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This study integrates the "Stress and Coping" theory with the "Ordinary Magic" model to propose a sequential "challenge appraisal -resource gain -cognitive resilience" framework. The framework aims to elucidate the psychological adaptation processes contributing to athletes' cognitive resilience in high-temperature environments. The study specifically explores the mediating role of challenge appraisal in the relationship between psychological resources and cognitive resilience, as well as the moderating effect of team support on this relationship. Data were collected from 240 professional athletes via a questionnaire-based survey, capturing multidimensional psychological and contextual variables. The analysis utilized structural equation modeling (SEM), latent profile analysis (LPA), and moderated effect testing to assess the proposed mediation, heterogeneity, and moderation pathways. Findings reveal that cognitive resilience in high-temperature environments is a dynamic process influenced by cognitive reappraisal and resource coupling. The study demonstrates that challenge appraisal mediates the relationship between psychological resources and cognitive resilience, with team support acting as a moderating factor. These results provide empirical support for targeted psychological interventions and the development of team-support systems in sports involving thermal stress. Additionally, the findings offer a theoretical advancement in sports psychology by transitioning from a static trait-oriented approach to a more dynamic "individual-context" interaction paradigm. This shift highlights the complex nature of psychological adaptation mechanisms in extreme environments. Show less

Hydrophobic membrane proteins are widely believed to require lipid bilayers for proper folding, collapsing or aggregating in aqueous environments. Using lactose permease (LacY) as a model membrane protein, we show instead that folding Show less

Mendelian randomization studies suggest a causal effect of lipoprotein(a) (Lp(a)) on atherosclerotic cardiovascular disease. Noncardiovascular effects (eg, diabetes risk) are inadequately investigated. In this noninterventional phenome-wide association study designed to better understand the potential causal role of Lp(a), direct causal phenotypic effects of exposure to Lp(a) were estimated. Also, the association between LPA null allele rs41272114 with type 2 diabetes was assessed, and ancestry-specific Lp(a) thresholds were determined. In the UK Biobank (n = 425,677 adults, 55% female), we studied 1,456 phenotypes spanning 18 classes using 4 ancestry-specific polygenic risk scores and false discovery rate multiple testing correction. Network deconvolution Mendelian randomization was leveraged to separate direct from indirect (ie, associations via mediating variables) causal phenotypic effects and account for confounding, reverse causation, and bidirectionality. Lp(a) was significantly associated with 80 phenotypes across 7 classes. Higher Lp(a) exposure had significant direct causal effects, independent of low-density lipoprotein cholesterol, on coronary artery disease (OR: 1.36; 95% CI: 1.21-1.54) and glycated hemoglobin (HbA1c; β = 0.099; 95% CI: 0.051-0.15) only. Very low Lp(a) exposure was not associated with type 2 diabetes (OR: 0.92; 95% CI: 0.64-1.31) or HbA1c (β = -0.016; 95% CI: -0.062 to 0.030). Among European and African ancestries, 86 (77th percentile) and 93 (59th percentile) nmol/L optimally discriminated myocardial infarction risk, respectively. Increasing Lp(a) exposure had direct, independent causal effects on coronary artery disease and HbA1c only; very low Lp(a) exposure is suggested to not be causally associated with type 2 diabetes. The optimal European and African ancestry threshold to stratify cardiovascular risk is comparable, and below 125/105 nmol/L in current U.S./European medical professional society guidelines. 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

To describe the network structure and heterogeneity of symptom burden in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), and to examine factors associated with different symptom burden profiles to inform risk-stratified management after PCI. A convenience sample of 261 patients with ACS who underwent PCI at a tertiary hospital in Chongqing between November 2024 and August 2025 was recruited. Data were collected using a demographic questionnaire, the Cardiac Symptom Survey, and the Seattle Angina Questionnaire. Network analysis was conducted to identify inter-symptom associations and the structural characteristics of the symptom network. Latent profile analysis (LPA) was performed to classify symptom burden patterns, and multinomial logistic regression analysis was used to explore factors associated with profile membership. Network analysis indicated that depression was the most central symptom (strength Symptom burden in patients with ACS after PCI demonstrates substantial individual heterogeneity. Depression occupies a central position within the symptom network, and BMI is associated with moderate and high symptom burden profiles. These findings suggest that integrating symptom network characteristics and BMI status into post-PCI assessment may facilitate risk-stratified management and targeted psychological and weight-related interventions to improve recovery outcomes. Show less

