👤 Shude Xu

Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising intervention for Autism Spectrum Disorder (ASD), but objective markers for rTMS tolerance remain lacking. This case-control study explored gaze behavior variability toward emotional faces in ASD children undergoing rTMS, focusing on identifying subgroups associated with rTMS intolerance. Eye-tracking data (Tobii technology, preferential-looking paradigm) were collected from 104 ASD children (48 intolerant, 56 tolerant) receiving DLPFC-targeted rTMS (left high-frequency, right low-frequency). Latent Profile Analysis (LPA) identified fixation subgroups across eight conditions. Demographic (sex, age), clinical (CARS scores) differences, and profile-tolerance associations were analyzed. LPA revealed three gaze profiles: moderate non-preferential fixation (80.76%), low diverse fixation (9.62%), and increased fixation with mild variability (9.62%). Sex and CARS scores differed across profiles (age did not). Intolerance rates were 38.1%, 60.0%, and 100%, with profiles predicting rTMS intolerance (OR = 0.210, 95% CI: 0.079-0.557). ASD children exhibit heterogeneous emotional face gaze patterns. Findings highlight the need for personalized rTMS interventions, especially for those with higher CARS scores and increased emotional face fixation-at elevated intolerance risk. Show less

The relationship between ambient air pollution and chronic liver disease (CLD), and whether physical activity (PA) modifies this association, remains unclear. We analyzed 17,708 middle-aged and older adults from the 2013 China Health and Retirement Longitudinal Study (CHARLS). Individual-level exposures to CO, O In fully adjusted models, higher pollutant levels were associated with increased CLD risk: CO (OR 1.13, 95% CI 1.04-1.19, p = 0.025), O Ambient CO, O Show less

Little is known about the association between physical activity and the risk of pre-sarcopenic obesity (pre-SO) among adolescents. Hence, this study aimed to examine the association between physical activity and pre-SO in a sample of 2143 adolescents aged 12 to 18 years from Yinchuan, China. The pre-SO was defined by three criteria: low skeletal muscle mass adjusted by weight (SMM/W) combined with body mass index (BMI), fat mass percentage (FMP), and waist circumference (WC). After adjusting for age, smoking, drinking, sleep time, and high-fat food consumption, participants with high physical activity (HPA) had a lower risk of pre-SO compared to those with low physical activity (LPA) according to the obesity criteria of FMP (OR   0.63, 95% CI, 0.48-0.83, P < 0.05), and WC (OR 0.71, 95% CI, 0.52-0.96, P < 0.05). Additionally, restricted cubic spline models showed a linear dose-response association between total physical activity (TPA) and pre-SO no matter what obesity criteria were adopted (all P overall trend < 0.05, all P non-linear > 0.50). Subgroup analyses revealed that individuals with higher TPA levels exhibited a decreased risk of pre-SO in boys according to the obesity criteria of FMP, and WC. In conclusion, HPA is associated with a reduced risk of pre-SO in adolescents, especially among boys. Show less

Calcific aortic stenosis (CAS) is frequently accompanied by systemic comorbidities, but their causal relationships and shared genetic architecture remain poorly defined. We aimed to map the multisystem comorbidity network of CAS and clarify underlying genetic mechanisms. In 467 484 participants from the UK Biobank, observational and polygenic phenome-wide association studies evaluated associations between CAS and 1571 phenotypes, integrating disease-trajectory analyses to visualise temporal patterns. Associations replicated across observational and polygenic analyses were tested using two-sample Mendelian randomisation (MR) based on 22 CAS-related variants from FinnGen. Polygenic risk score (PRS) analyses excluding specific genes assessed their contributions, particularly LPA and plasma lipoprotein(a) (Lp(a)) levels. CAS was associated with higher risks of 42 cardiovascular and non-cardiovascular conditions, most prominently metabolic, endocrine, haematological and respiratory disorders. Temporal analyses showed that circulatory and metabolic diseases typically precede other comorbidities in CAS trajectories. MR findings were consistent with causal effects of CAS on multiple cardiovascular diseases, iron-deficiency anaemia, mental disorders and pleural effusion. When LPA variants were removed from the CAS PRS or plasma Lp(a) concentration was adjusted for, most associations lost significance, indicating a shared LPA/Lp(a)-mediated genetic pathway. CAS is embedded within a broad multisystem comorbidity network, driven largely by genetic variation at LPA and elevated Lp(a). These findings highlight pleiotropic mechanisms linking valvular calcification with systemic disease and support LPA-targeted therapies as a promising avenue for reducing the multisystem burden of CAS. Show less

