👤 Liang Hu

Diabetic foot ulcer (DFU), a serious complication of diabetes, is a life-threatening disease that often leads to lower limb amputation and a shortened lifespan. Interleukin-27 (IL-27) is a member of the IL-12 family and has the potential to exert dual effects on the immune response. The role of IL-27 in diabetic skin wound healing is unknown. The aim of this study was to investigate whether there is abnormal expression of IL-27 in diabetic skin and whether supplementation with IL-27 can promote diabetic wound healing by modulating macrophage polarization. We established a streptozotocin (STZ)-induced diabetic mouse model and constructed diabetic wounds. We assessed protein expression by western blotting (WB) and immunohistochemical (IHC) staining. We also performed hematoxylin-eosin (H&E) staining and Masson's trichrome staining. In the presence of lipopolysaccharide (LPS) and high glucose (HG), we treated the mononuclear macrophage line RAW264.7 and bone marrow-derived macrophages (BMDMs) with IL-27. To assess macrophage polarization, we examined the expression of inducible nitric oxide synthase (iNOS), IL-1β and arginase-1 (Arg-1). To understand the underlying mechanisms, we used macrophage IL-27ra knockout mice to knockout macrophage IL-27 receptors. Our in vivo experiments revealed that the expression of IL-27 in the skin of diabetic mice was significantly decreased and that supplementation with IL-27 promoted diabetic wound healing. In vitro, compared with the LPS group, supplementation with IL-27 alleviated the suppression of multiple cellular functions, such as iNOS and IL-1β expression, cell migration, and phagocytosis, in macrophages after HG exposure. Mechanistically, we found that IL-27 expression was decreased and that the activation of signal transducer and activator of transcription 3 (STAT3) by phosphorylation was inhibited in diabetic skin, leading to an inability of wound macrophages to polarize to an M1 phenotype effectively, which in turn blocked M1-to-M2 polarization of wound macrophages and ultimately delayed wound healing. The present study revealed that supplementation with IL-27 promoted M1-to-M2 polarization of wound macrophages and diabetic wound healing through the IL-27-IL-27Rα-p-STAT3 axis. These findings suggest that IL-27 may be a potential therapeutic target for DFU. Show less

Neurodevelopmental disorders such as attention deficit and disruptive behaviour disorders (ADHD), autism spectrum disorder (ASD), and schizophrenia have been increasingly prevalent recently. Previous research has demonstrated that inflammatory activity from autoimmune diseases is involved in neurological diseases. However, some studies question the association between inflammatory activities and neurodevelopmental disorders. Herein, we attempt to clarify this relationship using Mendelian randomization (MR) analysis. We used systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and type 1 diabetes mellitus (T1D) to represent autoimmune diseases. First, we conducted MR analysis to examine associated SNPs between autoimmune and neurodevelopmental disorders. Second, we performed bidirectional MR analysis to identify 429 types of signalling peptides and proteins or relevant receptors with causality reported diseases. Finally, we compared the genes with the gene loci identified in the available TWAS-hub site. The MR results of autoimmune diseases on neurodevelopmental disorders did not present any significant association in all models. However, we identified 20-45 factors in ADHD, ASD, and schizophrenia, including semaphorin 3, IL-27 receptor subunit alpha, and fibroblast growth factor 16, which were considered clinically significant pro-inflammatory mediators. GO and KEGG enrichment analyses revealed unequal integrities among the three neurodevelopmental diseases, and we failed to identify a shared pathway linking autoimmune diseases and neurodevelopmental disorders. TWAS analysis indicated that CHRNA5 potentially mediates inflammatory activities in schizophrenia. According to our data, we failed to identify an association between autoimmune diseases and neurodevelopmental disorders. However, we demonstrated that some pro-inflammatory factors are involved in neurodevelopmental disorders. Show less

Tuberculosis (TB) is a serious public health concern in many regions of the world and the only approved vaccine to prevent TB is the live-attenuated BCG vaccine. Despite being widely used, the BCG vaccine fails to prevent pulmonary TB in adults. The BCG vaccine is administered during the neonatal period when levels of the immunosuppressive cytokine interleukin (IL)-27 are elevated, and previous studies have demonstrated that the source of IL-27 can impact downstream immune responses. We therefore sought to characterize the specific subpopulations of myeloid cells that produce IL-27 following BCG vaccination. To investigate this, we administered the BCG vaccine to neonatal IL-27p28eGFP mice that report IL-27 production. Our studies demonstrated that BCG vaccination steadily increased IL-27 production throughout the weeks post-vaccination. We also showed that a predominantly CD11b+ F4/80+ population of IL-27 producers increased MHC class II expression following BCG vaccination in both the spleen and the lung. However, producers of IL-27 in these tissues differ, with a population of CD11c+ MHC II+ cells emerging in the spleen and a subset of Ly6G/C+ MHC II+ emerging in the lung. 10x scMultiome analysis further validated the increase in MHC class II expression and demonstrated improved antigen presentation functionality following vaccination. The sequencing analysis also revealed subpopulations of IL-27 producers with immunosuppressive functions such as a population of macrophages with increased Mrc1 expression post-vaccination. Our findings suggest that IL-27 producers are a heterogenous population of myeloid cells that impact the development of protective immune responses induced by the BCG vaccine. Show less