Nursing interns often face maladjustment during the early stages of clinical practice, which not only directly affects their physical and mental health as well as work efficiency but also significantly inhibits their proactive feedback-seeking behavior (FSB). As an active self-regulation strategy, FSB can enhance interns' work initiative and promote role transition. However, existing research has yet to thoroughly investigate the potential heterogeneity and categorical characteristics of FSB within this population, and the role of psychological resources such as career adaptability in shaping these patterns requires further investigation. To investigate the status of FSB in early-stage nursing interns, identify latent subgroups via latent profile analysis (LPA), and analyze associated factors, thereby providing evidence for targeted clinical educational interventions. Multicenter cross-sectional research. This study employed a multistage stratified cluster sampling to survey 1,308 early-stage nursing interns from nine universities in Hubei, China, between June and September 2024. Data were collected using a demographic questionnaire, Feedback-Seeking Behavior Scale, and Career Adapt-Abilities Scale. LPA was employed to delineate FSB profiles and multivariate logistic regression analysis to examine the associated predictors. A total of 1,370 questionnaires were distributed, with 1,308 valid responses, yielding an effective response rate of 95.47%. The mean score on the feedback-seeking behavior scale was 5.06 ± 1.08. LPA identified three distinct feedback-seeking profiles: low (20.87%), moderate (38.3%), and high (40.83%). Education level, student cadre experience, internship hospital type, and career adaptability were significant predictors of profile membership ( FSB among early-stage nursing interns exhibited heterogeneity. Nursing educators and managers should implement tiered interventions: for the low and moderate feedback-seeking groups, career guidance and feedback awareness cultivation should be strengthened; for the high feedback-seeking group, peer modeling should be encouraged. This strategy can enhance proactive FSB, supports role transition and professional identity, and promotes long-term nursing workforce stability. Show less

Inflammatory bowel disease (IBD) is an immune-mediated disorder driven by overactivation of autotaxin (ATX), which elevates lysophosphatidic acid (LPA) signaling and suppresses autophagy, exacerbating intestinal inflammation. Given the pivotal role of autophagy in maintaining intestinal homeostasis, inhibiting ATX offers a dual therapeutic mechanism by both restoring autophagic activity and attenuating LPA-mediated inflammatory responses. Current treatments are hindered by nonspecific immunosuppression and frequent systemic side effects, underscoring the need for targeted, multifunctional therapeutic strategies. Here, we present a dual-functional nanotherapeutic platform, ATX-scavenging liposomes loaded with rapamycin (AS-Lipo@R), engineered for the oral treatment of acute colitis. Our proposed formulation incorporates BMP-22, a lipid ATX inhibitor that simultaneously functions as a structural building block of the liposomal membrane. Rapamycin, an autophagy activator, is encapsulated within the bilayer of liposomes. We confirmed that AS-Lipo@R exhibits strong binding affinity to extracellular ATX and mediates its lysosomal degradation upon cellular internalization, thereby demonstrating its ATX-scavenging property. In vitro, AS-Lipo@R inhibited inflammatory macrophage activation, promoted M2 macrophage polarization, and substantially restored autophagic activity in LPS/IFN-γ-stimulated macrophages. In vivo, oral administration of AS-Lipo@R led to preferential accumulation in ATX-overexpressing inflamed colonic tissue, resulting in reduced pro-inflammatory cytokine production, recovered autophagy, and enhanced intestinal barrier integrity in colitis mice. These findings highlight AS-Lipo@R as a synergistic and targeted nanomedicine that simultaneously modulates ATX and autophagy pathways, offering novel insights into immunomodulatory strategies for IBD treatment. Show less

Examine whether neonatal neurobehavioral profiles are related to need for pharmacological treatment among infants with prenatal opioid exposure. Prospective cohort study of 217 infants with need for treatment determined using the Finnegan Neonatal Abstinence Tool (FNAST), Neonatal Withdrawal Inventory (NWI), or Eat Sleep Console (ESC). Neurobehavior was assessed with the NeoNatal Neurobehavioral Scale II (NNNS-II). Latent Profile Analysis (LPA) classified infants into neurobehavioral profiles, and logistic regression assessed the association between NNNS-II profiles and need for treatment. A 3-profile LPA solution best fit the NNNS-II data comprised of typical (67%), hyper-aroused (19%) and hypo-aroused groups (15%). Infants with atypical NNNS-II profiles were more likely to receive treatment (OR = 3.45, 95% CI 1.21-9.81) compared to infants with typical profiles (p < 0.05). Newborn neurobehavioral profiles may aid in early identification of infants requiring pharmacological treatment for opioid withdrawal, reducing length of stay and healthcare costs. Show less

