The rapid evolution of Padel in Saudi Arabia (SA) has positioned the sport as a popular recreational and social activity, mainly among young adults. However, limited research has examined how different forms of sport motivation are associated with mental health outcomes in this emerging context. Drawing on Self-Determination Theory (SDT), this study investigated the associations between intrinsic and extrinsic motivation and depression, stress, and anxiety among Padel players in SA. A quantitative, cross-sectional online survey was conducted with a sample of 475 players, the majority of whom were aged 17-35 and held at least a bachelor's degree. Data were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM) to evaluate the relationships between multidimensional motivation factors and mental health symptoms. The findings revealed a nuanced, at times paradoxical, pattern of relationships. Intrinsic motivation to experience stimulation (engaging in an activity because of the positive sensations, excitement, enjoyment, or stimulation that the activity itself provides, rather than for external rewards or pressures) was consistently associated with lower levels of depression, stress, and anxiety, suggesting that enjoyment-driven involvement is associated with better mental health outcomes. In contrast, intrinsic motivation to accomplish was positively correlated with all three mental health indicators, indicating that achievement-oriented engagement might intensify emotional pressure. Among extrinsic motivations, external regulation was significantly associated with poorer mental health outcomes. In contrast, introjected regulation unexpectedly displayed a negative association with psychological distress, demonstrating a potentially adaptive role in this setting. Identified regulation, however, was not significantly associated with any mental health symptoms. These results underscore the "double-edged" nature of sport motivation, showing that not all internal or external motives yield uniformly positive consequences. The study contributed to the growing literature by providing a context-specific understanding of how motivational dynamics function within a rapidly growing sport in Saudi Arabia. In practice, the findings suggested that enjoyment-based involvement was associated with more favourable mental health outcomes, whereas performance-related pressures might be associated with less favourable outcomes.

Background: Competitive esports represents a rapidly developing digital performance environment in which players must regulate attention, affect, psychophysiological activation, and performance under dynamic, high-demand conditions. Although cognitive overload and related states are increasingly relevant to esports research, these constructs have not been consistently defined, operationalized, or measured. Objective: This scoping review aimed to map empirical evidence on cognitive overload and related states in competitive esports, with emphasis on cognitive demands, psychophysiological and neurophysiological markers, coping and recovery approaches, game genres, and performance outcomes. Methods: The review followed Joanna Briggs Institute guidance and PRISMA-ScR reporting principles. Searches were conducted in Scopus, PubMed, Web of Science, and EBSCOhost on 5 May 2026. Eligible studies were peer-reviewed empirical articles involving ranked, collegiate, semi-professional, professional, elite, or otherwise competitive esports players and included at least one objective or semi-objective indicator relevant to overload-related states. Results: Forty-eight studies were included. Evidence was distributed across in-game performance, stress and arousal, cardiometabolic load, mental workload, sleep and recovery, perceptual-cognitive processing, neurophysiological markers, and intervention-oriented approaches. Heart rate (HR), heart rate variability (HRV), eye-tracking, sleep or wearable measures, electroencephalography (EEG), event-related potential (ERP), cortisol, pupil diameter, electrodermal activity (EDA), cognitive tasks, and in-game metrics were used across the literature. However, these measures were rarely integrated into unified, multimodal models. Conclusions: Cognitive overload in esports is best understood as a dynamic, multidimensional state emerging from interactions between game demands, competitive context, player regulation, and performance consequences. Future research should develop genre-sensitive, multimodal, and time-synchronized models that distinguish workload, stress, fatigue, arousal, tilt, and performance decline.

