👤 Zihao Xu

Interleukin-27 (IL-27) in the pleural fluid has gained significant attention as a diagnostic biomarker for tuberculous pleural effusion (TPE); however, considerable variability exists across available studies. This systematic review and meta-analysis aimed to determine the diagnostic accuracy of IL-27 in identifying TPE. In addition, we also compared the diagnostic accuracy of IL-27 and adenosine deaminase (ADA) with a head-to-head meta-analysis. We searched the PubMed and Web of Science databases to identify diagnostic test accuracy studies evaluating the accuracy of IL-27 for diagnosing TPE. The last search date was September 2025. We extracted data from the eligible studies and constructed a two-by-two table with true positives (TP), false positives (FP), true negatives (FN), and false negatives (FN). The QUADAS-2 tool was used to assess the quality of eligible studies. A bivariate model was applied to pool sensitivity and specificity, and a summary receiver operating characteristic (sROC) curve with the area under the curve (AUC) was generated to estimate the overall diagnostic accuracy of IL-27 and ADA. A Deeks funnel plot asymmetry test was used to evaluate publication bias. Nine studies encompassing ten cohorts were included, involving 1573 patients (429 with TPE and 1144 with non-TPE). The reported AUCs for IL-27 ranged from approximately 0.73 to 0.99 across eligible studies. The pooled sensitivity and specificity were 0.94 (95% CI, 0.83-0.98) and 0.96 (95% CI, 0.89-0.98), respectively. The AUC for sROC was 0.99 (95% CI, 0.97-0.99). The pooled positive likelihood ratio was 21.97 (95% CI, 7.95-60.69), the negative likelihood ratio was 0.07 (95% CI, 0.02-0.18), and the diagnostic odds ratio (DOR) was 329 (95% CI, 72-1506). Significant heterogeneity was observed in both sensitivity (I IL-27 is a promising diagnostic marker for TPE, and its diagnostic accuracy is comparable to that of ADA. IL-27 should be used as a complementary diagnostic marker to ADA for TPE. Show less

To detect the expression of Interleukin-27 (IL-27) and Interleukin-35 (IL-35) in orbital fat in patients with severe TAO (thyroid-related eye disease) exophthalmos, and to investigate its potential role and significance in the development of TAO. A study group of 30 patients (30 eyes) who underwent orbital decompression with severe TAO exophthalmos in the Department of Ophthalmology, Provincial Hospital affiliated to Shandong First Medical University from January 2022 to December 2023, the expression of IL-27 and IL-35 of the orbital adipose tissue was detected by western-blot, and which in 30 patients (30 eyes) underwent orbital fracture surgery and plastic repair as control group. The contents of IL-27 and IL-35 were higher in severe TAO patients than in normal controls, and the difference was significant ( Show less

Immune checkpoint blockade (ICB) has improved outcomes for patients with triple-negative breast cancer (TNBC), yet resistance remains widespread and its molecular basis is not fully understood. Through single-cell RNA sequencing (scRNA-seq) of paired pre- and post-treatment tumor samples from patients who failed to achieve pathological complete response (non-pCR) after neoadjuvant PD-1 therapy, we identified a marked upregulation of interleukin-27 receptor subunit alpha (IL27RA) in malignant epithelial cells within residual lesions. Integration with scRNA-seq profiles from an independent cohort of three pCR patients showed that this IL27RA upregulation in malignant epithelium is largely restricted to non-pCR residual tumors, and high IL27RA expression correlated with poor survival in TNBC cohorts. Mechanistically, IL27RA suppresses MHC-I expression by activating the PI3K/AKT pathway-rather than the classical IL-27/STAT axis-thereby impairing CD8⁺ T-cell cytotoxic function. Inhibition of AKT reversed this phenotype and restored antigen-specific killing. In orthotopic tumor models, mimicking systemic loss of Il27ra significantly reduced tumor growth and prolonged survival in immunocompetent mice, with single-cell profiling indicating enhanced intratumoral T-cell and NK-cell effector activity. Collectively, our findings identify an epithelial-intrinsic IL27RA-PI3K/AKT-MHC-I axis as a central driver of immune evasion and ICB resistance in TNBC and support IL27RA as a promising therapeutic target for overcoming immunotherapy resistance. Show less