Ischemic heart disease (IHD), particularly myocardial infarction (MI), ranks as a leading cause of death globally. While studies have associated physical activity (PA) with a decreased risk of MI, the extent of the global IHD burden attributable to LPA and the impact of PA on MI remain uncertain. This study accessed data from the Global Burden of Disease (GBD) 2021 and employed Mendelian randomization (MR) to evaluate these relationships. We analyzed the global age-standardized death rate (ASDR) for IHD attributable to LPA from 1990 to 2021. Additionally, we utilized the MR analysis to assess the relationship between PA and MI, using relevant data from GWAS databases. Within this framework, PA is defined based on the types of PA in the last 4 weeks, including other exercises such as swimming, cycling, keep fit, and bowling. From 1990 to 2021, the global ASDR for IHD attributable to LPA exhibited an upward trend (estimated annual percentage change [EAPC] = 0.70, 95% CI: 0.61 to 0.79). The MR analysis revealed an inverse association between PA and MI (IVW method: OR = 0.17, 95% CI: 0.04 to 0.68, This study highlights that LPA contributes significantly to the global burden of IHD, with an increasing trend in related mortality from 1990 to 2021. From a genetic perspective, MR analysis indicates that PA reduce the risk of MI, though further research using larger sample sizes and more robust genetic tools is required to definitively establish this relationship. Globally, promoting PA is essential for reducing the burden of disease and enhancing cardiovascular health. The online version contains supplementary material available at 10.1186/s12872-025-05453-6. Show less

To identify risk factors for heart failure (HF) within one year after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and to develop a predictive nomogram model. A retrospective analysis was performed on 492 patients with ACS treated at Suzhou Municipal Hospital between January 2020 and October 2023. Patients were divided into the HF group and the non-HF group according to the occurrence of HF within one year after PCI. 70% of the cases were randomly assigned to the training set and 30% to the validation set. Univariate and multivariate logistic regression analyses were conducted to screen independent predictors, and a nomogram model was subsequently established. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Among the 492 patients, the incidence of HF within one year after PCI was 26.42% (n = 130). Logistic regression identified type 2 diabetes mellitus (T2DM), left ventricular ejection fraction (LVEF), lipoprotein(a) [LP(a)], B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (Hs-CRP) as independent predictors of HF, with odds ratios of 5.756, 0.904, 1.427, 1.012, and 1.666, respectively (all P < 0.05). The model demonstrated excellent discrimination, with areas under the ROC curve of 0.946 in the training set and 0.958 in the validation set. DCA indicated that the model provided greater net clinical benefit than the "treat-all" or "treat-none" strategies, and its predictive performance surpassed that of each individual factor (P < 0.05). The nomogram model incorporating T2DM, LVEF, LP(a), BNP and Hs-CRP provides an effective tool for predicting HF risk within one year after PCI in patients with ACS, offering valuable guidance for early clinical identification and risk stratification of high-risk individuals. Show less

Chronic diseases have become a major public health challenge facing the world. Identifying key factors and developing effective management strategies to promote proactive health behaviors in patients is crucial for improving health outcomes. This study aims to construct a comprehensive model of proactive health behaviors in chronic disease patients, elucidate multilevel determinants, and guide targeted policy interventions in China. A cross-sectional survey was conducted among 805 patients with chronic diseases in China. Latent profile analysis (LPA) was conducted to identify distinct profiles of proactive health behaviors among patients. Binary logistic regression analysis was used to verify and analyze the determinants affecting the proactive health behaviors of patients. Among the 805 participants, 471 were classified as highly proactive, and 334 were classified as less proactive. The average score for proactive health behaviors was 70.37 ± 10.93. Several factors positively predicted proactive health behaviors: patients aged > 74 years (AOR = 8.85, 95% CI 2.06-39.45), married patients (AOR = 1.78, 95% CI 1.02-3.11), urban residents (AOR= 1.33, 95% CI 1.04-1.70), those with stronger health intentions (AOR = 1.42, 95% CI 1.28-1.60), higher self-efficacy (AOR = 1.12, 95% CI 1.04-1.20), positive health beliefs (AOR = 1.21, 95% CI 1.09-1.34)), and greater community support (AOR = 1.18, 95% CI 1.07-1.32). Regarding policy support, perceiving an adequate upper payment limit for drugs was associated with twice the odds of proactive health behaviors (AOR = 2.61, 95% CI 1.44-4.78). Additionally, age and the medication reimbursement policy for drug expenses exerted negative effects on proactive health behaviors (β = -0.507, P < 0.01). Governments should transform medical insurance from a passive payer into an active health investor. By incorporating behavioral economics principles, such a reform reallocates policy design, resources, and decision-making power toward disadvantaged populations. This shift breaks the "well-intentioned policy trap", achieving lower medical costs alongside improved population health. Show less