Acute pulmonary inflammation is a severe lower respiratory tract infection. Sinensetin (SIN), a polymethoxyflavone with strong anti-inflammatory properties, is known to ameliorate LPS-induced acute inflammatory lung injury, but its molecular mechanisms are not fully understood. This study aimed to provide insight into the pharmacological mechanisms of SIN in attenuating acute pulmonary inflammation. In LPS-induced inflammation assays in vivo and in vitro, SIN significantly reduced the mRNA levels of inflammatory genes including MCP-1, ICAM1, Ccl3, Ccl4, Ccl5, Ccl7, Cxcl9, Cxcl10, IL1α, IL1β, IL6, IL11, IL18, IL27, TNF-α, IFN-γ, TLR4, MyD88, F4/80, COX2, iNOS, NLRP3, ASC, JAK2, STAT3, STAT4, and Bcl2l1, as well as increased the mRNA levels of anti-inflammatory genes such as IL4, IL10, and IL12α. Besides, SIN markedly decreased the expression of CD68, TLR4, MyD88, phospho-IκBα (S32/S36), phospho-NF-κB p65 (S536), MCP-1, ICAM1, phospho-JAK2 (Tyr1008), phospho-STAT1 (S727), phospho-STAT3 (Y705), and phospho-STAT4 (Y693), inhibited NF-κB p65 translocation into the nucleus, thereby blocking in combination with STAT transcription factors to induce target gene expression. Further GC-MS/MS and LC-MS/MS metabolomic analysis revealed that SIN significantly increased the abundance of anti-inflammatory metabolites, such as L-alanine, L-carnitine, L-glutamic acid, Glycine, and L-cysteine. In conclusion, the results indicated that SIN attenuated LPS-induced acute pulmonary inflammation by modulating NF-κB p65-mediated immune resistance and STAT3-mediated tissue resilience. All these favorable findings presented critical insights into the remarkable abilities and health benefits of SIN in ameliorating inflammatory lung disease. Show less

Human neonates are predisposed to an increased risk of mortality from infection due to fundamental differences in the framework of innate and adaptive immune responses relative to those in the adult population. As one key difference in neonates, an increase in the immunosuppressive cytokine, IL-27, is responsible for poor outcomes in a murine neonatal model of bacterial sepsis. In our model, the absence of IL-27 signaling during infection is associated with improved maintenance of body mass, increased bacterial clearance with reduced systemic inflammation, and decreased mortality rates that correlate to preservation of glucose homeostasis and insulin production. To further elucidate the mechanisms associated with IL-27 signaling and metabolic fitness, we analyzed global transcriptomes from spleen, liver, pancreas, and hindlimb muscle during Show less

In recent years, the discovery of IL-12 family cytokines, which includes IL-12, IL-23, IL-27, IL-35, and IL-39, whose biological functions directly or indirectly affect various autoimmune diseases. In autoimmune diseases, IL-12 family cytokines are aberrantly expressed to varying degrees. These cytokines utilize shared subunits to influence T-cell activation and differentiation, thereby regulating the balance of T-cell subsets, which profoundly impacts the onset and progression of autoimmune diseases. In such conditions, IL-12 family members are aberrantly expressed to varying degrees. By exploring their immunomodulatory functions, researchers have identified varying therapeutic potentials for each member. This review examines the physiological functions of the major IL-12 family members and their interactions, discusses their roles in several autoimmune diseases, and summarizes the progress of clinical studies involving monoclonal antibodies targeting IL-12 and IL-23 subunits currently available for treatment. Show less

Tuberculous pleural effusion (TPE) diagnosis still faces many difficulties and challenges. Some studies have shown that pleural interleukin -27 (IL-27) had a diagnostic potential for TPE. However, their findings are not always consistent. This study aimed to investigate the diagnostic accuracy of pleural IL-27 for TPE. We prospectively enrolled 211 patients with undiagnosed pleural effusion. Effusion Mycobacterium tuberculosis (Mtb) culture, Ziehl-Neelsen staining, biopsy, and response to antituberculosis therapy were used to define TPE. The pleural IL-27 levels were determined by enzyme-linked immunosorbent assay (ELISA). A receiver operating characteristic curve (ROC) with the area under the curve (AUC) was used to evaluate the diagnostic accuracy of IL-27 for TPE. In addition, we investigated the influence of age on the diagnostic performance of IL-27 by resampling patients with different upper age limits in the inclusion criteria. Among the 211 enrolled participants, 33 were TPE and 178 were non-TPE. The mean concentration of IL-27 in TPE patients was significantly higher than that of non-TPE patients. The AUC of IL-27 was 0.76 (95 %CI: 0.67-0.86). At the threshold of 500 pg/mL, the sensitivity and specificity of IL-27 were 0.26 (95 %CI: 0.20-0.33) and 0.91 (95 %CI:0.76-0.97), respectively. The AUC of IL-27 is 0.84 in patients with an upper age limit of 70. Still, it decreased to 0.76 in patients with an upper age limit of 75. Age can affect the diagnostic performance of IL-27 for TPE. Show less