Colorectal cancer (CRC) shows strong heterogeneity in tumor microenvironment (TME) dynamics, but the mechanisms that shape epithelial-stromal crosstalk are still unclear. Here we focus on A-kinase anchor protein 12 (AKAP12) and Leiomodin 1 (LMOD1) and test a compartment-dependent model in which this program aligns with tight-junction features in epithelium but with a fibrotic, immune-suppressive program in stroma. Single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) were employed to profile gene expression patterns in CRC tissues. Immunohistochemistry (IHC) and multiplex immunofluorescence (mIF) validated protein expression and localization. Cell-cell communication analysis and trajectory inference were used to dissect spatial interaction networks. Functional experiments were employed to validate the role of the AKAP12-LMOD1 axis in CAFs in regulating ECM remodeling and antitumor immunity. AKAP12-LMOD1 exhibited a compartment-dependent pattern in CRC. In ACTA2⁻ epithelial regions, the epithelial AKAP12-LMOD1 signal was lower in tumors than in matched normal epithelium and showed a positive association with the tight-junction marker CLDN1. In ACTA2⁺ stromal regions, AKAP12-LMOD1 was enriched, positively associated with the gap-junction marker GJA4, and higher in tumor stroma than matched normal stroma. In a CAF-macrophage non-contact co-culture model, AKAP12 overexpression supported CAF activation and collagen deposition, and shifted macrophages toward an M2-like phenotype; LMOD1 knockdown or SB-431542 partially reversed these effects. Stromal AKAP12-LMOD1-enriched regions also aligned with fibrosis- and M2-related features, and these stromal patterns were prominent in mucinous carcinoma. This study defines AKAP12-LMOD1 as a compartment-dependent stromal program in CRC that links ACTA2⁺ stroma to gap-junction features, fibrosis, and M2-like macrophage polarization, while showing a distinct epithelial association with tight-junction features. These findings support a stroma-centered working model for AKAP12-LMOD1 in CRC microenvironmental heterogeneity and suggest that stromal modulation of this program, together with targeting fibrosis and M2-like immune features, may be explored as hypothesis-level, subtype-oriented therapeutic directions in stroma-rich CRC. Show less

Insufficient physical activity is prevalent among perinatal women, and digital health interventions offer a promising avenue to promote engagement in physical activity within this population. However, previous studies have relied heavily on self-reported data, lacking a systematic synthesis based on objective measurements. This study aims to systematically evaluate the effects of digital health interventions on objectively measured physical activity and sedentary behavior in perinatal women. A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to December 20, 2025. Fourteen randomized controlled trials (RCTs) involving 2,101 participants were included. The Risk of Bias 2.0 (RoB 2.0) tool was used to assess bias risk, random-effects models were employed to pool effect sizes, and the quality of evidence was evaluated using the GRADE system. The meta-analysis showed that, following the exclusion of outliers via sensitivity analysis, digital health interventions significantly increased daily step counts (MD = 0.68, Digital health interventions can effectively and robustly enhance daily baseline activity levels in perinatal women, with the observed increments potentially reaching the minimal effective dose for improving metabolic health. However, current intervention designs face challenges in driving high-intensity behavior change and disrupting sedentary habits. Future research should explore more targeted and personalized intervention strategies. This systematic review and meta-analysis has been registered in PROSPERO (www.crd.york.ac.uk/prospero), identifier CRD420261280936. Show less

Lipoprotein(a) [Lp(a)] has emerged as a critical determinant of residual cardiovascular risk. However, its impact on plaque morphology remains underinvestigated. This study aimed to elucidate the relationship between the serum Lp(a) levels, coronary plaque vulnerability, and vascular remodeling characteristics by utilizing intravascular ultrasound (IVUS). We retrospectively enrolled 292 consecutive patients with coronary artery disease who underwent IVUS. Target lesions were classified into vulnerable (n = 83) or stable (n = 209) plaque groups based on the IVUS criteria. Multivariate binary logistic regression was performed to identify independent predictors. The morphological parameters were further compared between the high (＞18.8 mg/dL) and low (≤ 18.8 mg/dL) Lp(a) groups. The vulnerable plaque group exhibited significantly higher median serum Lp(a) levels than the stable group (14.56 vs. 11.04 mg/dL, P = 0.011). After adjusting for age, sex, LDL-C, smoking, diabetes, and hypertension, Lp(a) ＞18.8 mg/dL remained an independent predictor of plaque vulnerability (OR = 1.76; 95% CI: 1.00-3.07; P = 0.049). Notably, the LDL-C levels did not predict vulnerability in this cohort. Furthermore, the high Lp(a) group demonstrated significantly larger vascular dimensions (EEM CSA: 14.67±4.95 vs. 13.22±4.20 mm Elevated serum Lp(a) levels are independent predictors of coronary plaque vulnerability. The underlying mechanism involves Lp(a) promoting compensatory vascular enlargement, accompanied by an increased plaque volume. These findings underscore the necessity of Lp(a) screening to identify any residual risk, particularly in patients with effectively controlled low-density lipoprotein cholesterol (LDL-C). Show less

Falls have long been a significant safety concern worldwide, not only compromising the physical and psychological health of older adults and limiting their social engagement but also imposing substantial economic and caregiving burdens. Evidence on fall risk perception among Chinese community-dwelling older adults remains limited, especially for those transitioning to community living after hospital discharge. This research examined the subtypes of fall risk perception of Chinese community-dwelling older adults in the post-discharge transition and to explore subgroup characteristics and associated factors. A cross-sectional survey was conducted between January 2024 to March 2025 in Hangzhou, Zhejiang Province. A self-designed questionnaire was used to collect demographic and health-related information, The Fall Risk Perception Scale for Community-dwelling Older Adults was used to assess the fall risk perception, the objective fall risk was assessed by Morse Fall Scale. Latent profile analysis (LPA) was performed to extract latent classes of fall risk perception, and multinomial regression analyses were used to identify differences between these categories. A total of 468 older adults were included, with 56.0% were male. Three fall risk perception subtypes were identified by LPA: Low Perception-Social Context Desensitized Type (29.2%), Moderate Perception - Balanced Type (43.4%), and High Perception - Bio-behaviorally Salient Type (27.4%). Individuals who were aged with 70-79 (OR = 0.46, 95% CI: 0.27-0.77), with college education or above (OR = 0.31, 95% CI: 0.13-0.76), those who underwent surgery during hospitalization (OR = 0.26, 95% CI: 0.15-0.43), reported difficulty falling asleep (OR = 0.40, 95% CI: 0.20-0.82), and those with a history of falls (OR = 0.44, 95% CI: 0.24-0.81) were significantly more likely to be in the High Perception - Bio-behaviorally Salient Type. Compared to objective fall risk level, a third of participants (31.4%) correctly estimated their fall risk, 23.1% overestimated it and 45.5% underestimated it. Most older adults possess a Moderate Perception - Balanced Type toward fall risk. Key determinants of heightened risk perception included advanced age, higher education, fall history, and recent surgical experience. Tailored, profile-specific risk communication strategies are essential to improve perceptual accuracy during the hospital-to-home transition may support post-discharge fall prevention. Show less