Pulmonary embolism is a potentially fatal cardiovascular condition that demands prompt and accurate diagnostic imaging. Traditional single-energy computed tomography pulmonary angiography (CTPA), while widely used, is associated with high radiation doses and substantial volumes of contrast agents, which may increase the risks of radiation-induced tissue damage and contrast-induced nephropathy (CIN), respectively. Dual-energy CTPA (DE-CTPA) presents a promising alternative, though challenges, including elevated image noise at low kilo-electron volt (keV) levels (e.g., 40 keV), persist. The primary aim of this study is to evaluate and compare the image quality of 40 keV virtual monoenergetic images (VMI) reconstructed using deep learning image reconstruction (DLIR) and Adaptive Statistical Iterative Reconstruction-V (ASIR-V) algorithms within the context of low-dose DE-CTPA protocols. This prospective study enrolled patients who underwent DE-CTPA between January and April 2025. Using a Revolution CT scanner, 40 keV VMI were reconstructed with four distinct algorithms: ASIR-V 50%, ASIR-V 70%, Deep learning image reconstruction with medium setting (DLIR-M), and deep learning image reconstruction with high setting (DLIR-H). Iodixanol (350 mgI/mL) was administered at a dose of 0.4 mL/kg. The image quality was assessed through both objective measures [image noise, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR)] and subjective evaluation via a Likert scale. Statistical analysis was conducted using SPSS 27.0, employing analysis of variance (ANOVA) for normally distributed data and the Kruskal-Wallis test for non-normally distributed data. A total of 75 patients with clinical suspicion of pulmonary embolism were included in the study. The mean effective dose (ED) was 3.76±1.02 mSv, with a mean CT volume dose index (CTDIvol) of 6.13±1.69 mGy and a mean dose-length product (DLP) of 221.12±59.85 mGy·cm. The mean contrast agent volume was 26.0±5.0 mL. Statistical analysis of image quality revealed significant differences between the four groups in terms of image noise, CNR, and SNR, measured at the levels of the main pulmonary artery, left pulmonary artery, and right pulmonary artery (P<0.001). Post-hoc analysis demonstrated that the DLIR-H algorithm provided the highest image quality, significantly reducing noise while enhancing CNR and SNR relative to both ASIR-V and DLIR-M (P<0.001). Compared with ASIR-V 50%, DLIR-H reduced image noise by 45% at the PA [24.25±16.18 The DLIR-H algorithm significantly enhances the image quality of 40 keV VMI images under low-dose DE-CTPA scanning protocols. It outperforms DLIR-M, ASIR-V 50%, and ASIR-V 70%, making it a promising tool for improving image quality in CTPA, particularly in clinical settings where minimizing radiation dose and contrast agent volume is essential. Show less

This study aimed to investigate the effect of lipoprotein(a) (Lp(a)) on major adverse cardiovascular events (MACEs) among individuals with chronic coronary syndrome (CCS) according to ABO blood groups. Two independent cohorts of patients with CCS were included consecutively. Blood groups and Lp(a) levels were measured. Patients with the AB group were excluded due to the small sample size. In the exploratory cohort ( Show less

Falls are a significant concern for elderly Maintenance Hemodialysis (MHD) patients, with a rising fall-related mortality rate observed over the past decade. However, the heterogeneity of fall awareness within this population has not been sufficiently explored. Understanding these differences is crucial for developing targeted interventions to address fall risk. This cross-sectional study included 313 elderly MHD patients from a tertiary hospital in China (January-March 2025). Latent Profile Analysis (LPA) was utilized to identify distinct profiles of fall self-awareness based on the Self-Awareness of Falls in Elderly Scale (SAFE), which assesses four dimensions of fall awareness. Multivariate logistic regression analysis was performed to examine factors influencing these profiles, adjusting for demographic and clinical variables. Three latent profiles emerged: the Vulnerable Type (17.6%, low awareness across all dimensions, particularly in cognitive-behavioral aspects), the Balanced Type (48.9%, moderate awareness), and the Active Type (33.6%, high awareness in medication and environmental safety). Younger age, moderate or lower Charlson Comorbidity Index (CCI) scores, and a history of falls were significant predictors for membership in the Vulnerable/Balanced profiles. The findings highlight significant variability in fall awareness among elderly MHD patients, with over 65% demonstrating suboptimal awareness. These descriptive findings emphasize the meaningful variability in fall self-awareness among older MHD patients and may inform class-specific education and screening strategies. Prospective and interventional studies are needed to determine causal effects and evaluate their impact on fall events. Show less

We investigated the association between lipoprotein(a) [Lp(a)] levels and stroke recurrence in type 2 diabetes mellitus (T2DM) patients with recent acute ischemic stroke or transient ischemic attack (TIA). This study included 3,311 T2DM patients with recent acute ischemic stroke or TIA and complete Lp(a) data from the Third China National Stroke Registry. The patients were categorized into three groups based on the 40th and 70th percentiles of the Lp(a): ≤13.1, 13.1 to 29.2 and ≥ 29.2 mg/dL. The primary outcome was stroke recurrence within one year, with incident cases further classified as either ischemic or hemorrhagic. Cox proportional hazards regression and restricted cubic splines were used to evaluate these associations. A total of 3311 patients (2142 men, 64.69%, median age 63) were analyzed. Restricted cubic spline analysis revealed a U-shaped relationship between Lp(a) levels and the risk of stroke recurrence. After adjusting for cardiovascular risk factors, patients with Lp(a) levels ≤ 13.1 mg/dL or ≥ 29.2 mg/dL had hazard ratios of 1.34 (95% confidence interval (CI), 1.02-1.76) and 1.35 (95% CI, 1.01-1.79), respectively, for total stroke compared to those with Lp(a) levels between 13.1 and 29.2 mg/dL. The corresponding hazard ratios were 1.36 (95% CI, 1.02-1.81) and 1.36 (95% CI, 1.01-1.83) for ischemic stroke and 0.88 (95% CI, 0.37-2.09) and 0.77 (95% CI, 0.31-1.94) for hemorrhagic stroke, respectively. Both low and high levels of Lp(a) are associated with an increased risk of stroke recurrence in T2DM patients with a recent history of acute ischemic stroke or TIA, demonstrating a U-shaped relationship. Show less