Although the human cerebellum is known to be neuropathologically impaired in Alzheimer's disease (AD) and AD-related dementias (ADRD), the cell type-specific transcriptional and epigenomic changes that contribute to this pathology are not well understood. Here, we report single-nucleus multiome (snRNA-seq and snATAC-seq) analysis of 103,861 nuclei isolated from both cerebellum and frontal cortex of AD/ADRD patients and normal controls. Using peak-to-gene linkage analysis, we identified 431,834 significant linkages between gene expression and cell subtype-specific chromatin accessibility regions enriched for candidate cis-regulatory elements (cCREs). These cCREs were associated with AD/ADRD-specific transcriptomic changes and disease-related gene regulatory networks, especially for RAR Related Orphan Receptor A (RORA) and E74 Like ETS Transcription Factor 1 (ELF1) in cerebellar Purkinje cells and granule cells, respectively. Trajectory analysis of granule cell populations further identified disease-relevant transcription factors, such as RORA, and their regulatory targets. Finally, we pinpointed two likely causal genes, Seizure Related 6 Homolog Like 2 (SEZ6L2) in Purkinje cells and KAT8 Regulatory NSL Complex Subunit 1 (KANSL1) in granule cells, through integrative analysis of cCREs derived from snATAC-seq, genome-wide AD/ADRD loci, and three-dimensional (3D) genome data. Via CRISPRi experiments, we found that perturbation of rs4788201 and rs62056801 significantly inhibited the expression of their target genes, SEZ6L2 and KANSL1, in human iPSC-derived neurons. This cell subtype-specific regulatory landscape in the human cerebellum identified here offers novel genomic and epigenomic insights into the neuropathology and pathobiology of AD/ADRD and other neurological disorders if broadly applied. Show less

Studies have indicated that COVID-19 infection may accelerate the aging process in organisms. However, it remains unknown whether contracting COVID-19 affects life expectancy. Furthermore, the underlying biological mechanisms behind these findings are still unclear. We conducted a prospective cohort study on 56,504 participants of European ancestry from the UK Biobank who reported the time and number of COVID-19 infection between January 2020 and September 2023. The parental average longevity was used as a proxy for their own longevity. Linear regression was used to assess the relationship between COVID-19 infection and longevity. Furthermore, we investigated the shared genetic basis between COVID-19 and longevity using large-scale genome-wide association studies (GWAS) for COVID-19 (122,616 cases and 2,475,240 controls) and longevity (3,484 cases and 25,483 controls). Mendelian randomization (MR) and mediation analysis were utilized to assess causal relationships and potential mediators between COVID-19 susceptibility and longevity. Shared genetic loci between the two phenotypes were identified using conjunctional false discovery rate (conjFDR) statistical frameworks. After controlling for relevant covariates, COVID-19 infection might not be significantly correlated with longevity. In all MR methods, generalized summary-data-based Mendelian randomization (GSMR) analysis revealed a significant decrease in longevity due to severe COVID-19 infection (OR = 0.91, 95%CI: 0.84-0.98, P = 0.015). Mediation analysis identified stroke and myocardial infarction as potential mediators between COVID-19 susceptibility and reduced longevity. At conjFDR < 0.05, we identified rs62062323 (KANSL1) and rs9530111 (PIBF1) as shared loci between COVID-19 and longevity. Together, our findings provided preliminary evidence for the shared genetic basics between COVID-19 and aging. This discovery may have implications for personalized medicine and preventive strategies, helping identify individuals who may be more vulnerable to severe outcomes from COVID-19 due to their genetic makeup. Show less

Health literacy plays an important role in disease prevention and control. The aim of this study is to explore the health literacy patterns and associated factors among residents in Zhejiang Province. This study included 56,863 residents aged 15-69 years from the 2024 Zhejiang Province Health Literacy Survey. Latent Profile Analysis (LPA) was used to investigate health literacy patterns, and multinomial logistic regression analysis was employed to identify associated factors. Dominance analysis was performed to compare the relative contribution of the main variables associated with health literacy. The analysis identified three distinct health literacy profiles: low literacy (15.13%), moderate literacy (32.24%), and relatively high literacy (52.63%). The low literacy group was characterized by an older demographic (with an average age of 58.71 years), lower educational attainment (20.72% had no formal education), a higher proportion of farmers (52.93%), and a significant share of low-income individuals (40.98%). Multinomial logistic regression and dominance analysis revealed that education level, age, and occupation were the most important associated factors of health literacy. The study findings highlighted the heterogeneity in health literacy among various population groups and emphasized the need for targeted interventions. This study provides empirical evidence to inform precision health promotion strategies in developed regions of China. Show less