Current genetic testing for coronary artery disease (CAD) primarily targets monogenic variants in individuals with severe hypercholesterolemia. Whether supplementing monogenic testing with polygenic risk scores for CAD and Lp(a; lipoprotein[a]) levels [PRS A genetic probability for CAD (GenProb In the UK Biobank development cohort, PVs, polygenic risk scores for CAD and PRS GenProb Show less

This study aimed to explore the association between serum lipoprotein(a) [Lp(a)] levels and recurrent acute coronary syndrome (ACS) and revascularization of target lesions in patients with ACS who showed no functional ischemia on fractional flow reserve (FFR) testing during coronary angiography (CAG). The retrospective observational study was conducted at the General Hospital of Northern Theater Command and included 513 patients with new ACS recruited from 23 February 2016 to 6 November 2023 and followed up. These patients underwent CAG examination and were found to have at least one coronary artery with moderate or greater stenosis, and also underwent FFR measurement with FFR value >0.80. Patients experienced recurrent ACS and underwent unplanned revascularization were defined as the revascularization group, while patients did not experience recurrent ACS and undergo unplanned revascularization were assigned to the no revascularization group. The study employed propensity score matching (PSM) and receiver operating characteristic (ROC) curve analysis to evaluate the correlation between serum Lp(a) and recurrent ACS and unplanned revascularization in target lesion with FFR value >0.80. Serum Lp(a) levels were higher in female patients. There were no statistically significant differences in the basic clinical characteristics, medication use, laboratory test results or ejection fraction values between the two groups. During a average follow-up of 6.5 years, 119 patients (23.2%) experienced recurrent ACS and unplanned revascularization in the target lesion. The level of serum Lp(a) in the patients that underwent unplanned revascularization was significantly higher than in the group that did not undergo repeated revascularization (65.80 mmol/L vs. 60.57 mmol/L, Serum Lp(a) is an independent risk factor for recurrent ACS and unplanned revascularization in patients with ACS and FFR negative plaque. Show less

In recent years, the global incidence of Non-Suicidal Self-Injury (NSSI) has risen, posing a significant challenge in public health. Adolescents are the main group affected. A cross-sectional study was conducted using a self-administered questionnaire to collect data from 6,311 adolescents in Hefei, China. This study employed the Compositional Isotemporal Substitution Model (CISM, a statistical method that estimates health effects of replacing time in one behavior with another while accounting for the interdependent, compositional nature of 24-h time-use data) to examine the impact of Screen Time (ST), Non-Screen-based Sedentary Time (NSST), Physical Activity, and Sleep Time on NSSI among adolescents. Compositional logistic regression analysis revealed that, relative to the remaining behavioral components, higher Light Physical Activity (LPA) ( The findings highlight those reasonably allocating adolescents' daily activities, reducing ST, can help lower the risk of NSSI among adolescents. Show less

To evaluate the predictive value of novel lipid parameters for coronary lesion severity in pCAD and to develop a nomogram-based prediction model. Patients newly diagnosed with pCAD at Qingdao Municipal Hospital (2021-2024) were enrolled and randomly assigned to training and validation cohorts in a 7:3 ratio. Coronary lesion severity was assessed using the Gensini score (GS), with patients stratified into mild or significant stenosis groups. Spearman correlation analysis was performed between GS and lipid parameters. Key predictors were selected using LASSO regression, and independent risk factors were identified by multivariable logistic regression to construct the nomogram model. The model's discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Lp(a), non-HDL-C, RC, FFA, and BAR were positively correlated with GS (r = 0.34, 0.34, 0.18, 0.19, 0.18; all The proposed nomogram provides an effective tool for identifying pCAD patients with severe coronary artery stenosis, demonstrating robust predictive accuracy and potential clinical utility. Show less

