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This study employed a latent profile analysis (LPA) to identify distinct subgroups of learned helplessness among Chinese breast cancer chemotherapy patients and examined influencing factors. Through convenience sampling, 260 breast cancer chemotherapy patients aged 18-74 years from a tertiary hospital in Henan Province were recruited between May 2024 and January 2025. Data were collected using a general demographic questionnaire, the Learned Helplessness Scale, the Brief Illness Perception Questionnaire, the Social Support Rating Scale, and the General Self-Efficacy Scale. An LPA was applied to classify learned helplessness patterns, followed by a multivariate logistic regression to determine the influencing factors. The latent profile analysis revealed three distinct profiles of learned helplessness among breast cancer patients undergoing chemotherapy: a "low helplessness-low hopelessness stable profile" (17.0%), a "moderate helplessness-moderate hopelessness fluctuating profile" (52.0%), and a "high helplessness-high hopelessness profile" (31.0%). The multivariable logistic regression revealed that age range 18-44 years, low monthly household income per capita, fatigue, and illness perception were significantly associated with the "high helplessness-high hopelessness profile" (P < 0.05). Conversely, the age range 45-59 years was significantly associated with the "moderate helplessness-moderate hopelessness fluctuating profile" (P < 0.001). Furthermore, experiencing ≤2 chemotherapy-related side effects, a higher level of perceived social support, and greater self-efficacy were significant predictors of membership in the "low helplessness-low hopelessness profile" (P < 0.05). Breast cancer chemotherapy patients were categorized into three distinct subgroups, which were influenced by age, income, fatigue, treatment side effects, illness perception, self-efficacy, and social support. Show less

Neonatal hyperoxia is a key contributor to bronchopulmonary dysplasia (BPD) which is characterized by airway hyperreactivity due to increased contraction and impaired relaxation of airway smooth muscle (ASM). This study investigated whether inhibition of the Rho/Rho-kinase signaling pathway restored tracheal smooth muscle (TSM) relaxation and reactivated the nitric oxide-guanosine 3',5'-cyclic monophosphate (NO-cGMP) pathway in neonatal rats exposed to hyperoxia. Newborn rats (P4) were exposed to either ambient air (AA; n = 61) or hyperoxia (FiO Show less

Hodgkin lymphoma (HL) is one of the most common cancers during adolescence. Advances in treatment have achieved survival rates exceeding 90%. However, long-term treatment-related sequelae, including cardiovascular disease and metabolic syndrome, significantly affect the quality of life of survivors. Physical activity (PA) is considered a key strategy to mitigate these risks. Current studies predominantly rely on subjective assessments of movement behavior, which may lack accuracy. This cross-sectional study aims to use device-based monitoring to characterize levels of sedentary behavior and physical activity in survivors of childhood-diagnosed HL. Specific objectives were to evaluate these behaviors across age and gender groups and to assess compliance with physical activity guidelines for the adult population. The study involved 51 participants (59% female), with a median age of 25 years, a median age at diagnosis of 16 years, and a median time since diagnosis of 11 years. PA and sedentary behavior (SB) were measured over seven days using the Axivity AX3 accelerometer with a 24-hour wear protocol. Movement behavior was categorized into SB, light PA (LPA), moderate PA (MPA), and vigorous PA (VPA). Group differences in movement behaviors were examined using non-parametric tests, and results are presented as medians with interquartile ranges. Participants had a median daily time of 704.8 min in SB (IQR 127.9), 181.2 min in LPA (IQR 81.3), 110.2 min in MPA (IQR 68.8), and 2.8 min in VPA (IQR 2.8). Combined moderate-to-vigorous physical activity (MVPA) accounted for a median of 115 min per day (IQR 69.8). Significant differences in LPA were observed: men spent less time in LPA compared to women (p = 0.032), and younger participants spent less time in LPA compared to older participants (p = 0.006). While 100% of participants met the WHO-recommended threshold of > 150 min of MPA per week, only 14% met the guideline of > 75 min of VPA per week. Our study indicates that survivors diagnosed with childhood HL can achieve the levels of MVPA recommended by current adult PA guidelines, despite undergoing chemotherapy and radiotherapy. Additionally, significant differences in low-intensity PA were identified: men and younger participants spent less time in LPA compared to women and older participants, respectively. These findings highlight the importance of monitoring movement behaviors in long-term follow-up care to identify survivors with insufficient physical activity and excessive sedentary behavior and to implement targeted interventions to reduce long-term cardiovascular and metabolic risk. Given the cross-sectional design, causal relationships and changes in physical activity behavior over time cannot be inferred. Show less