In China, work connectivity behavior after-hours (WCBA) among operating room nurse who are parents (OR nurse-parents) are associated with increased occupational fatigue, whereas psychological detachment may serve as a potential protective factor. A thorough understanding of the relationship among the three factors is conducive to the management of occupational fatigue. Explore the relationship between OR nurse-parents' WCBA and occupational fatigue through Latent Profile Analysis (LPA), and analyze the mediating effect of psychological detachment. This study constituted a secondary analysis of cross-sectional data from a prior study involving OR nurse-parents in 15 tertiary hospitals in Shandong Province, China. Inclusion criteria were: (1) registered nurse with >1 year of OR experience; (2) parent of at least one child aged 0-18 years; (3) voluntary informed consent. Exclusion criteria were: (1) temporary staff or interns; (2) on extended leave during the study; (3) major comorbidities. A two-part analytical strategy was used. First, latent profile analysis identified subgroups by WCBA, psychological detachment, and occupational fatigue, with multinomial logistic regression then examining predictors of profile membership. Second, a parallel mediation analysis tested psychological detachment as a mediator between WCBA and occupational fatigue. Data came from the 724 included OR nurse-parents. LPA revealed a three-profile model: "low WCBA-high psychological detachment-low occupational fatigue group (22%)," "moderate WCBA-moderate psychological detachment-moderate occupational fatigue group (50%)," and "high WCBA-low psychological detachment-high occupational fatigue group (28%)." Multivariate analysis identified working over 10 h daily as a risk factor for the high-risk group. Furthermore, Psychological detachment partially mediated the WCBA- occupational fatigue relationship across all occupational fatigue dimensions, accounting for 17.73%-31.52% of total effects. Mediation analysis confirmed that psychological detachment partially mediates the relationship between WCBA and occupational fatigue. LPA of WCBA, psychological detachment, and occupational fatigue revealed a three-profile solution among operating room nurse-parents in Shandong Province. A critical finding of LPA is that WCBA moderates the relationship between occupational fatigue and psychological detachment, creating a dual effect: while psychological detachment generally reduces occupational fatigue, its benefit diminishes or reverses under moderate WCBA, likely due to unclear communication expectations. Therefore, effective interventions must address both aspects: managing after-hours connectivity to reduce its intrusion and proactively promoting genuine psychological detachment to mitigate fatigue. Show less

Patients experiencing premature cardiovascular events (males: <55 years; females: <65 years) represent a high-risk subgroup within the atherosclerotic cardiovascular disease (ASCVD) population. Elevated lipoprotein(a) (Lp[a]) is an independent, genetic, causal risk factor for ASCVD. Lp(a) distribution among patients with premature ASCVD is poorly characterized. This study aimed to describe Lp(a) distribution and baseline characteristics in a large real-world sample of patients with premature ASCVD. We identified 17,594 patients with premature ASCVD who had Lp(a) values from US Medicare, Medicaid, and commercial plans between January 2016-September 2022. Mean age (SD) was 50.9 (10.1) years, most patients were female (68.9%), and half (52.2%) were not prescribed lipid-lowering therapy. Lp(a) levels ≥125, ≥175, and ≥225 nmol/L occurred in 26.8%, 18.8%, and 11.5%, respectively. Black patients had higher median (Q1-Q3) Lp(a) levels (111.0 [51.1-206.0] nmol/L) than Asian (35.0 [14.4-100.0] nmol/L), Hispanic (31.0 [10.9-95.0] nmol/L), or White patients (31.0 [10.7-110] nmol/L). In one of the largest studies in the US investigating Lp(a) distribution in premature ASCVD, we found over a quarter of patients had elevated Lp(a) (≥125 nmol/L). Show less