Given the clinical heterogeneity of Parkinson's disease (PD), identification of early -stage subgroups with shared non-motor symptom (NMS) profiles may clarify its pathophysiology. This study used latent-profile analyses (LPA) to define subgroups based on sleep disturbances, cognitive performance and neuropsychiatric symptoms, and examined dopaminergic function and brain volume differences between them. We analyzed data from 51 cognitively normal non-PD older adults and 105 early-stage PD participants from the iPARK trial, including 19 who underwent [ LPA identified a two-cluster solution as the best fit. Group 1 ( These findings indicate clinically distinct subgroups in early-stage PD. Greater NMS burden is linked to impaired dopaminergic integrity, suggesting a potential neurobiological signature. Early identification of such subgroups may improve understanding of disease heterogeneity and support personalized management and interventions. https://clinicaltrials.gov/study/NCT03680170?id=NCT03680170&rank=1, identifier (NCT03680170). Show less

This cross-sectional study involved secondary data analysis to: (1) examine relationships between psychosocial factors (autonomous motivation for physical activity [PA], PA self-efficacy, social support for PA) and various levels of PA intensity (light PA [LPA], moderate PA [MPA], vigorous PA [VPA]), and moderate-to-vigorous PA [MVPA]) in adolescents aged 10-14 years in the U.S.; and (2) investigate the influence of demographic, physiological, and activity-related characteristics (age, sex, race/ethnicity, body mass index [BMI], annual family income, cardiorespiratory fitness [CRF; estimated maximal oxygen uptake: VO2 max], current sports or cheerleading team participation, and non-sport PA program participation) on various PA intensities. In 2022-2024, adolescents completed demographic and psychosocial surveys and wore accelerometers to assess PA. Of 935 adolescents enrolled, 623 (66.6%) provided valid accelerometer data (≥4 days). Structural equation modeling was used. MPA, VPA, and MVPA were positively associated with male sex, higher CRF, and sports or cheerleading team participation. Age and BMI z-score were negative predictors of MVPA and VPA. MPA was negatively associated with age, and LPA was negatively associated with annual family income. Social support for PA predicted autonomous motivation for PA and PA self-efficacy. Indirect effects of social support on the various levels of PA intensity via autonomous motivation or PA self-efficacy were not significant. Strengthening social support for PA may enhance adolescents' autonomous motivation for PA and PA self-efficacy to help them increase PA. However, indirect effects on the PA levels were not statistically significant. Findings underscore the promise and limitations of psychosocial pathways.ClinicalTrials.gov Identifier NCT04213014. Show less

People with HIV (PWH) and undetectable virus experience elevated cardiovascular risk independent of traditional risk factors. Vascular inflammation may contribute to this residual risk. The perivascular fat attenuation index (FAI), derived from coronary computed tomography angiography (CCTA), is a biomarker of coronary inflammation. Lipoprotein(a) [Lp(a)] carries oxidized phospholipids that may promote inflammation. Statins have demonstrated cardiovascular benefit in PWH, including pleiotropic anti-inflammatory effects. This study assessed the associations of Lp(a) and of statin use with coronary inflammation (FAI) in men with HIV (MWH). We analysed FAI of the left anterior descending (LAD) and the right coronary arteries (RCA) in 583 men from the Multicenter AIDS Cohort Study, a prospective, multicentre cohort study, including 280 with undetectable HIV RNA, <50 copies/ml. Associations between log Lp(a) was associated with increased coronary inflammation, independent of traditional cardiovascular risk factors, in MWH with undetectable virus. Statin therapy did not modify the relationship between coronary inflammation and Lp(a). Show less

Previous research on breast cancer patients has primarily examined singular behavioral indicators, often overlooking the coexistence and interaction between physical activity and sedentary behavior-particularly screen-based sedentary time. This study aims to identify the latent activity pattern categories among breast cancer patients during chemotherapy intervals and explore their associated factors to inform targeted behavioral interventions. A cross-sectional survey was conducted with 292 breast cancer patients undergoing chemotherapy intervals at four general hospitals in Foshan, Guangdong Province. Latent Profile Analysis (LPA) was applied as a person-centered analytic approach to identify distinct activity pattern profiles. Data were collected using a general information questionnaire, the Adult Sedentary Behavior Questionnaire (ASBQ), the Chinese version of the International Physical Activity Questionnaire (IPAQ-SC), the Exercise Self-Efficacy Scale (ESES), the Perceived Social Support Scale (PSSS), and the Hospital Anxiety and Depression Scale (HADS). The activity patterns of breast cancer patients were categorized into three groups: Moderate Activity-Dominant Group (37.33%), Screen-Sedentary High-Risk Group (8.22%), and Activity-Sedentary Coexistence Group (54.45%). Logistic regression analysis showed that, compared to the Moderate Activity-Dominant Group, patients with low exercise self-efficacy and higher anxiety and depression levels were more likely to be classified into the Screen-Sedentary High-Risk Group and Activity-Sedentary Coexistence Group. Higher education levels and being on medical leave were associated with a higher probability of belonging to the Activity-Sedentary Coexistence Group (all Activity patterns in breast cancer patients show significant heterogeneity. Healthcare providers should pay attention to the individual physical activity characteristics of patients and offer personalized physical activity guidance. Tailored interventions that meet the needs of breast cancer patients should be developed to improve health outcomes. 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