This study aims to identify distinct mindfulness profiles among young and middle-aged lymphoma patients and to examine the mediating role of psychological resilience in the relationship between these mindfulness profiles and social function deficits. From November 2024 to June 2025, a total of 324 young and middle-aged lymphoma patients were recruited using convenience sampling from a tertiary cancer hospital in Urumqi, Xinjiang, China. Participants completed the Mindful Attention Awareness Scale, the 10-item Connor-Davidson Resilience Scale, and the Social Dysfunction Screening Scale. We used latent profile analysis (LPA) to identify distinct mindfulness profiles and tested the mediating role of psychological resilience with the Bootstrap method. Latent profile analysis identified three distinct mindfulness profiles among the patients: a low mindfulness type (29.3%), a moderate mindfulness type (40.1%), and a high mindfulness type (30.6%). Furthermore, psychological resilience partially mediated the relationship between these mindfulness profiles and social function deficits. Young and middle-aged lymphoma patients exhibit heterogeneous mindfulness profiles. Higher mindfulness can enhance psychological resilience, which in turn alleviates social function deficits. Therefore, healthcare providers should develop personalized interventions targeting psychological resilience based on patients' specific mindfulness profiles to improve their social function. Show less

This study aimed to identify distinct in-hospital cardiac rehabilitation (CR) adherence profiles and explore their associated clinical and sociodemographic factors among patients following percutaneous coronary intervention (PCI). A cross-sectional survey was conducted among patients undergoing Phase I cardiac rehabilitation following percutaneous coronary intervention (PCI) who were hospitalized in the cardiology department between June and July 2025 (n=384). Data were collected using a general information questionnaire and a treatment adherence questionnaire (Since the study population consisted of inpatients undergoing PCI followed by phase I cardiac rehabilitation, the dimension of follow-up compliance was excluded). LPA, a person-centered method that identifies unobserved subgroups (profiles) based on response patterns, was prespecified to classify CR adherence profiles. Multinomial logistic regression was performed to examine factors associated with profile membership. Clinical indicators (number of diseased vessels, LVEF, LDL-C, and serum creatinine) were included as candidate predictors; after LASSO selection, LDL-C and number of diseased vessels were retained and entered the final multinomial logistic regression model as continuous variables (original values). Three distinct CR adherence profiles were identified: Low CR Adherence (125/384, 32.55%), Medium CR Adherence (169/384, 44.01%), and High CR Adherence (90/384, 23.44%). Profile membership was significantly associated with gender, living situation, family monthly income, residential distance, smartphone use/proficiency and LDL-C ( CR adherence among post-PCI patients was overall moderate-to-low, with substantial heterogeneity across adherence patterns. The associated sociodemographic and contextual factors may help inform profile-based, tailored support to improve CR adherence after PCI. Given the cross-sectional design, these associations are non-causal and should be validated in future multicenter longitudinal and intervention studies. Show less

While family resilience is a recognized determinant of adaptation following stroke, the distinct, empirically derived profiles of family resilience among Chinese stroke survivor-caregiver dyads have not been clearly delineated. Identifying these profiles and their determinants is crucial for developing targeted interventions. To identify latent profiles of family resilience and examine the socio-demographic and clinical factors associated with profile membership among stroke patient-caregiver dyads in China. In this cross-sectional study, a convenience sample of 773 stroke survivor-caregiver dyads was recruited from three hospitals in Zhejiang Province, China. Latent profile analysis (LPA) was conducted on the 20-item Family Resilience Questionnaire (FRQ). Multinomial logistic regression was used to determine factors associated with profile membership. LPA supported a four-profile solution: Profile 1 "Low-Functioning Families" (22%), Profile 2 "Moderately Resilient - Low Cohesive Families" (24%), Profile 3 "Highly Resilient - Well-Functioning Families" (31%), and Profile 4 "High-Functioning - Optimistically Resilient Families" (24%). Multinomial logistic regression revealed that lower caregiver competence (higher FCTI scores) was strongly associated with profile membership (standardized aORs ranged from 2.58 to 43.19), whereas higher perceived social support (PSSS) was a significant protective factor (standardized aORs ranged from 0.03 to 0.19). Caregiver relationship and payment source were also significantly associated with profile membership. Family resilience among Chinese stroke families manifests in four distinct profiles, which are differentiated predominantly by caregiver competence and perceived social support. Our findings advocate for a precision family support paradigm, shifting from one-size-fits-all approaches to interventions tailored to distinct resilience profiles. Given the strong association, intervention programs should prioritize enhancing core caregiver competencies as a primary leverage point for building family resilience. Show less

Diabetic foot (DF) is a serious diabetes complication that increases ulceration, amputation and mortality risks. Effective foot self-care can prevent up to 85% of ulcer events. This study aimed to assess foot self-care behaviors among middle-aged and older DF patients, evaluate the impact of social support, and explore the mediating effects of frailty and fear of progression (FoP). We also identified patient subtypes using latent profile analysis. A cross-sectional study was conducted in a tertiary hospital from November 2024 to March 2025. A total of 361 patients with DF aged ≥45 years completed validated questionnaires, including the Social Support Rating Scale (SSRS), FRAIL Scale, FoP-Q-SF, and DFSQ-UMA. Structural equation modeling (SEM) assessed mediation effects, and latent profile analysis (LPA) identified subgroups based on frailty and FoP. A total of 383 questionnaires were distributed, with 361 valid responses collected, resulting in an effective response rate of 94.3%. The average score for foot self-care behavior was 58.52 ± 13.46, while levels of social support, frailty, and FoP were all at moderate levels. SEM indicated that Social support significantly predicted better foot self-care behavior (β = 0.225, P < 0.01). Frailty and FoP partially mediated this relationship (mediation effect: 6.68%). LPA identified three types of physical and mental profiles: Low FoP - Low Frailty Group (75.1%), Moderate FoP - Moderate Frailty Group (15.2%), and High FoP - High Frailty Group (9.7%). Importantly, patients in the High FoP-High Frailty Group demonstrated the lowest foot self-care behavior (mean = 43.70, P < 0.001), indicating the highest potential risk for ulcer occurrence and poor tissue outcomes. Social support enhances foot self-care in DF patients through reduced Frailty and FoP. Tailored interventions targeting high-risk subgroups may improve tissue outcomes and prevent ulcers. Show less