Background: The transition to motherhood represents a critical life phase marked by profound biological, psychological and social changes. During this period, women's nutritional practices are shaped not only by physiological needs but also by shifting identities, caregiving responsibilities and social expectations. Although nutrition during pregnancy and the postpartum period has been widely studied from a biomedical perspective, less attention has been paid to how women experience, negotiate and attribute meaning to food during the transition to motherhood. Objective: This systematic qualitative review aimed to synthesise existing qualitative evidence on women's experiences of nutritional practices during the transition to motherhood, with particular attention to food as self-care, control, autonomy, identity formation and mental well-being. Methods: A systematic search of electronic databases was conducted to identify qualitative studies exploring women's experiences of nutrition during pregnancy and early motherhood. Eligible studies employed qualitative methodologies such as interviews, focus groups or ethnographic approaches. Study selection followed PRISMA guidelines. Methodological quality was appraised using established qualitative appraisal tools. A thematic synthesis approach was used to integrate findings across studies. Results: The synthesis identified several interrelated themes: nutrition as a form of self-care and emotional regulation; loss of autonomy and heightened moral surveillance around food choices; food practices as a means of performing and negotiating "good motherhood"; and the emotional burden of dietary expectations in relation to mental health and identity. Women described navigating competing demands between their own nutritional needs and those of their infants, often within contexts of social judgement and limited support. Conclusions: Nutritional practices during the transition to motherhood extend beyond health behaviours and are deeply embedded in issues of identity, autonomy and care. Recognising the social and emotional dimensions of maternal nutrition may inform more holistic, woman-centred approaches to nutritional guidance and maternal health support.

Objective: To explore the relationship between long-term exposure to atmospheric ozone (O₃) and adolescent depressive mood, and provide baseline data for the prevention of depression in adolescents and mental health interventions in schools. Methods: Daily environmental pollutant and meteorological data were collected from Inner Mongolia Autonomous Region between 2023 and 2024. A total of 83 601 adolescents from 12 leagues (103 banners/counties/districts) in the region were selected by using stratified random cluster sampling. Depressive symptoms were measured by using the Center for Epidemiologic Studies Depression Scale. A multivariate logistic regression analysis model was used to evaluate the association between O₃ exposure and the prevalence of depression. Results: A total of 83 601 adolescents were surveyed, with a depression detection rate of 18.4% (15 356 individuals). There was a significant association between long-term O₃ exposure and the risk for depression in adolescents. The annual average concentration of O₃ one year prior to the survey showed the greatest effect, with every 10 μg/m³ increase in O₃ exposure associated with a 15% rise in depression risk (OR=1.15, 95%CI:1.10-1.21). Stratified analysis revealed that the following subgroups had significant higher risks for depression:girls (OR=1.36, 95%CI:1.25-1.49), junior high school students (OR=1.39, 95%CI:1.27-1.52), those whose mother's had educational attainment at and above university or college level (OR=1.35, 95%CI:1.15-1.58), and those whose father had educational attainment at or below the primary school level (OR=1.41, 95%CI:1.21-1.65), non-only children (OR=1.28, 95%CI:1.18-1.39), those with parents suffering from chronic diseases (OR=1.26, 95%CI:1.13-1.41), students without personal health conditions (OR=1.27, 95%CI:1.17-1.36), those who had experienced harm (OR=1.42, 95%CI:1.15-1.75), those satisfied with life (OR=1.37, 95%CI:1.20-1.57), participants reporting moderate stress (OR=1.35, 95%CI:1.21-1.50), individuals with daily internet use exceeding 4 hours (OR=1.26, 95%CI:1.06-1.49), members of large families (OR=1.47, 95%CI:1.24-1.74), and residents of the eastern region (OR=1.67, 95%CI:1.50-1.86). The results of the sensitivity analysis model remained relatively stable, indicating that O₃ has an independent effect on the risk of depression onset. Conclusion: There is a statistically significant association between long-term O₃ exposure and the risk of depression in adolescents, which warrants more attention.