To assess the predictive value of serum lipoprotein(a) [Lp(a)] for contrast-induced nephropathy in patients with type 2 diabetes mellitus (T2DM). Consecutive T2DM patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) between January 2019 and December 2021 were enrolled. Baseline Lp(a) was measured before the operation. CIN was defined as an increase in serum creatinine of more than 25% or 44 μmol within 72 h of contrast administration. The relationship between Lp(a) and CIN risk was analyzed. A total of 928 T2DM patients were included. CIN developed in 11.1% (103/928) of patients. The Lp(a) level was significantly higher in patients with CIN than in non-CIN patients (311.12 ± 278.66 vs. 254.19 ± 274.56 mg/L, A higher serum Lp(a) level indicates an increased risk of CIN in T2DM patients undergoing CAG or PCI and can serve as an independent predictor of CIN in this population. This study's findings will aid in the clinical prevention and treatment of contrast agent-induced kidney disease. Show less

Previous studies have indicated that Kinesiophobia is associated with adherence to exercise rehabilitation. Given the multifaceted impact of Kinesiophobia and the complex diversity of individual characteristics, existing research struggles to identify the distinct features of Kinesiophobia. Latent Profile Analysis (LPA) identifies individuals’ latent traits based on their response patterns to observable measures, grouping individuals with similar symptom profiles into different categories, thereby better distinguishing differences among individuals. However, there is currently a lack of research on the kinesiophobia in the out-of-hospital early rehabilitation phase after Percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Therefore, the aim of this study is to investigate kinesiophobia in the out-of-hospital early rehabilitation phase after Percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD), classify it based on latent profile analysis, and explore the related factors of Kinesiophobia in CHD patients across different categories. This study selected coronary heart disease patients who were in the early outpatient rehabilitation stage after receiving PCI treatment at a tertiary hospital as the survey subjects. Latent Profile Analysis (LPA) was employed to fit potential classes of kinesiophobia among these patients. Chi-square tests, Kruskal-Wallis tests, and multinomial logistic regression were utilized to explore the factors influencing different kinesiophobia profiles in these patients. A total of 293 survey subjects were included, the age of the 293 patients was 62.31 ± 11.49 years, Males represent 77% of the total population. The results of potential profile analysis revealed that kinesiophobia in the out-of-hospital early rehabilitation phase of CHD in PCI-treated patients could be divided into three potential categories: the low kinesiophobia-exercise avoidance group (52.1%), the medium kinesiophobia-danger perception group (41.6%), and the high kinesiophobia-dysfunction group (6.3%). The logistic regression analysis results revealed that age, mode of residence, chronic comorbidities, polypharmacy, and debilitation were influential factors for different categories of kinesiophobia in the out-of-hospital early rehabilitation phase of CHD patients undergoing PCI. There is obvious group heterogeneity in kinesiophobia in the out-of-hospital early rehabilitation phaseof CHD patients undergoing PCI, and healthcare professionals should carry out individualized intervention Strategies to reduce the degree of kinesiophobia in patients on the basis of the characteristics and influencing factors of different categories. Show less

To identify latent profiles of proactive health behaviors in patients with hypertension, examine the category-specific influencing factors. Proactive health behavior, as an emerging concept, refers to a self-motivated approach to systematically managing health-related factors in order to actively maintain and promote one's health status. However, existing studies have largely focused on describing the overall level of such behaviors among patients with hypertension, with insufficient exploration of behavioral heterogeneity within this population. Moreover, there has been a lack of systematic integration of established behavioral theories to explain the multifactorial mechanisms underlying different behavioral patterns, which limits the development of precise nursing interventions. A cross-sectional study was performed, involving 352 patients with hypertension from 8 communities in Anhui Province from September to December 2025. The survey tools included self-designed demographic and clinical instrument, the Proactive Health Behavior Scale for Hypertensive Patients, the Self-Efficacy Scale for Hypertensive Patients, the Health Literacy Management Scale (HeLMS). Latent profile analysis (LPA) was used to identify subtypes of proactive health behavior among hypertension patients. Multinomial logistic regression analysis was applied to determine the factors associated with the identified subtypes. A total of 352 questionnaires were distributed, yielding 321 valid responses (a response rate of 91.2%). The total score of proactive health behavior was 89.57 ± 22.99 points. The LPA revealed four profiles of proactive health behavior: the positive proactive health behavior profile (Class 1, The proactive health behavior among hypertension patients was at a moderate level, revealing four distinct behavioral categories with significant differences. Guided by the Health Belief Model, profile-specific influencing factors were analyzed, which informed the development of tailored intervention strategies. Show less