The impact of obstructive sleep apnea (OSA) on subsequent cardiovascular events in patients with acute coronary syndrome (ACS) remains debated. This study aims to investigate whether the association of OSA with cardiovascular events is affected by lipoprotein (a) [Lp(a)] levels. This is a sub-analysis of prospective cohort study (OSA-ACS, NCT03362385) enrolled ACS patients. OSA defined as an apnea-hypopnea index ≥15 events/h. The effects of OSA on subsequent cardiovascular outcomes were evaluated across varying Lp(a) thresholds. Coronary plaque features by coronary computed tomography angiography were also analyzed. A total of 1137 patients were enrolled, 608 patients (53.5%) were diagnosed with OSA. At a median follow-up of 3.6 years, OSA was associated with a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with Lp(a) level > median (HR 1.59, 95% CI 1.12-2.26, p=.009), but not in patients with Lp(a) level ≤ median (HR 1.09, 95% CI 0.80-1.49, p=.60). There were consistent increases in HRs for MACCE in the OSA group with Lp(a) levels rising, as stratified by tertiles or quartiles of Lp(a). In patients with Lp(a) level > median, OSA demonstrated a higher prevalence of ≥1 high-risk plaque (HRP) feature (51.4% vs. 33.3%, p=.03) and low-attenuation plaque (50.0% vs. 32.8, p=.04) per vessel than non-OSA. OSA was associated with a continuously increased cardiovascular risk and a higher prevalence of HRP features as Lp(a) levels rose. Lp(a) may help identify ACS patients at higher cardiovascular risk, in whom the efficacy of OSA treatment should be further investigated. Show less

Fear of disease progression (FoP) is a common psychological concern among patients with unruptured intracranial aneurysms (UIAs). However, heterogeneity in FoP and the role of psychological resilience before treatment remain insufficiently understood. In this cross-sectional study, patients with UIAs scheduled for endovascular treatment were recruited. FoP was assessed using the Fear of Progression Questionnaire-Short Form (FoP-Q-12), and psychological resilience was measured with the Connor-Davidson Resilience Scale (CD-RISC-25). Latent profile analysis (LPA) was conducted to identify distinct FoP profiles. Least Absolute Shrinkage and Selection Operator (LASSO) regression followed by multinomial logistic regression were used to examine factors associated with profile membership. Five distinct FoP profiles were identified: Minimal Fear-Good Adjustment, Mild Emotionally Elevated Fear, Moderate Emotionally Reactive Fear, Moderate Functionally Concerned Fear, and High Pervasive Fear. Multinomial logistic regression showed that higher psychological resilience-particularly the tenacity dimension-was associated with lower odds of belonging to the Mild Emotionally Elevated Fear, Moderate Emotionally Reactive Fear, and Moderate Functionally Concerned Fear profiles, compared with the Minimal Fear-Good Adjustment profile. No significant association was observed between tenacity and the High Pervasive Fear profile. Sensitivity analyses using alternative resilience indicators yielded consistent results. Among patients with UIAs prior to endovascular treatment, FoP exhibits marked heterogeneity. Psychological resilience, especially tenacity, is differentially associated with specific FoP profiles. These findings support the value of profile-based psychological assessment to inform targeted psychosocial support during treatment planning. Show less

Carboxymethylcellulose (CMC), a common food emulsifier, induces microbiota dysbiosis and systemic inflammation; however, its impact on transplant immunity remains unclear. Allogenic heart rejection was observed in CMC-fed recipient mice, with increased abundance of lysophosphatidic acid (LPA)-producing bacteria and increased serum LPA concentration. CMC-induced transplant rejection was caused by the gut microbiota, as confirmed by fecal microbiota transplantation and gut microbiota depletion. Furthermore, LPA-treated macrophages demonstrated a proinflammatory ability to accelerate allograft rejection in cytotoxic T lymphocyte-associated protein 4 immunoglobulin-induced allograft survival by upregulating glycolysis. Conversely, the administration of a glycolysis inhibitor resulted in allograft survival and abrogated the detrimental effect of LPA. Mass spectrometry and single-cell RNA sequencing confirmed that transplant patients with rejection showed significantly elevated serum LPA levels and LPA receptor 6 (LPAR6) expression in graft-infiltrate macrophages. Mechanistically, LPA preferentially promoted LPAR6 expression, which interacted with Rho-associated protein kinase 2 to activate the mammalian target of rapamycin/hypoxia-inducible factor 1-alpha pathway, thereby enhancing glycolysis and inducing proinflammatory macrophage polarization. Treatment with Ki16425, an LPAR antagonist, prolonged allograft survival in CMC-fed recipients. Our findings reveal a major detrimental effect of CMC on macrophage physiology and suggest that controlling LPAR6 expression or glycolysis in macrophages may improve allograft survival in transplant recipients. Show less