Osteoporotic bone defects pose significant clinical challenges. While icariin (ICA) exhibits pro-osteogenic effects in vitro, its capacity to repair osteoporosis (OP)-related bone defects remains unverified. This study investigates ICA' s therapeutic role in bone regeneration and elucidates its molecular mechanisms via the Hippo pathway in bone marrow mesenchymal stem cells (BMSCs) and OP rats. Rat BMSCs were isolated and characterized by flow cytometry (CD29+/CD34-/CD45-). BMSCs were induced under osteogenic conditions with ICA at 25 and 50 mg/L. Osteogenic differentiation and mineralization were assessed by ALP and Alizarin Red staining and by measuring mRNA and protein levels of ALP, Runx2, and OCN. The Hippo/TAZ pathway was evaluated by Western blot and qPCR for MST1, p-MST1, TAZ, and p-TAZ. A rescue experiment employed the Hippo pathway agonist lysophosphatidic acid (LPA). An ovariectomized (OVX) rat model of osteoporosis was established to validate ICA's effects in vivo, examined by micro-CT, histology, and tibial expression analyses of osteogenic markers and Hippo/TAZ signaling components. ICA promoted osteogenic differentiation and mineralization of BMSCs. Mechanistically, ICA did not alter MST1 or TAZ transcripts but markedly reduced MST1 and TAZ phosphorylation, thereby stabilizing total TAZ and enhancing downstream osteogenesis. Co-treatment with LPA abrogated ICA-induced osteogenesis, confirming Hippo/TAZ pathway dependence. In OVX rats, ICA mitigated bone loss, improved trabecular microarchitecture (BMD, BV/TV, Tb.N), and upregulated tibial expression of ALP, Runx2, and OCN. Consistently, ICA reduced p-MST1 and p-TAZ levels and increased total TAZ in bone tissues. ICA promotes bone formation both in vitro and in vivo by inhibiting Hippo kinase activity and stabilizing TAZ, thereby enhancing osteogenic differentiation. Our findings identify the Hippo/TAZ axis as a potential therapeutic target for OP and support further translational exploration of ICA as an anti-osteoporotic agent. Show less

Pancreatic cancer (PC) represents a highly lethal malignancy characterized by diagnostic challenges owing to nonspecific early symptoms and insufficiently sensitive biomarkers. This investigation sought to identify novel PC biomarkers through lipidomic profiling, an emerging metabolomics methodology examining lipid pathways in disease pathogenesis. We established a humanized murine PC model. Small-molecule oxidized lipid metabolites in primary pancreatic tumors and hepatic metastases were quantitatively analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) integrated with a comprehensive metabolomics platform. Multivariate statistical approaches including principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) were systematically applied. Analysis identified 64 differentially expressed oxidized lipids structurally classified as unsaturated fatty acid derivatives. Comparative assessment of metabolic profiles revealed a pronounced reduction in prostaglandins (PGE Our findings establish prostaglandins PGE Show less

Acquired renal cysts (ARC) are associated with kidney function decline, necessitating novel dietary pattern (DP) analyses in large cohorts. This UK Biobank prospective cohort study (2006-2010) included participants with ≥2 dietary records, excluding those with severe kidney damage. The constructed comprehensive dietary pattern integration (CDPI) utilized reduced rank regression (RRR) and latent profile analysis (LPA). ARC cases (ICD-10: N28.1) were assessed via Cox regression for risk and dose-response, with NMR metabolites examined as mediators. Among 119,709 participants (median follow-up: 10.57 years), 850 ARC cases were identified. Lipid-rich and hyperglycemic diets increased ARC risk [e.g., HRs for G1.DP1: 1.080 (1.024, 1.139); G1.DP2: 1.144 (1.048, 1.249)], while micronutrient-rich diets showed weak protective effects [G4.DP1: 0.943 (0.892, 0.998)]. LPA confirmed RRR findings, and 7/251 NMR metabolites had significant mediating effects. Diets high in fat (cheese, butter, pizza) and sugar (chocolate, sugary drinks) elevated ARC risk, whereas micronutrient- and fiber-rich diets (vegetables, fruit, lean poultry, nuts, eggs) were protective. Key mediators included branched-chain amino acids, IGF-1, and RBC distribution width. Show less