Given the globalization of the nursing workforce, psychological empowerment represents a critical intrinsic determinant of nurses' mobility intentions, specifically regarding cross-border work. To identify latent profiles of nurses' psychological empowerment, examine associated factors, and explore the relationship between these profiles and cross-border working intention. A cross-sectional multicenter study was conducted from March to September 2023. Using convenience sampling, clinical nurses were recruited through liaisons from nursing societies in nine cities of Guangdong Province. Data were collected through questionnaires covering sociodemographic questionnaire, psychological empowerment, and cross-border working intention, with analyses including chi-square tests, logistic regression, and latent profile analysis (LPA) performed using SPSS 23.0 and Mplus 8.3. A total of 3671 valid questionnaires were collected, and 39.5% of the respondents reported cross-border intentions. LPA identified three psychological empowerment profiles among nurses, ranked from high to low: the core-driven empowerment profile (16.94%), the adaptive empowerment profile (70.42%), and the constrained empowerment profile (12.64%). The nurses with lower salary, intermediate title, and without specialist nurse qualification were more likely to fall into the constrained empowerment profile. Psychological empowerment was positively correlated with nurses' cross-border work intention. The core-driven profile showed the highest cross-border work intention (50.6%), followed by the adaptive (38.2%) and constrained profiles (31.7%). For cross-border work, the constrained profile prioritized salary (87.1%) as the key concern, while the core-driven profile focused more on good promotion opportunities (70.3%). Psychological empowerment exerts a positive impact on clinical nurses' cross-border work intention, with the three identified empowerment profiles exhibiting divergent motivational priorities and decision logics. These findings highlight the need for subgroup-specific strategies to balance nursing workforce mobility and stability. The findings support a differentiated human resource strategy based on nurses' psychological empowerment profiles. For core-driven nurses, institutions should provide international career development channels to strengthen their domestic job embeddedness. For adaptive nurses, tailored skill training and decision-making autonomy should be offered to guide their mobility aspirations. For constrained nurses, competitive compensation and family support services should be prioritized to address their stability needs and rebuild professional confidence. These targeted measures balance talent mobility and domestic workforce stability. Show less

Adolescence is a critical period for rapid emotional and cognitive development. Depression and cognitive impairment frequently co-occur in this population, yet their comorbidity patterns and symptom-level interactions remain insufficiently explored. A total of 2,244 students (mean age = 16.8 ± 0.84 years; 1,218 males, 1,026 females) from a high school in Heilongjiang Province, China, were recruited. Depressive symptoms and cognitive impairment were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Deficits Questionnaire–Depression (PDQ-D). Latent profile analysis (LPA) was applied to identify subgroups, followed by network analysis to examine central symptoms (expected influence, EI), bridge symptoms (bridge expected influence, BEI), and network differences (NCT). The optimal LPA model identified three comorbidity subgroups: low, moderate, and high. NCT revealed significant differences in network structure and global strength between the low–moderate (S = 1.514, Adolescent Depression and Cognitive Impairment can be classified into low, moderate, and high comorbidity subgroups. Somatic symptoms emerged as the central symptom, while prospective memory impairment and interpersonal problems were identified as key bridge symptoms, suggesting potential intervention targets for early screening and stratified treatment. Not applicable. The online version contains supplementary material available at 10.1186/s12888-026-07946-w. Show less

Lipoprotein(a) [Lp(a)] represents one of cardiovascular medicine's most profound implementation gaps: a genetically determined risk factor affecting 1.5 billion people worldwide, yet historically underutilized in clinical practice despite overwhelming evidence of its importance. This review examines the transformation of Lp(a) from an untreatable genetic burden to a promising therapeutic target through four interconnected perspectives. First, we document the implementation gap, where, despite affecting 20% of the global population, screening remains below 1%. The evolution from selective screening (2018 American College of Cardiology/American Heart Association (ACC/AHA)) to universal measurement (2024 National Lipid Association (NLA) Class I recommendation) reflects growing recognition, yet persistent barriers, including reimbursement challenges, provider knowledge gaps, and laboratory standardization issues, perpetuate underutilization. Second, we synthesize evidence establishing Lp(a)'s dual nature as both a biomarker and a causal factor. Observational studies demonstrate markedly increased cardiovascular risk with elevated Lp(a), while Mendelian randomization confirms causal relationships with coronary heart disease, large-artery stroke, peripheral artery disease, and aortic stenosis, with differential effects on stroke subtypes and non-atherosclerotic outcomes. Third, we examine the transformation from genetic determinism to pharmacological tractability. Despite 70-90% heritability, novel RNA-targeted therapies achieve unprecedented 80-95% reductions, with phase 3 cardiovascular outcome trials (completing 2026-2029) poised to determine whether dramatic Lp(a) lowering translates to clinical benefit. Finally, we provide a practical management algorithm bridging current evidence-based risk stratification with emerging therapies, stratifying patients by Lp(a) levels with corresponding interventions. The Lp(a) story exemplifies how genetic insights and technological innovation can transform immutable disease aspects into treatable conditions, offering a paradigm for precision cardiovascular medicine while highlighting the urgent need to close the gap between scientific knowledge and clinical implementation. Show less