Serum lipoprotein(a) [Lp(a)] is recognized as an independent risk factor for cardiovascular disease. However, whether hypertension modifies the association between Lp(a) and adverse outcomes in acute decompensated heart failure (ADHF) remains unclear. We investigated how hypertension status influences the relationship between Lp(a) and all-cause mortality in ADHF. We conducted a single-center retrospective observational study including 2610 patients hospitalized with ADHF. We normalized the distribution of Lp(a) by a logarithmic transformation and assessed the risk of all-cause mortality with Lp(a), using Cox regression with adjustment for potential confounders. Among 2610 patients (39.0% women; mean age, 68.8 years), 1606 (61.5%) had hypertension. Over 4.1 years (median), 1287 deaths occurred. In all patients, log-transformed Lp(a) was significantly associated with mortality (adjusted HR 1.21; 95% CI, 1.05-1.39; Increased admission Lp(a) levels were associated with a higher risk of all-cause mortality in ADHF patients with hypertension. Further studies are needed to explore the mechanistic links among Lp(a), hypertension and ADHF. Show less

This study aims to examine the health characteristics of female sex workers (FSWs) in entertainment venues and to investigate the relationship between these characteristics and sleep quality. This study employed a cross-sectional design and was conducted from January to April 2024 in Wuhan, China. Participants were FSWs recruited through snowball sampling from entertainment venues, including hotels, restaurants, nightclubs, karaoke bars and dance halls. Data were collected via structured questionnaires covering sociodemographic information, work experience, psychological stress, health status, sleep quality and circadian rhythms. Latent profile analysis (LPA) was employed to identify health characteristic profiles among FSWs, and multivariate logistic regression was used to examine the associations between these profiles and sleep quality. Among the 1,036 FSWs surveyed, 45.1% had poor sleep quality. LPA classified FSWs’ health characteristics into three profiles: the high overall functioning group, the lower physical–emotional functioning group and the lower psychosocial functioning group. Multivariate logistic regression analysis showed that FSWs in the lower physical–emotional functioning group had higher odds of poor sleep quality (OR = 2.184) compared with those in the high overall functioning group. FSWs in the lower psychosocial functioning group had substantially higher odds of poor sleep quality (OR = 7.755) than that in the high overall functioning group. FSWs demonstrate substantial heterogeneity in health characteristics and exhibit lower overall sleep quality compared with the general population. Psychological and physiological factors are major influencing factors for their sleep quality, suggesting the importance of prioritising mental and physical health in this population. Show less

This study aimed to identify the heterogeneity of attitudes toward ageing among older adults in the “early transition period” (the initial 2–4 weeks after nursing homes transition from home to nursing homes). and the mediation effect of self-efficacy between attitudes toward ageing and quality of life (QoL). A total of 300 older adults were enrolled from October 2023 to May 2024. Participants completed the General Information Questionnaire, the Attitudes to Ageing Questionnaire (AAQ), the World Health Organization Quality of Life-Brief (WHOQOL-BREF), and the General Self-Efficacy Scale (GSES). Latent profile analysis (LPA), R3STEP methods, BCH methods, and mediation analysis were conducted to analyze the data. LPA categorized the attitudes toward ageing into three profiles: most negative (18.333%), moderately negative (64.000%), and positive (17.667%). Attitudes toward ageing profiles were associated with the following factors: age, pension, number of children, number of chronic diseases, ADL, willingness to reside in nursing homes, and social isolation. Self-efficacy partially mediates between attitudes toward ageing and the three dimensions of QoL (physical health, psychological health, and environmental health). Older adults during the “early transition period” had negative attitudes toward ageing. It may be related to the Chinese traditional interpersonal communication mode, family culture, and various maladaptive problems. Older adults who have two or more children, chronic diseases, no pension, moderate to severe dependency, involuntary admission to nursing homes, and social isolation are associated with more negative attitudes toward ageing. Mediation analysis reminds that self-efficacy can be used as intervention targets to improve the QoL. The online version contains supplementary material available at 10.1186/s12877-026-07007-7. Show less

Late-life depression shows heterogeneous developmental trajectories. Prior studies in older Chinese populations have identified distinct depressive trajectories, yet the influence of family emotional support across the life course remains underexplored. We conceptualized intergenerational emotional interaction patterns as the combined configuration of early-life parental affection and later-life emotional support from adult children. This study identified late-life depressive trajectories and tested whether these patterns predict depressive trajectory among Chinese older adults. Using China Health and Retirement Longitudinal Study (CHARLS) data (2011-2020; n = 9888), this study identified depressive trajectories using Latent Class Growth Modeling (LCGM) and Latent Profile Analysis (LPA) was used to categorize participants into subgroups based on maternal/paternal affection and emotional support from adult children. Multinomial logistic regression and Chi-square tests assessed associations between profiles and trajectories. Four depressive trajectories emerged: "no depression" (56.3%), "deterioration" (22.4%), "alleviation" (12.3%), and "chronic depression" (9.1%). Three distinct intergenerational emotional interaction patterns were found: "emotional inheritance" (40.7%), "emotional compensatory" (17.4%), and "emotional mismatch" (41.9%). The "emotion inheritance" group was overrepresented in the "no depression" trajectory, whereas the "emotional compensatory" group faced elevated risks for being classified into "deterioration" and "chronic depression" trajectories. Intergenerational emotional interaction patterns are independently and jointly associated with depressive symptoms trajectories in later life. The strongest protective effects were observed for individuals with both high childhood parental affection and ongoing emotional support from children. Conversely, low parental affection-even when compensated by later-life support-was linked to worse mental health outcomes. Show less