Perimenopause is a critical turning point in women's life cycle, and the issue of sleep disturbance during perimenopause not only affects individual health, but also has profound implications for family functioning, socioeconomic status, and public health policies. Therefore, this study aims to explore different potential profiles of sleep quality in perimenopausal women in the community and analyze the influencing factors of different profiles. A cross-sectional study was conducted from July 2024 to December 2024, and a total of 281 perimenopausal women in the community were recruited from 4 communities in Bengbu by convenience sampling. The participants completed the pittsburgh sleep quality index (PSQI), and self-rating anxiety scale (SAS), self-rating depression scale (SDS) and simplified coping style questionnaire (SCSQ). Latent profile analysis(LPA) was employed to identify latent profiles of sleep quality of perimenopausal women in the community. The predictors of sleep quality in different latent profiles were assessed via multinomial logistic regression analysis. One-way ANOVA, chi-square test or Fisher exact test, and the Kruskal-Walis test were used to compare the PSQI scores of perimenopausal women in the community under different latent profile characteristics. The mean age of 281 perimenopausal women was 50.09 ± 5.08 years, and the prevalence of sleep disorders was 31.3%. The sleep quality of perimenopausal women in community could be divided into three different latent profiles: good sleep quality group (68.7%), falling sleep and maintenance difficulty group (24.2%), and poor sleep quality with sleep disorder group (7.1%). Taking the good sleep quality group as the reference group, drinking history (OR = 2.061), chronic disease history (OR = 2.154), spouse's health status (OR = 1.871) and anxiety (OR = 4.390) were the risk factors to predict the difficulty in falling asleep and maintaining sleep in community perimenopausal women (P < 0.05). Spouse's health status (OR = 2.139) and anxiety (OR = 19.029) were the risk factors for poor sleep quality and sleep disorders in community perimenopausal women (P < 0.05). There are three qualitatively different potential profile categories of sleep quality in perimenopausal women in the community, and drinking history, chronic disease, poor spouse health and anxiety have predictive effects on their profile categories. In the future, community nursing staff can take targeted interventions according to different categories of sleep quality in perimenopausal women to improve sleep quality and level of health promotion. 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

This study aimed to elucidate the psychological mechanisms underlying the relationship between alexithymia and problematic eating behaviors (EB) among older adults. Specifically, we examined whether physical activity (PA) mediated this association, and we further explored the heterogeneity of alexithymia using Latent Profile Analysis (LPA). A cross-sectional survey was conducted among 1,773 community-dwelling older adults in China. Participants completed validated questionnaires assessing alexithymia, PA, and EB. Mediation analysis tested the indirect effect of PA on the alexithymia-EB relationship, while LPA identified subgroups of individuals with distinct alexithymia profiles. Mediation analysis revealed that PA significantly mediated the relationship between alexithymia and maladaptive EB, accounting for 18% of the total effect. LPA supported a three-profile solution: pervasive alexithymia (21.15%), adaptive (72.81%), and affective-cognitive dissociation (6.04%). Profile membership was differentially associated with health behaviors, with the pervasive group showing the most unfavorable outcomes (high EB, low PA), and the adaptive group demonstrating the most favorable pattern. These findings highlight PA as a key behavioral pathway through which alexithymia contributes to maladaptive eating in older adults. Moreover, alexithymia is not uniform but heterogeneous, with distinct profiles that confer varied health behavior risks. Interventions to improve eating habits in elderly populations may benefit from tailoring strategies to alexithymia subtypes and systematically promoting PA as an adaptive regulatory mechanism. 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

While most patients with stage I non-small cell lung cancer (NSCLC) remain recurrence-free after resection, some still develop recurrent disease. The surgical curative time window concept, defined as no recurrence through 5-year follow-up, helps identify potentially cured patients, yet predictive clinicopathologic features in stage I invasive NSCLC need clarification. This study sought to identify such features to enable risk-adapted surveillance. We analyzed a prospectively collected dataset of patients with stage I invasive NSCLC who underwent R0 resection between 2008 and 2015. Cox regression analysis was used to evaluate the association between clinicopathologic features and disease recurrence, aiming to identify independent prognostic factors. A total of 1,817 patients met the inclusion criteria. The 5-year cumulative incidence of recurrence was 14.6%. Female sex, tumor size ≤2 cm, lepidic-predominant adenocarcinoma (LPA) histologic type, presence of a ground-glass opacity (GGO) component, and solid component size ≤10 mm were identified as independent prognostic factors. A risk stratification system was subsequently developed, classifying patients into two groups: a low-risk group (with ≥4 factors; n=341) and an elevated-risk group (with <4 factors; n=1,476). Kaplan-Meier analysis revealed statistically significant differences in recurrence-free survival (RFS), overall survival (OS), and lung cancer-specific survival (LCSS) between the two groups (P<0.001). The low-risk group is considered to represent the population within the surgical curative time window. Patients with stage I invasive NSCLC who meet at least four of the following five criteria-female sex, tumor size ≤2 cm, solid component ≤10 mm, presence of a GGO component, and LPA histologic type-may be considered within the "surgical curative time window" and may therefore qualify for reduced surveillance intensity. Show less