To identify latent profiles and influencing factors of toxic leadership behaviors of nurse managers experienced by staff nurses. Cross-sectional study. A total of 12 public hospitals in Guiyang and Zunyi city, Guizhou Province, China. From May 7, 2024 to December 31, 2024, a total of 900 nurses participated, and 868 valid questionnaires were collected with a validity rate of 96.44%. Data was collected via the Toxic Leadership Behaviors of Nurse Managers scale and a demographic questionnaire. Using latent profile analysis (LPA), distinct profiles of toxic leadership behaviors among nurse managers were identified. Univariate and multiple logistic regression analyses were performed to identify the factors associated with the toxic leadership behavior of nurse managers. The toxic leadership behaviors suffered by nurses were divided into four profiles: low toxic leadership behavior group (55.07%), moderate toxic leadership behavior group (16.71%), high toxic leadership behavior group (13.36%), and high Intemperate behavior group (14.86%). The results of multiple logistic regression analysis showed that nurses who are male, employed as non-permanent staff, or working in general hospitals are more susceptible to toxic leadership behaviors. This study used latent profile analysis to identify four distinct subgroups and found that male nurses, non-permanent staff, and nurses in general hospitals are more susceptible to toxic leadership behaviors. These results emphasize the need for developing strategies to address toxic leadership behaviors in order to promote nurses' wellbeing. Show less

Epstein-Barr virus (EBV) is an enveloped, double-stranded DNA virus that selectively infects primates. Periodontitis, a common inflammatory disease characterized by alveolar bone destruction, affects more than half of the global adult population. While EBV has been linked to periodontitis due to its pro-inflammatory effects and presence in the human periodontium, its effects on bone metabolism, particularly alveolar bone resorption, remain unclear. This study demonstrated that EBV infection in humanized mice induced osteoclast differentiation and alveolar bone resorption, resulting in sparse trabecular bone patterns and increased lacunae resorption. Extracellular vesicles (EVs) from EBV-infected cells contained M-CSF, essential for osteoclast differentiation, and increased CTSK and RANKL expression in osteoclast precursor cells after uptake. EBV infection increased the expression of group IIA-secreted phospholipase A Show less

This study aimed to assess the childbirth readiness of women in their third trimester of pregnancy and to identify distinct readiness profiles using latent profile analysis (LPA). Additionally, it explored the factors influencing childbirth readiness in order to guide targeted interventions for improved maternal and neonatal outcomes. A cross-sectional study was conducted among women in their third trimester of pregnancy between May and November 2024. Eligible participants completed a general information questionnaire, the Childbirth Readiness Scale (CRS), the Childbirth Attitude Questionnaire (CAQ), and the Perceived Social Support Scale (PSSS). LPA identified three groups with distinct childbirth readiness levels: "Low Readiness - Childbirth Knowledge Deficit" (37.9%), "Moderate Readiness - Good Lifestyle Habits" (47.9%), and "High Readiness - Rich Health Knowledge" (14.2%). In addition, gestational age, previous childbirth history, adverse pregnancy outcomes, childbirth attitudes, and social support had different influences on women in different latent profiles of childbirth readiness. There was significant heterogeneity in childbirth readiness among women in their third trimester. Women with lower readiness-especially in childbirth knowledge-would greatly benefit from targeted educational programs, whereas those with moderate readiness levels would find enhanced emotional and psychological support most advantageous. These findings support the implementation of profile-based, personalized prenatal care strategies to improve childbirth preparedness and optimize maternal and neonatal outcomes. Show less

