While pioneering, early chemical methods had significant limitations in terms of specificity and reproducibility. Their gradual replacement by enzymatic techniques, particularly those based on glucose oxidase and later on hexokinase, represented a major advance, improving the reliability, sensitivity, and standardization of assays. These developments led to the establishment of internationally recognized reference values and diagnostic thresholds. However, the question of their comparability with the analytical methods currently used in laboratories remains. In this context, this review aims to trace the historical evolution of blood glucose assays and their associated reference values. This involves addressing, on the one hand, reference values according to sampling conditions (fasting, postprandial, oral glucose tolerance test), and on the other hand, diagnostic thresholds for diabetes mellitus. These values are based on recommendations from international scientific organizations, such as the World Health Organization and the American Diabetes Association.

In developing countries, cardiovascular disease is a major health burden, and there has been a rapid increase in the incidence of acute coronary syndrome (ACS) in the elderly population. Despite this, there are only limited studies or data available regarding the outcomes of ACS in elderly patients. Hence, this study focused on the management of ACS in the elderly treated conservatively and invasively.

This longitudinal study was conducted at a tertiary care center in Kerala, India, involving 64 geriatric patients (aged 60 years and above) newly diagnosed with ACS. Subjects were recruited via convenience sampling and divided equally into invasive (percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG); n = 32) and non-invasive/conservative treatment (n = 32) groups. Functional status was evaluated at initial admission, one month, and six months using the validated 7-item Seattle Angina Questionnaire (SAQ-7), which evaluates physical limitation, angina frequency, quality of life, and summary scores.

At six months of follow-up, invasively treated patients had significantly better functional status in all domains compared to non-invasive patients (p = 0.001 for all domains). Systemic hypertension was present in 37 patients and was significantly associated with a poorer functional status summary score at six months (p = 0.001). No significant clear associations were noted for diabetes mellitus or dyslipidemia with a functional decline.

Geriatric patients presenting with ACS achieve substantially better functional capacity, reduced angina frequency, and superior health-related quality of life when managed with an invasive strategy compared to a conservative approach. Systemic hypertension acts as an independent risk factor for functional status decline.