Anxiety is significantly correlated with levels of physical activity in university students. This research assessed the effects of anxiety on engagement in physical activity and explored the potential mediating function of psychological resilience. Additionally, latent profile analysis (LPA) was employed to identify distinct subtypes based on anxiety and resilience levels, and to explore their associations with physical activity. Utilizing a non-probability convenience sampling approach, this cross-sectional study recruited a total of 1,436 collegiate participants from multiple universities. Data collection was carried out with the Generalized Anxiety Disorder Scale (GAD-7), the abbreviated Connor-Davidson Resilience Scale (CD-RISC-10), and the Physical Activity Rating Scale (PARS-3). Data analysis included mediation effect analysis via Bootstrap methods (Model 4) and latent profile analysis (LPA). Anxiety demonstrated a significant negative association with physical activity ( Results demonstrated that anxiety affects physical activity both directly and indirectly, with the latter effect occurring through the channel of psychological resilience. Latent profile analysis identified three distinct profiles among college students based on anxiety and psychological resilience: High Anxiety-Low Psychological Resilience, Moderate Anxiety-Moderate Psychological Resilience, and Low Anxiety-High Psychological Resilience. Marked variations in physical activity levels were observed among these subgroups. The results underscore the complex relationships among mental health indicators and health behaviors within the collegiate population. The delineation of distinct profiles offers practical implications for designing tailored intervention strategies. Show less

This study employed a person-centered Latent Profile Analysis (LPA) to explore adolescents' perceived teacher-student and friendship relationships in the school environment and to examine their association with interest in physical education. A survey was conducted among 3,613 adolescents using the Teacher-Student Relationship Scale, the Friendship Quality Scale, and the Interest in Physical Education Scale. LPA was applied to identify relationship quality profiles, and multinomial logistic regression was used to examine gender differences and associations with interest in physical education. Three profiles emerged from the LPA: the Low Relationship Quality profile (23%, Adolescents exhibit heterogeneous experiences of teacher-student and friendship relationship quality, which were significantly associated with differences in interest in physical education. By applying a person-centered approach, the study extends prior research by showing that teacher-student and friendship contexts are linked to adolescents' interest in physical education, underscoring the importance of considering interest as a distinct outcome in relational research. Show less

Undergraduate nursing students face significant academic and practical challenges, with their responses reflecting their academic resilience. However, most studies have overlooked the differences in their levels of academic resilience and the factors contributing to these differences. To identify the latent profiles of undergraduate nursing students' academic resilience and to analyze their influencing factors. A cross-sectional study was carried out among 1795 undergraduate nursing students from November 2022 to October 2023 by employing the general information questionnaire, the academic resilience questionnaire for college students, and the brief 2-way social support scale. Latent profile analysis (LPA) was used to analyze the latent profiles of academic resilience, and multiple logistic regression was utilized to explore the factors associated with the identified profiles. Four potential profiles were identified: low academic resilience group, moderate academic resilience group, high academic resilience but low focus and dissociation group, and high academic resilience group. Residence, attitude towards the nursing profession, self-directed study duration, academic performance rank, received and provided instrumental support were found to be associated with the different profiles. These findings highlight the heterogeneity in academic resilience and support tailored educational interventions based on students' specific academic resilience profiles. Show less

ObjectiveTo describe characteristic CLEFT-Q response profiles and patterns in patients with cleft palate and/or lip (CP ± L).DesignRetrospective analysis using latent profile analysis (LPA) to categorize patient-reported outcome responses into distinct profiles.SettingTertiary care pediatric hospital with multidisciplinary cleft team.Patients, ParticipantsPatients aged 8-29 years with CP ± L completing CLEFT-Q questionnaires from September 2021 to June 2025 ( Show less

This cross-sectional study aims to describe the characteristics of physical activity, sedentary time, sleep quality, and resting EEG among college students with mild depressive symptoms, and further explore pairwise correlations between behavioral patterns, resting EEG, and mild depressive symptoms. This study included 75 college students with mild depressive symptoms (MDS) and 75 college students without depressive symptoms (ND) as research subjects. Physical activity (vigorous physical activity (VPA), moderate physical activity (MPA), and low physical activity (LPA)) and sedentary time（ST） were measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Resting EEG power values were collected from subjects in a quiet, eyes-closed state using an electroencephalography (EEG) device. (1) Characteristic analysis revealed that compared with the ND group, the MDS group exhibited reduced MPA and VPA scores, elevated ST scores, and increased total PSQI scores along with elevated scores across its subdimensions. Their behavioral patterns (Moderate-to-Vigorous Physical Activity (MVPA), Sedentary Behavior (SB), Poor Sleep Quality (PSQ) may have changed, including a decrease in the proportion of MVPA, an increase in the proportion of SB, and an increase in the proportion of PSQ. Analysis of resting EEG revealed increased Alpha2 (α2) band power in the temporal regions (T3 and T5) and increased Beta1 (β1) band power in the frontal region (Fp1) in the MDS group (all p College students with mild depressive symptoms may exhibit altered behavioral patterns and abnormal neural activity in the frontal and temporal regions. Their changed behavioral patterns may correlate with mild depressive symptoms, and recognition models based on certain resting EEG indicators demonstrate preliminary application potential. The association between specific sleep issues and localized EEG activity in this population may provide evidence for further elucidating the mechanistic pathways linking their behavior and brain activity. Future longitudinal studies are recommended to explore causal relationships among these variables. Show less