Background Although substantial evidence has demonstrated the impact of obesity on brain structure and cognition, the heterogeneity of adiposity-particularly in terms of fat distribution patterns-and its differential neurologic effects remain poorly understood. Purpose To identify body fat distribution patterns with MRI and latent profile analysis (LPA) and their associations with brain structure measurements, cognition, and neurologic diseases. Materials and Methods This secondary analysis used prospective data from the UK Biobank, including health records and MRI scans of the brain, heart, and abdomen. Fat distribution profiles were classified using LPA based on eight body mass index (BMI)-adjusted MRI-derived fat quantification metrics. Differences in brain volume, white matter properties, cognition, and the risk of neurologic disorders were analyzed across profiles and relative to a benchmark lean profile; analyses were stratified by sex. Group differences were examined using analysis of covariance (ANCOVA) or rank-based ANCOVA. Results Among 25 997 participants (mean age, 55 years ± 7.4 [SD]; 13 536 female participants), LPA identified six profiles of body fat distribution in both sexes. Four high-adiposity patterns were identified, including the pancreatic-predominant profile (profile 1), with elevated proton density fat fraction (mean BMI-adjusted Show less

Despite substantial progress in the management of cardiovascular disease (CVD), lipoprotein(a) [Lp(a)] persists as a genetically determined risk factor that remains insufficiently explored. Both extremely high and low levels of Lp(a) are linked to adverse outcomes. Current diagnostic assays for Lp(a) lack standardization, and conventional lipid-lowering therapies exert minimal effects on its levels, resulting in limited treatment options specifically targeting Lp(a). To address these gaps, we conducted a comprehensive molecular and clinical review of Lp(a), examining its unique structure, genetic determinants, metabolic pathways, and the factors influencing its plasma concentration. Furthermore, we discuss emerging therapeutic strategies aimed at targeting Lp(a). Show less

Physical inactivity is a health concern for children and adolescents with neurodevelopmental disorders (NDDs) as it directly increases their risk of developing various health problems. Evidence on differences in accelerometer-assessed physical activity between children and adolescents with and without NDDs is inconclusive. And age- and body mass index (BMI)-related effects on physical activity remain unclear. The systematic literature searches were performed in 6 databases up to March 2025. Methodological quality was evaluated by the Newcastle-Ottawa Scales. Data were pooled using a random-effects model. Hedges' g was used to express the effect size index with 95 % confidence interval (CI). Meta-regression on age and BMI was also performed to investigate the potential moderating effects. Out of the 2167 studies initially identified, 28 were included in the analysis, which comprised total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), and light physical activity (LPA) included in the meta-analysis, respectively. These studies involved 1060 children and adolescents with NDDs and 1820 without, aged 6.6-16.9 years. A small-to-moderate effect size exists for the difference in TPA (g=-0.299) and MVPA (g=-0.479) between children and adolescents with and without NDD, particularly indicating a difference in 12.7 min of MVPA daily. The difference in LPA was not significant (g=0.450, p = 0.125). The decline in MVPA with age was more pronounced in those with NDDs, and the difference in MVPA was smaller for those with lower BMI. The variation in MVPA differences by age and BMI highlights the need to develop better physical activity habits and reduce these disparities for children and adolescents with NDDs. Show less

Improved internet access has exposed rural adolescents in China to a greater risk of internet addiction. However, existing studies seldom examine the relationship between dynamic changes in internet addiction and psychosocial maladjustment. This study aims to explore the transition patterns of internet addiction and its associations with emotional and interpersonal problems over time. A one-year longitudinal survey was conducted among 782 middle school students in rural China. Latent Profile Analysis (LPA) was conducted to identify internet addiction profiles at two time points. Latent Profile Transition Analysis (LPTA) was then used to examine the transition patterns between profiles over time. Subsequently, statistical analyses were conducted to explore how these transitions were associated with emotional and interpersonal problems. Three profiles of internet addiction were identified: minimal-internet addiction, low-internet addiction, and high-internet addiction. Based on LPTA, most adolescents with higher internet addiction at T1 shifted to lower-severity profiles over time (high → minimal: 35.3%; low → minimal: 39.8%; high → low: 33.3%), while some with initially lower levels transitioned to more severe profiles (minimal → high: 6.9%; low → high: 12.2%; minimal → low: 25.7%). Transition into higher addiction profiles predicted increased depression, anxiety, and poorer relationships with parents, peers, and teachers. Conversely, reductions in addiction were linked to improved depressive symptoms. Changes in internet addiction have an impact on adolescent psychosocial maladjustment. Early detection and flexible interventions are essential in rural settings. Show less