Many studies have revealed the observational associations between lipoprotein(a) (Lp(a)) concentrations and the incidence of cardiovascular diseases (CVDs). However, the causal associations remain unclear. Public summary data were analyzed using a Mendelian randomization (MR) design to assess the causal associations between Lp(a) levels and risks of nine CVDs and evaluate the potential impact of aspirin on Lp(a) levels. The principal analysis was conducted employing the random-effects inverse-variance weighted (IVW) method. Furthermore, the weighted median and MR-Egger approaches were used as the sensitivity analysis. Additionally, the significantly associated single nucleotide polymorphisms (SNPs) in salicylic acid (INTERVAL and EPIC-Norfolk, n = 14,149) were chosen to assess the potential effects of aspirin on lowering Lp(a) levels. The IVW analysis showed that the per standard deviation (SD) increment in Lp(a) level was causally associated with a higher risk of coronary artery disease (odds ratio (OR), 1.237; 95% confidence interval (CI), 1.173-1.303), atrial fibrillation (OR, 1.030; 95% CI, 1.011-1.050), heart failure (OR, 1.074; 95% CI, 1.053-1.096), hypertension (OR, 1.006; 95% CI, 1.004-1.008), and peripheral artery disease (OR, 1.001; 95% CI, 1.001-1.001) (all A causal nexus was discerned between Lp(a) levels and an increased risk of conditions including coronary artery disease, atrial fibrillation, heart failure, hypertension, and peripheral artery disease. Furthermore, administering aspirin may be a potential therapeutic to reduce these CVD risks among individuals with elevated Lp(a) levels. Show less

Previous studies showed that obstructive sleep apnea (OSA) is associated with dyslipidemia. However, whether micro-arousals during rapid eye movement (REM) and non-rapid eye movement (NREM) sleep independently associated with dyslipidemia were unknown. 4472 participants with OSA-related symptoms were finally included in our cohort. Various sleep variables including micro-arousal index (MAI) were obtained from standard polysomnography (PSG) recordings. Fasting serum lipid levels were assessed at our hospital laboratory. Linear regression models were employed to investigate relationships between micro-arousals in REM and NREM sleep and lipid profile with adjusting for multiple confounding factors. Fully adjusted models demonstrated a significant dose-dependent positive correlation between the MAI during REM sleep (MAI MAI Show less

Recent researches highlight the interdependence of lipoprotein(a) [Lp(a)] and Lp(a)-associated cardiovascular risk with the background inflammatory burden. This study aimed to investigate whether systemic inflammation modulates Lp(a)-associated coronary stenosis in chronic coronary syndromes (CCS). A total of 1513 participants undergoing angiography at a tertiary cardiology center in China were included in our retrospective, cross-sectional study. Participants were categorized into normal, mild, and severe groups based on the Gensini Scores, which quantitatively assess stenosis severity. Multinomial logistic models were calculated according to accompanying systemic inflammation concentration. Participants with elevated Lp(a) levels had a high coronary stenosis risk: fully adjusted model odds ratios (ORs) [95% confidence intervals (CIs)] for the mild vs. normal and severe vs. normal groups were 1.47 (1.11-1.96) and 1.68 (1.21-2.33). Notably, the strongest Lp(a)-coronary stenosis associations after multi-variable adjustment persisted only in low inflammation concentration [systemic inflammation response index (SIRI) < 0.64)] [mild vs. normal, OR 2.03, 95% CI 1.17-3.54, Elevated Lp(a) correlates with coronary stenosis only in low inflammation concentration. Considering systemic inflammation in personalized Lp(a)-lowering therapies is more conducive for CCS managements. Show less

To identify the various profiles of social isolation among 18-59-year-old patients with cancer in Western China and examine their demographic, clinical, and cultural predictors. This cross-sectional study included 300 patients from a tertiary hospital who completed standardized assessments of social isolation (Social Avoidance Scale, UCLA Loneliness Scale) and family functioning. Latent Profile Analysis (LPA) was used to identify the subgroups, and multinomial logistic regression was used to analyze predictors of the profiles. Three distinct latent profiles were identified: "avoidance-dominant" (52.3%), which was characterized by high levels of social avoidance (12.52 ​± ​1.38) and low loneliness (30.87 ​± ​6.89), "loneliness-dominant" (27.0%), which was characterized by high levels of loneliness (53.15 ​± ​6.24) and low social avoidance (2.07 ​± ​1.38), and "balanced" (20.7%), which was characterized by balanced scores on both the measures. Individuals with fatigue, employment status, personality traits, and family dynamics significantly predicted profile membership ( Social isolation was heterogeneous among young and middle-aged patients with cancer. Fatigue significantly predicted distinct patterns of social isolation. Furthermore, exploratory findings indicated a potential role of religious beliefs in the avoidance-dominant profile; however, replication with larger samples is required. Family dynamics may buffer the risk of isolation in patients prone to avoidance, whereas those dominated by loneliness may lack such safeguards. Health care providers can implement tailored interventions to mitigate social isolation based on these varying profiles. Show less