Traditional approaches to assessing sleep quality in clinical nurses often overlook population heterogeneity and the complex interplay of influencing factors. This study employs Latent Profile Analysis (LPA) and Association Rule Mining (ARM) to identify distinct sleep quality subgroups and uncover key factor combinations, thereby informing targeted intervention strategies. A total of 1,686 nurses from 123 hospitals in Shandong Province were recruited through multistage stratified sampling. LPA was used to classify participants based on seven sleep dimensions from the Pittsburgh Sleep Quality Index (PSQI), while ARM was applied to identify frequent itemsets of sleep disorder triggers. Key influencing factors were further examined using univariate analysis and multivariate logistic regression. Three latent sleep profiles were identified: high (63.11%), moderate (34.10%), and low (2.79%) sleep quality. The low-sleep subgroup was characterized by higher proportions of being unmarried/divorced (42.55%), low monthly income (≤ 3,000 CNY, 42.55%), non-permanent employment (76.60%), and severe psychological distress (44.68%). In contrast, the high-sleep subgroup featured higher rates of being married (85.62%), moderate income (3,001–7,000 CNY, 73.03%), and low psychological distress (51.32%). Key determinants included marital status (OR = 2.153/2.252), income (OR = 9.098), employment type (OR = 1.475), and psychological state (OR = 0.060–0.555). ARM revealed distinct risk combinations: “low income + non-permanent employment” (lift = 3.895) for the low-sleep group; “married + moderate income + non-permanent employment + patient conflict” for the moderate group; and “high income + low psychological distress” buffering night-shift effects in the high-sleep group. By integrating LPA and ARM, this study reveals the multidimensional heterogeneity and interactive mechanisms underlying clinical nurses’ sleep quality. The findings support a stratified intervention framework combining institutional safeguards with precision strategies to enhance sleep health management in nursing populations. Show less

Human papillomavirus (HPV) infection is a global public health issue, and HPV-related stigma can affect cervical cancer prevention. But no validated tools exist to assess HPV stigma in Chinese adult women infected with HPV. This study aimed to adapt and validate the HPVsStigma scale (HPV-SS) in the Chinese context. A cross-sectional study was conducted from December 2024 to February 2025 among 501 HPV-infected women in Shenzhen, China. The HPV-SS was adapted from a 12-item HIV stigma scale. Demographic characteristics, HPV-related variables, and data on mental health were collected. Factor analyses (FA) were used to assess the scale's factorial structure, reliability, and validity. The bi-factor model was used to determine the score-reporting method of the scale. Item response theory (IRT) was employed to assess the relationship between participants' stigma levels and scale scores. Latent profile analysis (LPA) was conducted to classify the participants with different HPV stigma characteristics and determine the optimal cut-off value for HPV-SS. FA showed that the 3-factor model (personalized stigma, public-disclosure concerns, and negative self-image) had the best fit among the nested models, with good reliability and validity. The bi-factor model analysis indicated that the total scale score was more meaningful than dimension scores. IRT analysis confirmed that higher HPV-SS scores represented higher stigma levels. LPA identified a 2-class model as optimal, and the optimal cut-off value of the scale for high HPV stigma was 35. This study validated the 12-item HPV-SS for Chinese women infected with HPV, with good reliability and validity. The scale can be used to evaluate HPV stigma levels, facilitating targeted interventions to improve cervical cancer prevention and the psychological well-being of affected women. Show less

The treatment of multidrug-resistant tuberculosis (MDR-TB) is characterized by a prolonged duration and complex medication regimens, often resulting in a substantial medication-related burden that negatively impacts patients' adherence and quality of life. However, research on the heterogeneity of medication-related burden among MDR-TB patients and its influencing factors remains limited. This study aimed to identify latent profiles of medication-related burden among MDR-TB patients and examine differences in burden characteristics across these profiles, thereby providing evidence for tailored intervention strategies. A convenience sampling method was employed to recruit MDR-TB patients diagnosed at a tertiary infectious disease hospital in Chengdu between December 2024 and May 2025. Data were collected using a general information questionnaire, the Living with Medicines Questionnaire (LMQ), and the Health Literacy Management Scale (HeLMS). Latent profile analysis (LPA) was conducted to identify distinct profiles of medication-related burden, and multivariate logistic regression was used to explore associated factors for each profile. A total of 214 valid responses were analyzed. The LPA identified two distinct profiles of medication-related burden: C1 - "Low-Burden (Attitude & Practice-Dominated)" (44%) and C2 - "High-Burden (Daily Interference-Dominated)" (56%). Absence of side effects, not employing a caregiver, and higher levels of health literacy were positively associated with membership in the C1 group ( Medication-related burden among MDR-TB patients exhibits clear heterogeneity. Healthcare professionals should adopt stratified management and personalized interventions based on the identified influencing factors to alleviate the burden of medication in this population. 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