Coronary artery calcification (CAC) signifies advanced atherosclerosis and portends increased cardiovascular risk. Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerosis; however, its association with in vivo lesion morphology and clinical outcomes in patients with symptomatic, advanced CAC remains incompletely characterized. This study aimed to investigate the association between elevated Lp(a) levels and both in vivo lesion morphology and clinical outcomes in this high-risk population. In this retrospective cohort, 292 patients with intravascular ultrasound(IVUS)-confirmed CAC were stratified into elevated (≥50 mg/dL,n = 77) or low (<50 mg/dL,n = 215) Lp(a) groups. The primary endpoint was major adverse cardiovascular events (MACEs). Associations were assessed via multivariable Cox models adjusted for clinical covariates. Patients in the elevated Lp(a) group presented a greater incidence of aortic valve calcification (p < 0.001). IVUS revealed constrictive remodeling with a smaller lumen and vessel dimensions. During a median follow-up of 17.2 months, the elevated Lp(a) cohort had a significantly higher MACE rate (37.7% vs. 15.8%; adjusted hazard ratio [aHR] 2.60, 95% CI 1.55-4.35, p < 0.001). Elevated Lp(a) independently predicted increased risks of ischemic stroke (aHR 7.14) and in-stent restenosis (aHR 2.78). In symptomatic patients with IVUS-confirmed CAC, elevated Lp(a) identifies a high-risk phenotype characterized by constrictive vascular remodeling and a markedly increased risk of MACEs, driven particularly by ischemic stroke and in-stent restenosis. These findings support the integration of routine Lp(a) testing into the risk stratification of patients with severe CAC, thereby identifying a precise high-risk phenotype that warrants intensified monitoring and represents an ideal target for emerging Lp(a)-lowering therapies. Show less

To identify latent classes based on symptom clusters and to explore the association between these distinct symptom experience subtypes and social isolation in older adults with comorbid diabetes mellitus (DM) and coronary heart disease (CHD). A cross-sectional study was conducted among 337 older adults with DM and CHD recruited from the Department of Endocrinology and Cardiology of Nantong Sixth People's Hospital between February 2023 and October 2025. Data were collected using a general information questionnaire, the Chinese version of the Memorial Symptom Assessment Scale (MSAS), and the Lubben Social Network Scale-6 (LSNS-6). Exploratory factor analysis (EFA) was used to identify symptom clusters. Latent profile analysis (LPA) was then employed to classify patients into different symptom experience subtypes based on the symptom cluster scores. One-way ANOVA, Chi-square tests, and multiple linear regression were used to analyze the association between latent classes and social isolation. EFA extracted three symptom clusters (cardiopulmonary-fatigue, emotional-perceptual, and metabolic), accounting for 62.3% of the total variance. LPA identified three distinct latent classes: Class 1 "Low Burden-Balanced Pattern" (45.4%), Class 2 "Psycho-Somatic Co-dominant Pattern" (31.8%), and Class 3 "Metabolic-Physical Dominant Pattern" (22.8%). Univariate analysis revealed significant differences in social isolation scores (LSNS-6) across the three classes ( The findings reveal significant heterogeneity in symptom experiences among older adults with comorbid DM and CHD, which can be categorized into distinct latent classes. The subtype characterized by a Psycho-Somatic Co-dominant Pattern shows the strongest association with social isolation. In clinical practice, early identification of this high-burden subgroup may facilitate the provision of integrated interventions that address physical, psychological, and social dimensions. Show less

A growing body of research highlights the crucial role of self-regulated learning (SRL) strategies in enhancing teaching effectiveness and promoting continuous professional growth. Teachers’ ability to plan, monitor, and evaluate their own learning processes has been linked to improved instructional quality and adaptability. While prior studies have explored the effects of accountability on teacher motivation and pedagogical practices, limited evidence exists regarding how teachers’ self-regulation patterns differ and how these variations relate to perceived accountability. This study aimed to identify distinct SRL profiles among teachers and examine their associations with internal and external accountability perceptions. A total of 339 primary and secondary school teachers in Türkiye participated in the study. Using latent profile analysis (LPA), teachers were classified based on their reported SRL strategies. Differences in accountability perceptions across the resulting profiles were examined through multivariate analyses. The LPA revealed three meaningful SRL profiles: Low Self-Regulators (Profile 1), High Self-Regulators (Profile 2), and Moderate Self-Regulators (Profile 3). Teachers in the High Self-Regulators profile reported significantly higher levels of both internal and external accountability than those in the other two groups, whereas the Low Self-Regulators profile was characterized by lower accountability across all measures. Moreover, internal accountability emerged as a stronger motivational factor than external mechanisms for teachers with well-developed SRL skills. These results indicate that SRL is a multidimensional construct closely linked to how teachers perceive and respond to accountability demands. The findings underscore the importance of fostering teachers’ self-regulatory capacities as part of professional development initiatives. Teacher education programs should adopt differentiated approaches that consider individual SRL profiles and accountability orientations to enhance reflective and autonomous teaching practices. Future research is encouraged to explore the longitudinal development of these profiles and evaluate the impact of accountability-driven interventions on sustained professional growth. Show less