Physical fitness in preschoolers, encompassing muscular strength, speed-agility, balance, and cardiorespiratory fitness, serves as a key health indicator. While preschools are ideal settings for promoting physical fitness, the association between preschool-based movement behaviors and physical fitness remains unclear. This cross-sectional study included 1144 Chinese preschoolers aged 3-6 years. Preschool-based movement behaviors including moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior (SB), were measured using ActiGraph GT9X accelerometers. Physical fitness was assessed via the PREFIT battery, which includes handgrip strength, standing long jump, 4 × 10 m shuttle run, one-leg stance, and 20 m shuttle run. Compositional linear regression and isotemporal substitution modeling were employed to examine associations and time-reallocation effects, respectively. Greater amounts of MVPA during preschool hours were positively associated with better performance in muscular strength, speed-agility, and cardiorespiratory fitness. Reallocating time from SB or LPA to MVPA enhanced physical fitness, whereas substituting MVPA with SB or LPA reduced fitness levels, demonstrating an asymmetric effect. Moderate-to-vigorous physical activity during preschool hours significantly enhances physical fitness. Prioritizing the implementation of physical activity programs to increase MVPA in preschool settings is crucial for improving physical fitness and addressing insufficient MVPA in this age group. First large-scale study (N = 1144) demonstrating preschool-based moderate-to-vigorous physical activity (MVPA) is essential for developing preschoolers' muscular strength, speed-agility, and cardiorespiratory fitness, complementing existing 24-h movement behavior research. Reveals critical asymmetry: Reducing MVPA time significantly harms fitness, with losses exceeding the benefits from equivalent MVPA increases. Provides objective evidence to guide policymakers in optimizing preschool schedules to prioritize MVPA for enhancing children's physical fitness. Show less

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a global health issue due to its high prevalence, yet the impact of accelerometer-measured physical activity on clinical outcomes remains unclear. This study aims to examine the associations of physical activity with the risk of liver cirrhosis, cancer, cardiovascular disease (CVD) incidence and mortality. 32 681 MASLD participants with accelerometer-derived physical activity data from the UK Biobank were analysed. Physical activity intensity was categorised into light (LPA), moderate (MPA) and vigorous (VPA) intensity. Cox proportional hazard and acceleration failure models were employed to assess associations between physical activity duration and outcomes. During a median follow-up of 7.5-7.9 years, 1883 deaths, 151 liver cirrhosis, 3312 cancers and 6657 CVD events were recorded. Physical activity, regardless of intensity, was consistently associated with a reduced risk of liver cirrhosis, CVD and all-cause mortality. Compared with non-MASLD individuals, our analysis indicates that longer duration of physical activity, specifically >1945 min/week of LPA or >383 min/week of MPA may theoretically eliminate the excess risk of mortality associated with MASLD. Among MASLD individuals, longer physical activity duration, regardless of intensity, was associated with reduced risks of liver cirrhosis and mortality. MPA and VPA were associated with lower CVD risk, while VPA was associated with reduced cancer risk, highlighting the potential benefits of increasing the intensity and duration of physical activity in MASLD management. Show less

Lipoprotein(a) [Lp(a)], one of the major residual cardiovascular risks, is a highly polymorphic low-density lipoprotein (LDL)-like particle. Epidemiological and Mendelian randomization studies have suggested that elevated Lp(a) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) due to its pro-inflammatory, pro-atherogenic and pro-thrombotic properties. However, metabolic and pathological mechanisms of Lp(a) remain under-investigated. Recent genomic and population studies show that very low Lp(a) levels are associated with increased risk of type 2 diabetes mellitus (T2DM). Thus, whether potent Lp(a)-lowering therapies might increase the risk of T2DM incident has been raised as a potential issue from recent guidelines. This review details Lp(a)-induced inflammation and thrombosis evidences, the underlying mechanisms of Lp(a) in ASCVD, and the complicated associations and potential mechanistic effects of Lp(a) on the development of T2DM. Current evidences tend to favor that the anti-atherogenic benefits of lowering Lp(a) shall override the paradoxical negative impact on the new-onset T2DM. The risk-benefit assessments for potent Lp(a)-lowering therapies are warranted. Show less

Early identification of individuals with low advance care planning (ACP) engagement remains a critical component of clinical care. However, we know little about the heterogeneity of ACP engagement at the individual level. This study identified latent subgroups of ACP engagement using latent profile analysis (LPA), and explored their associations with death attitudes. This study recruited 302 end-stage renal disease (ESRD) patients undergoing dialysis. Data included sociodemographic characteristics, the Advance Care Planning Engagement Survey (ACPES; Chinese version), and the Death Attitude Profile-Revised (DAP-R). Based on multidimensional indicators, LPA was employed to identify distinct ACP engagement profiles. Model fit and classification quality in LPA were evaluated based on class sizes and entropy values. All analyses were completed in SPSS 26.0 and Mplus 8.3, with R3STEP and BCH methods employed to uncover underlying patterns and relationships. Among dialysis-dependent ESRD patients, ACP engagement was categorized into two latent profiles: a "low-ACP Engagement" profile (n = 162, 53.6%) and a "high-ACP Engagement" profile (n = 140, 46.4%), with good classification quality (entropy = 0.909). The profile membership was significantly associated with dialysis vintage, and educational level (both This study identifies two distinct ACP engagement profiles among dialysis-dependent ESRD patients. Findings emphasize the need for tailored interventions, particularly for patients with shorter dialysis vintage and lower education level, and highlight the role of death attitudes in shaping ACP engagement. These findings should be interpreted with caution due to the cross-sectional design and single-center setting. Show less