To elucidate the accurate roles of dysfunctional sleep beliefs in modulating cancer-related fatigue (CRF), identify distinct sleep hygiene profiles, and assess whether and how these profiles serve as mediators in lung cancer patients undergoing chemotherapy. This study recruited 396 lung cancer patients receiving chemotherapy between May and December 2023. Participants completed the Sleep Hygiene Index, Brief Fatigue Inventory, and Dysfunctional Beliefs and Attitudes about Sleep Scale. Latent profile analysis (LPA) was conducted to identify profiles of sleep hygiene, and mediation analysis was performed to explore the impacts of sleep hygiene profiles and dysfunctional sleep beliefs on CRF. LPA revealed three distinct sleep hygiene profiles: normal (33.3%), excellent (50.3%), and poor (16.4%). Family monthly disposable income, radiotherapy, and performance status were identified as influential factors distinguishing these profiles. Additionally, the dimensions of dysfunctional sleep beliefs and sleep hygiene profiles showed different correlations with CRF. With the normal sleep hygiene group as reference, mediation analysis revealed that poor sleep hygiene serves as a mediator between sleep worry of dysfunctional sleep beliefs and CRF (SE = 0.010, 95% CI [0.006, 0.047]). This study contributes to understanding the heterogeneity in sleep hygiene in lung cancer patients undergoing chemotherapy and elucidates the underlying mechanisms of the relationship between sleep worry of dysfunctional cognitions and CRF. Clinical healthcare providers developing targeted interventions in terms of sleep beliefs and sleep hygiene might be helpful to alleviate CRF in this population. Show less

Lipoprotein(a) [Lp(a)] is an independent, genetic, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). There are limited data on its impact on premature ASCVD, including in diverse populations and with family history. We examined Lp(a) in relation to premature ASCVD (male aged <55, female aged <65 years) compared to later onset ASCVD, and differences by family history, sex, and race/ethnicity in a large, multi-ethnic U.S. cohort. We analyzed data from 27,756 individuals without prior ASCVD at baseline from a pooled cohort consisting of five U.S. prospective studies. Lp(a) levels were stratified by cohort-specific percentiles. Multivariable Cox regression assessed the association of Lp(a) with composite incident premature and non-premature ASCVD events by sex, race, and family history. Among 5276 ASCVD events over a mean follow-up of 21.1 years, 773 (14.7 %) were premature ASCVD events. A higher proportion of women (65.2% vs. 38.3%) and Black individuals (45.8% vs. 27.7%) were observed in individuals with premature ASCVD compared to those with non-premature ASCVD events. For each 50 mg/dL increase in Lp(a), the risk of premature ASCVD increased by 30 % (HR: 1.30, 95% CI: 1.28-1.51), compared to a 24 % increase for non-premature ASCVD (HR: 1.24 [1.14-1.33]). Compared with Lp(a) levels <50th percentile, Lp(a) levels ≥ 90th percentile had adjusted HRs of 1.39 (1.10-1.75) and 1.39 (1.26-1.54) for premature and non-premature ASCVD events, respectively. We observed a trend for elevated Lp(a) levels predicting premature ASCVD events more strongly in those with a family history of ASCVD and in White individuals. Elevated Lp(a) is an important predictor of both premature and later onset ASCVD events. Show less

Given the high co-occurrence of various forms of childhood maltreatment (CM) and its negative effects on non-suicidal self-injury (NSSI) urges, investigating the mechanism between multiple CM and NSSI urges is crucial. Study 1 (a cross-sectional study) recruited 5181 adolescents from China (M Latent profile analysis (LPA) was used to explore the potential profiles based on different types of CM. Then, a mediation model was constructed to explore the mediating role of relative deprivation between profiles of CM and NSSI urges. All variables were assessed using self-report questionnaires. Three subgroups were identified: low CM, high emotional neglect, and high CM groups. Study 2 confirmed the results of Study 1 that relative deprivation (T2) mediates the association between subgroups and NSSI urges (T3). Compared to the low CM group, the mediating effect via relative deprivation is 0.39 (95 %CI = [0.20, 0.62]), 0.49 (95 %CI = [0.20, 0.83]) in the high emotional neglect and high CM groups, respectively. This study highlights the importance of using a person-centered approach to consider the heterogeneity of subgroups based on CM in understanding NSSI urges. It suggests that experiencing CM has a multifaceted negative effect on adolescents and exacerbates urges involving NSSI by inducing relative deprivation. Show less