Inborn errors of immunity (IEI) are monogenic disorders of the immune system that lead to immunodeficiency, autoimmunity, autoinflammation, allergy, and/or cancer. This review provides a comparative review of the epidemiology, clinical manifestations, and management of IEI in China. While individual forms of IEI are generally rare disorders globally, collectively they represent a significant disease burden. China has recently made great strides in the diagnosis and treatment of IEIs with the increasing utility of next-generation sequencing and the availability of hematopoietic stem cell transplantation. Challenges remain in the establishment of national registry databases comparable to the European Society for Immunodeficiencies and The United States Immunodeficiency Network. Also, the absence of a national newborn screening program for severe combined immunodeficiency poses risks regarding live attenuated vaccination in undiagnosed infants. Current access to treatment including subcutaneous immunoglobulin, targeted molecular therapies, and commercialized gene therapy remains limited in China. Nevertheless, the therapeutic landscape is rapidly evolving, marked by an increasing clinical application of precision molecular-targeted treatments and the emergence of AI-empowered gene editing therapies. Ultimately, advancing the field of IEI necessitates global collaboration, integrating the complementary strengths of both regions to establish scientific breakthroughs and clinical innovation.

Diabetes mellitus impairs bone metabolism through chronic hyperglycemia, oxidative stress, and inflammation, leading to reduced osteoblast activity and downregulation of key pluripotency genes such as Octamer-binding transcription factor 4 (OCT4), Nanog homeobox (NANOG), SRY-box transcription factor 2 (SOX2), and Reduced expression protein 1 (REX1).The present study investigated whether the timing of aerobic exercise (morning vs. evening) influences the expression of pluripotency genes in the bone tissue of diabetic mice.

Eighteen male NMRI mice were assigned to healthy control, diabetic control, or diabetic exercise groups. Diabetes was induced using a high-fat diet combined with low-dose streptozotocin. Aerobic training was performed for eight weeks at either ZT3 (morning) or ZT15 (evening), five sessions per week, at 50-60% Vmax. Blood glucose, insulin, HOMA-IR, and maximum running speed were assessed, and gene expression in bone tissue was measured using qRT-PCR. Data were analyzed using one-way ANOVA with Tukey post hoc testing (p < 0.05).

Diabetic mice exhibited significant increases in glucose, insulin, and HOMA-IR, along with marked reductions in pluripotency gene expression, particularly at ZT3. Aerobic exercise significantly improved metabolic parameters and partially restored gene expression, with the greatest enhancement observed at ZT15. SOX2 and REX1 showed the most robust recovery under evening training conditions.

The findings indicate that circadian timing modulates the beneficial effects of aerobic exercise on pluripotency gene expression in diabetic bone tissue. Evening exercise (ZT15) exerts superior restorative effects, suggesting that chronobiology aligned training may serve as an effective strategy for improving bone regenerative potential in diabetes.

The unequal distribution of resources in society generates social gradients that translate into health inequalities and differential use of health care resources and their costs. Non-medical factors such as employment, income, ethnicity and education impact the prevalence and treatment outcomes of patients with type 2 diabetes mellitus (T2DM); however, there is a scarcity of articles assessing the relationship between health inequalities and the economic costs of treatment. Therefore, we conducted a systematic review of published studies examining the cost differences of treating T2DM across social determinants of health (SDH).

We systematically searched MEDLINE, Embase, PsycINFO, EconLit, and NHS EED for original peer-reviewed articles that provided cost differences of treating T2DM by SDH: education, income, employment, residency and ethnicity. We grouped the studies by each SDH and calculated the percentage differences where possible between the lowest and highest ends of the gradient (education, income and employment). Residency was categorised as rural vs. urban and ethnicity as white or general population vs other ethnic minorities.

We included 19 articles retrieved internationally from varying healthcare systems. Results were contextualised given the healthcare financing model. In countries with high out-of-pocket expenses, Black and Hispanic ethnic backgrounds and rural residence were associated with lower direct health care and costs likely to be determined by ability to pay rather than clinical need. Indirect costs such as lost productivity due to absenteeism were also lower in unemployed, and lower income groups.

There are evident health disparities in the direct and indirect economic consequences of T2DM. The effect of decreased healthcare use and costs on treatment outcomes needs to be further explored to inform policies to ensure healthcare delivery is based on clinical need rather than socio-economic factors.