Depression and anxiety are highly prevalent and often co-occurring mental health issues among adolescents, with comorbidity leading to poorer outcomes and additional challenges. Left-behind adolescents-a unique group experiencing disrupted parent-child relationships and limited social support-may face a higher risk of such comorbidity. Yet, few studies have examined the depression-anxiety network in this population. Latent profile analysis (LPA) identified subgroups with similar symptom patterns, and network analysis visualized the structure of comorbidities. Network comparison tests evaluated differences across subgroups. Based on the "Science Database of People Mental Health" managed by the National Population Health Data Center (China), a total of 3,205 left-behind adolescents (1,538 males; 1,667 females) were included. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Scale-7 were used to assess depression and anxiety among left-behind adolescents. Three distinct profiles were identified: high-comorbidity (8.2%), moderate-comorbidity (28.7%), and low-comorbidity (63.1%). Network structures and global strength differed significantly between subgroups. "Restlessness" was the central bridge symptom in the high-comorbidity group, while "Nervousness" was central in the moderate- and low-comorbidity groups. These findings suggest tailored interventions targeting subgroup-specific bridge symptoms-such as restlessness or nervousness-may improve outcomes for left-behind adolescents with comorbid depression and anxiety. Show less

Lipoprotein(a) (Lp[a]) is an independent risk factor for atherosclerotic cardiovascular events and aortic stenosis. In Spain, the prevalence of elevated Lp(a) and its clinical impact remain poorly defined. We conducted a cross-sectional study including two cohorts: patients discharged after a non-fatal acute coronary syndrome (secondary prevention), and asymptomatic patients with subclinical atherosclerosis ("1.5 prevention"). The prevalence of elevated Lp(a) levels was assessed in both groups. Associations with multivessel coronary artery disease (secondary prevention) and with a coronary artery calcium (CAC) score ≥300 AU (1.5 prevention) were analyzed. A total of 1043 patients were included (788 secondary prevention). Median Lp(a) levels were 61 nmol/L in secondary prevention and 29 nmol/L in the 1.5 prevention cohort. In secondary prevention, 36.8%, 33.6%, 29.2%, and 24.5% had Lp(a) ≥125, ≥150, ≥175, and ≥ 200nmol/L, respectively; in the 1.5 prevention cohort the corresponding proportions were 27.5%, 24.3%, 17.6%, and 14.1%. In secondary prevention, Lp(a) ≥175 nmol/L was associated with multivessel disease after multivariable adjustment for age, sex, LDLc, and statin treatment (OR 1.45, 95% CI: 1.04-2.01; Elevated Lp(a) levels are common in both populations and correlate with greater atherosclerotic burden. These findings support the systematic assessment of Lp(a) to guide preventive strategies across both patient populations. Show less

Cardiovascular (CV) disease risk is increased in rheumatoid arthritis (RA) and is the leading cause of mortality. Improved CV risk stratification tools in RA could enhance use of preventative care and improve outcomes. We previously studied biomarkers of CV disease - adiponectin, hsCRP, Lp(a), osteoprotegerin (OPG), high-sensitivity cardiac troponin T (hsTnT), serum amyloid A (SAA), YKL-40, soluble TNF receptor1 (sTNFR1) -- that were associated with CV risk. In the current study, these biomarkers were tested in an unrelated external cohort of RA patients followed at a single academic medical center without a history of CV events. CV events were identified through Medicare and Medicaid administrative data or through medical record review of self-reported events.Biomarkers were assessed at cohort entry among a nested cohort of cases and controls, matched 1:1 on sex and age. Analyses were conducted using conditional logistic regression. We examined whether the candidate biomarkers added to clinical CV risk factors improved model prediction, using the area under the curve (AUC) as well as the net reclassification index (NRI). From a cohort of 1,345 eligible patients with RA, we identified 123 patients with confirmed CV events. Cases and matched controls were typical of RA: median age 63 years, 77% women, RA disease duration 11 years, 72% seropositive, 85% used a biologic or conventional disease modifying anti-rheumatic drug, 58% non-steroidal anti-inflammatory drugs, and 30% oral glucocorticoids. From the candidate biomarkers, LASSO regression selected hsTnT and sTNFR1 as associated with CV events. The AUC for models that included only clinical risk factors was 0.758 (95% CI 0.689-0.829); after adding hsTnT and sTNFR1, the AUC increased to 0.802 (95% CI 0.718-0.998). The NRI of the model with biomarkers was 16.3%, with improvement only observed in patients who did not have CV events during follow-up. Adding selected biomarkers to clinical risk factors enhances the discrimination of models predicting CV events among patients with RA. These risk models require prospective testing to see if they have value in clinical practice decision-making regarding preventative care. Show less