This study aimed to investigate the latent profiles of clinical nurse preceptors (CNPs)' compassion fatigue (CF), identify the influencing factors, and examine their association with work alienation. Between July and August 2025, 340 nurse preceptors from a tertiary grade A general hospital in Zhejiang Province were recruited as participants using convenience sampling. The Chinese version of the Professional Quality of Life Scale Version 5 (ProQOL-5) and the Work Alienation Scale (WAS) were used to assess compassion fatigue and work alienation, respectively. Demographic information was also collected from the participants. Latent Profile Analysis (LPA) was employed to identify potential profiles of compassion fatigue. After screening variables through univariate analysis and multicollinearity tests, multinomial logistic regression was used to assess the influencing factors. Furthermore, a one-way ANOVA was conducted to examine differences in work alienation among different potential profiles, and the results were interpreted based on the job demands-resources (JD-R) model theoretical framework. A total of 320 CNPs were included in the final analysis. The findings of the latent profile analysis indicated that three latent profiles of CNPs' compassion fatigue were identified: high-satisfaction-low-exhaustion group (n = 56, 17.5%), moderate compassion fatigue group (n = 160, 50%), and severe exhaustion group (n = 104, 32.5%). Multinomial logistic regression analysis showed that age, marital status, education, years of preceptorship, experience, employment type, and professional title were significant predictors of compassion fatigue among CNPs. There were statistically significant differences in the work alienation scores among the three latent profiles (P < 0.001). CNPs' compassion fatigue can be categorised into three types, with significant heterogeneity observed among them. Notable differences exist in work alienation among CNPs with different compassion fatigue types. These findings suggest that clinical managers and educators should develop targeted interventions and support systems based on these circumstances. Therefore, formulating such management strategies is crucial for alleviating work alienation among CNPs and will help improve nurse retention rates and the quality of clinical education. Show less

The associations between 24-h movement behaviours (24 h MBs) and emotional and behavioural problems (EBPs) in early years are not well understood. This study examined these associations in a nationally representative sample of Chinese preschoolers. As part of the Chinese cohort of the SUNRISE International Study of Movement Behaviors in the Early Years main study, this research recruited 1316 children aged 3-4 years through multistage stratified cluster sampling in urban and rural areas across seven major administrative regions in China. Moderate- to vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA) and sedentary behaviour (SED) were measured using 24-h accelerometry over five consecutive days. Sleep duration was parent-reported. EBPs were evaluated using the parent-rated Strengths and Difficulties Questionnaire (SDQ), which assesses total difficulties, internalising problems, externalising problems and prosocial behaviour. Compositional multiple linear regression was employed to analyse the relationships between 24 h MBs and EBPs. Compositional isotemporal substitution was also utilised to predict changes in EBPs due to reallocating time among 24 h MBs. Isotemporal substitution analyses revealed that replacing as little as 1 min of MVPA, LPA or SED with sleep was associated with significant reductions in total difficulties (β Increasing LPA by reducing MVPA or SED was significantly associated with improvements in internalising and conduct problems, whereas increasing sleep to decrease MVPA or SED-even by small amounts-was consistently associated with improvements in EBPs across all SDQ subscales. However, increasing LPA at the expense of sleep exacerbates total difficulties and externalising problems. Promoting diverse LPA opportunities alongside sufficient sleep, while maintaining a balance between them, is essential for supporting preschoolers' emotional and behavioural development. Show less

Lupus nephritis (LN) is a severe autoimmune disease often complicated by steroid resistance (SR), leading to treatment failure and poor prognosis like atherosclerosis (AS). Our study found that Panax notoginseng saponins (PNS) improve lipid metabolism and prevent AS in steroid-resistant LN by up-regulating PPARγ, though mechanisms are unclear. Recent research highlights the roles of macrophages, with M1 Mø promoting inflammation and M2 Mø providing protection, as PPARγ influences Mø's polarization, linking it to inflammation and M2 polarization, necessitating further investigation. Therefore, we conduct this study to investigate the regulatory effect of PNS on the "Mø M2 polarization-PPARγ" positive regulation, endeavoring to elucidate its therapeutic potential of delaying AS and reversing SR in LN. PPARγ expression in polarized Mø was measured via PCR and WB, while M1/M2 biomarkers and cytokines, influenced by PPARγ modulation, were assessed using flow cytometry and ELISA. In mouse Mø treated with PNS, IL-4, or both, PPARγ and cytokines were measured. ICR and MRL/lpr mice were used to establish an in vivo SR model to confirm PNS's role in M2 polarization of Mø and AS protection by analyzing blood lipid levels, iNOS, Lp(a), and apoptosis rates through WB, immunohistochemistry, HE-staining, and TUNEL. PNS's efficacy in renal protection and SR reversal was evaluated through Scr, BUN, urine protein, renal pathology, and P-gp; MDR1 expression was assessed via biochemical detection, HE-staining, flow cytometry, and WB. This study confirmed that PNS upregulates PPARγ and promotes M2 polarization, improving abdominal aorta pathology and delaying AS. It also enhances renal function and reverses SR by reducing P-gp and MDR1. This study shows that PNS promotes Mø polarization to M2 and enhances PPARγ expression, effectively preventing AS, improving renal function, and reversing SR in LN, offering insights for LN treatment and expanding PNS's therapeutic benefits for future research. Show less