Diabetes mellitus complicated with osteoporosis requires coordinated management of metabolic control, bone health, psychological status, and social support. This retrospective clinical study evaluated a symptom-psychology-society three-dimensional nursing intervention for patients with diabetes complicated by osteoporosis. A retrospective evaluation was conducted in 132 patients with diabetes complicated by osteoporosis. Patients were categorized according to the nursing pathway documented in medical and nursing records: routine nursing or a three-dimensional intervention. The intervention consisted of three sequential components. First, symptom management included individualized glucose monitoring, medication-adherence support, dietary and exercise guidance, calcium and vitamin D supplementation guidance, and osteoporosis-related follow-up. Second, psychological support included SAS/SDS-based screening, monthly counseling for patients exceeding predefined thresholds, routine emotional support for patients below the thresholds, and referral when persistent severe symptoms were identified. Third, social support included family education, community-health linkage, monthly home visits, and adherence documentation. Outcomes were assessed at baseline, 6 months, and 12 months, including BMD, FRAX scores, metabolic indicators, SAS, SDS, SSRS, and fracture occurrence. The intervention group showed more favorable changes in BMD, FRAX scores, metabolic indicators, psychological scores, social support, and total 12-month fracture incidence than the routine nursing group. These findings provide preliminary clinical evidence for a structured and reproducible nursing pathway for integrated management of diabetes complicated by osteoporosis.

Metformin is the first-line therapy for obese patients with type 2 diabetes mellitus (T2DM); however, a substantial proportion of patients exhibit inadequate glycemic control despite optimal dosing. This protocol describes a retrospective cohort approach to evaluate the effects of saxagliptin combined with liraglutide on microinflammation and adipokine profiles in obese T2DM patients with poor response to metformin. A total of 116 eligible patients were identified from electronic medical records and assigned to receive either saxagliptin monotherapy or saxagliptin combined with liraglutide based on predefined clinical criteria. The protocol includes standardized procedures for patient selection, group allocation, metabolic assessment, and laboratory measurement of inflammatory markers, adipokines, and metabolic parameters. Representative outcomes demonstrate that both treatment regimens are associated with improvements in glycemic control, lipid metabolism, and insulin resistance. The combination regimen shows greater reductions in inflammatory markers and more favorable modulation of adipokine profiles compared to monotherapy, while maintaining a comparable safety profile. These findings illustrate the application of this protocol for evaluating multi-target metabolic interventions in real-world clinical settings. This method provides a reproducible framework for assessing combined pharmacological strategies in obese T2DM patients with suboptimal response to first-line therapy and may support further clinical and translational investigations. Key words: Saxagliptin; Liraglutide; Obesity-related type 2 diabetes; inflammatory response; Microinflammatory response.

Acute cholecystitis (AC) can occur as a potentially fatal complication in critically ill patients, with multiple risk factors such as old age, male sex, diabetes mellitus, and history of cardiovascular disease reported. Recently, a history of cerebrovascular disease (CVD) has been suggested as a risk factor for the development of a complication in which vascular disease pathogenic factors, including atherosclerosis and ischemia, may play a role. However, little has been reported about the occurrence of AC in patients who have experienced CVD. This study aimed to investigate the incidence and clinical details of AC after CVD.

This was a retrospective review performed at a single institution. The records of all patients hospitalized with CVD were examined. In addition to the incidence of AC, atherosclerotic factors as well as previously reported risk factors were reviewed and then compared with those in patients with traumatic brain injury (TBI).

AC was identified in 4/156 (2.6%) patients with CVD and 1/135 (0.7%) patients with TBI, which was not a statistically significant difference ( P = 0.233). In addition, factors were comparable, except for hypertension, fever, and nonambulant status, which were found significantly more often in CVD patients. Notably, three of the four patients developed AC after recurrent CVD.

AC can occur as a potentially fatal complication in CVD patients. In addition to nonspecific clinical findings, consciousness disturbance with neurological deficits may lead to delayed diagnosis. A prospective study with a larger cohort is warranted to clarify the relationship between AC development and CVD.