The mediation effect of 24-hour physical activities on the association between type 2 diabetes and mortality is unclear. Additionally, Little evidence was found on the isotemporal substitution effect of 24-hour physical activities components on changing Life expectancy among patients with type 2 diabetes diagnosed. To address the abovementioned research gap, the study has a two-fold aims: first, to examine the mediation effect of 24-hour physical activities in type 2 diabetes and mortality; and second, to address how reallocating time on different daily activities would affect life expectancy. Analysis was conducted on the accelerometer data of 103,359 participants in the UK Biobank, with a median age of 57 years (range 39 to 70). Compositional mediation cox model was conducted to analyze the mediating effects of 24-hour physical activities. Additionally, the cohort Life table method was utilized to estimate the changes of Life-years over the next 10 years resulting from the substitution effect of different physical activities. During a mean follow-up of 13.95 (range 2.95-16.28) years, 2,649 deaths were recorded. Diabetes was significantly associated with increased time spent engaging in sedentary behavior (SB), and reduced time spent on moderate-to-vigorous physical activity (MVPA) and light-intensive physical activity (LPA), thereby demonstrating an association with higher mortality risk. The indirect effect of physical activity (HR = 1.27, 95% CI 1.23-1.30) accounted for 41.9% of the total effect of diabetes on mortality. Furthermore, the Life expectancy gains with a maximum of 1.32 years over the next 10 years was found when reallocating SB time to MVPA. The results revealed that 24-hour physical activities might mediate the association between diabetes and mortality. Therefore, promoting participation in MVPA and reducing sedentary activities among diabetes patients was expected to have a positive effect on Life expectancy over the next 10 years. Show less

"Penumbra freezing" aims to extend vascular recanalization treatment to acute ischemic stroke (AIS) patients beyond the standard time window by preserving the ischemic penumbra. Efficient biomarkers are crucial for identifying patients eligible for AIS treatment. This study enrolled 141 AIS patients who exceeded the conventional treatment window. Using CT perfusion imaging, patients were categorized into "penumbra freezing" and "non-penumbra freezing" groups based on the EXTEND criteria. Multiple regression analysis assessed the association of nine baseline factors and five blood lipid indicators with "penumbra freezing." Diagnostic accuracy was evaluated using ROC curves. Mendelian randomization (MR) analysis validated these findings using blood lipid indicators as exposures and penumbra biomarkers as outcomes. Among AIS patients beyond the treatment window, males exhibited better penumbra preservation (OR=0.243, 95% CI=0.072-0.813, p=0.022), while those with hyperlipidemia showed poorer preservation (OR=2.429, 95% CI=1.027-7.747, p=0.043). In the "penumbra freezing" group, ApoA1 levels were significantly lower (1.29 ± 0.03 g/L) compared to the "non-penumbra freezing" group (1.42 ± 0.06 g/L, p=0.034). Conversely, Lp(a) levels were significantly higher in the "penumbra freezing" group (304.63 ± 52.44 mg/L) than in the "non-penumbra freezing" group (110.26 ± 40.71 mg/L, p=0.034). Higher ApoA1 levels increased the likelihood of "non-penumbra freezing" beyond the time window (OR=3.206, 95% CI=1.034-9.938, p=0.044), while elevated Lp(a) levels reduced this likelihood (OR=0.075, 95% CI=0.007-0.848, p=0.036). MR analysis confirmed genetic associations of ApoA1 and Lp(a) with penumbra biomarkers. ApoA1 and Lp(a) may be linked to ischemic penumbra status, but further validation is needed due to limitations in sample size and study methodology. ApoA1 and Lp(a) are promising biomarkers for identifying AIS patients eligible for "penumbra freezing," suggesting the potential to extend the treatment window. Show less

Coronary heart disease (CHD) is a prominent cause of mortality and disability worldwide. Like most complex diseases, the risk of CHD in individuals is regulated by the interaction between genetic factors and lifestyle. To investigate the influence of A total of 324 patients with CHD and 143 control participants were involved in this study. Single nucleotide polymorphisms rs429358 and rs7412 in the In the CHD group, the frequencies of In the Teochew population, the Show less

Given the lack of evidence, we cannot definitively determine the relationship between attachment networks and problematic mobile phone use, hindering effective intervention strategies. Therefore, a three-wave longitudinal study was designed to explore the heterogeneity of parent-child attachment networks using latent profile analysis (LPA) and random intercept latent transition analysis (RI-LTA). Participants included 2116 adolescents (ages 14-21; 53.8% girls). Results identified five stable parent-child attachment network profiles, each showing moderate but decreasing stability. Notably, adolescents who were grouped into an attachment network characterized by secure maternal attachment but insecure paternal attachment, similar to those in attachment networks with both insecure maternal and paternal attachment, scored higher levels of problematic mobile phone use than those who were grouped into attachment networks with both secure maternal and paternal attachment. Our findings fill empirical gaps and provide strong evidence supporting attachment-based interventions to reduce problematic mobile phone use. Show less

The extensive co-occurrence of cardiovascular diseases (CVDs), as evidenced by epidemiological studies, is supported by positive genetic correlations identified in comprehensive genetic investigations, suggesting a shared genetic basis. However, the precise genetic mechanisms underlying these associations remain elusive. By assessing genetic correlations, genetic overlap, and causal connections, we aim to shed light on common genetic underpinnings among major CVDs. Employing multi-trait analysis, we pursue diverse strategies to unveil shared genetic elements, encompassing SNPs, genes, gene sets, and functional categories with pleiotropic implications. Our study systematically quantifies genetic overlap beyond genome-wide genetic correlations across CVDs, while identifying a putative causal relationship between coronary artery disease (CAD) and heart failure (HF). We then pinpointed 38 genomic loci with pleiotropic influence across CVDs, of which the most influential pleiotropic locus is located at the LPA gene. Notably, 12 loci present high evidence of multi-trait colocalization and display congruent directional effects. Examination of genes and gene sets linked to these loci unveiled robust associations with circulatory system development processes. Intriguingly, distinct patterns predominantly driven by atrial fibrillation, coronary artery disease, and venous thromboembolism underscore the significant disparities between clinically defined CVD classifications and underlying shared biological mechanisms, according to functional annotation findings. Show less

This study aims to investigate the effect and mechanism of naringin on anti-osteoporosis by regulating lipid-bone balance. Thirty healthy female SD rats(8-week-old, SPF grade) were selected and randomly divided into a sham group, an ovariectomy group, and a naringin group. Except for the sham group, postmenopausal osteoporosis models were established for both the ovariectomy group and the naringin group by removing bilateral ovaries. Rats in the naringin group were given a naringin suspension at a dose of 100 mg·kg~(-1), while those in sham and ovariectomy groups were administered an equivalent volume of saline. Following the treatment once daily for 12 weeks, an enzyme-linked immunosorbent assay(ELISA) was used to detect the changes in the content of serum estradiol(E₂₎ and bone metabolism biomarkers, including procollagen type Ⅰ N-terminal propeptide(PINP), osteocalcin(OC), and tartrate-resistant acid phosphatase 5(TRACP5). Micro-CT analysis was performed to assess structural alterations in the femoral trabeculae of rats and analyze morphometric parameters of the bone. Hematoxylin-eosin(HE) and Masson staining were used to observe the histopathological changes in the bone tissue. Western blot was employed to analyze the protein expression level of osteogenesis-and adipogenesis-related factors, including peroxisome proliferator-activated receptor gamma(PPARγ), lipoprotein lipase(LPL), RUNT-related transcription factor 2(RUNX2), osterix(OSX), farnesoid X receptor(FXR), and fibroblast growth factor 19(FGF19). Additionally, immunohistochemistry was employed to evaluate the expression of key metabolic pathway proteins FXR and FGF19. After 12-week treatment, compared with the sham group, the ovariectomy group exhibited a significantly reduced level of serum E₂, PINP, and OC, alongside significantly elevated TRACP5. Compared with the ovariectomy group, the levels of serum E₂, PINP, and OC in the naringin group were significantly increased, while the level of TRACP5 was significantly decreased. Compared with the sham group, the ovariectomy group exhibited a decrease in trabecular number and continuity, sparse and disorganized arrangements, and partial formation of voids. The group also showed decreased bone mineral density(BMD), bone volume fraction(BV/TV), trabecular number(Tb.N), and trabecular thickness(Tb.Th), coupled with increased trabecular separation(Tb.Sp). Compared with the ovariectomy group, naringin intervention resulted in improved bone microarchitecture, characterized by increased trabecular number and continuity, more compact arrangements, and a significant reduction in voids. Quantitatively, this was reflected in elevated levels of BMD, BV/TV, Tb.N, and Tb.Th, alongside a significant decrease in Tb.Sp. Under light microscopy, fragmented trabeculae, uneven collagen staining, disorganized arrangements, and an expanded number and size of marrow adipocyte vacuoles were observed in the ovariectomy group, whereas naringin administration attenuated these pathological alterations. Compared with the sham group, the ovariectomy group showed a significant increase in the expression of adipogenic proteins PPARγ and LPL, alongside significant decreases in the expression of osteogenic proteins(RUNX2 and OSX) and of FXR and FGF19 proteins. In contrast, the naringin group exhibited a reversal of these trends compared to the ovariectomy group, with decreased PPARγ and LPL expression and increased RUNX2, OSX, FXR, and FGF19 expression. These findings demonstrate that naringin modulates lipid-bone metabolism homeostasis in postmenopausal osteoporotic rats, ameliorating trabecular microstructure and attenuating bone marrow adipogenesis, with its therapeutic effects mechanistically linked to the FXR/FGF19 signaling pathway. Show less

(Co)doping luminescent center(s) in a host is a universal strategy to photoluminescence (PL) modulations for extensive applications, yet its mechanism and interactions between structure and behavior in many phosphors remain ambiguous. Herein, via a facile sol-gel reaction method, differently tendentious occupations of Ce Show less