Lipoprotein(a) [Lp(a)] is a genetically determined independent risk factor for atherosclerotic cardiovascular disease (ASCVD) that drives a significant residual risk through proatherogenic, proinflammatory, and prothrombotic pathways. However, current mainstay lipid-lowering therapies such as statins have limited efficacy in reducing Lp(a) levels, highlighting a critical therapeutic gap. This review aims to synthesize evidence on the role of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors in targeting Lp(a). We systematically searched PubMed and Embase for clinical trials and mechanistic studies (2010-2025), using the PRISMA and AMSTAR-2 frameworks to ensure methodological rigor and demonstrated that PCSK9 inhibitors (eg, alirocumab, evolocumab, and tafolecimab) not only reduced low-density lipoprotein (LDL-C) by 55%-60% but also lowered Lp(a) by 20%-30%. The efficacy of these agents varies ethnically, with tafolecimab showing superior performance in East Asian populations, which is partly attributable to the higher prevalence of the PCSK9 R46L loss-of-function allele. Mechanistically, PCSK9 inhibitors lowered Lp(a) levels through 2 pathways: suppression of hepatic synthesis and enhanced plasma clearance. This evidence supports the 2023 ESC guidelines, which issued a Class IIa recommendation for PCSK9 inhibitor use in patients with ASCVD and elevated Lp(a) levels. Given the evolving landscape, further research is warranted to confirm the role of these therapies in precision medicine paradigms for managing Lp(a)-associated risks. Show less

Family members of patients with digestive tract cancer represent a high-risk population for cancer development due to shared genetic and lifestyle factors, yet their own disease self-monitoring behaviors remain largely uncharacterized. Understanding the typologies and determinants of these behaviors is essential for precision prevention. A cross-sectional study was conducted among 414 family members of hospitalized patients with esophageal, gastric, or colorectal cancer in Sichuan Province, China (March-October 2023). Self-reported data were collected using validated questionnaires assessing socio-demographics, cancer risk perception, and digestive tract cancer self-monitoring behaviors. Latent profile analysis (LPA) was applied to identify subgroups of monitoring behaviors, and multinomial logistic regression was used to determine influencing factors. LPA revealed three distinct behavioral profiles: poor behavior group (47.10%), average behavior group (38.16%), and good behavior group (14.74%). The mean total self-monitoring score was 2.76 ± 0.69. Multivariate analysis showed that low educational level, family per capita monthly income ≤ 2000 CNY, and not living with patient were significant risk factors for poor monitoring behaviors. Conversely, having existing chronic disease and higher cancer risk perception were strongly associated with better monitoring performance. Nearly half of family members of digestive tract cancer patients exhibit insufficient self-monitoring of early symptoms. Education level, family per capita monthly income, cohabitation, comorbidity, and cancer risk perception are key determinants of behavioral heterogeneity. Tailored, risk-profile-based interventions that enhance risk awareness and promote regular screening are urgently needed to strengthen family-centered cancer prevention. Show less

Pulmonary artery sling (PAS) is a rare congenital vascular anomaly, in which the left pulmonary artery arises aberrantly from the right pulmonary artery and courses between the trachea and esophagus, often causing tracheobronchial compression. It is frequently considered within the spectrum of vascular rings. Prenatal diagnosis remains challenging yet crucial for optimizing perinatal management and neonatal outcomes. This case report illustrates the enhanced diagnostic capability achieved by integrating conventional two-dimensional (2D) ultrasound with spatiotemporal image correlation (STIC) technology for the accurate prenatal identification of PAS. A 33-year-old gravida 2 para 0 woman was referred for routine fetal assessment at 31 weeks of gestation. Initial 2D ultrasonography in the three-vessel tracheal view revealed an anomalous vascular configuration, suggesting the left pulmonary artery (LPA) originating from the right pulmonary artery (RPA). To confirm the diagnosis and delineate the vascular course, STIC technology was employed. The STIC volumetric acquisition and subsequent multi-planar reconstruction unequivocally demonstrated the LPA arising from the RPA and coursing posteriorly behind the trachea, thereby confirming the diagnosis of PAS. A comprehensive fetal echocardiogram excluded associated intracardiac anomalies. Following extensive parental counseling, the pregnancy continued uneventfully. The infant was delivered via elective cesarean section at 38 The synergistic use of routine 2D ultrasound and STIC technology provides a robust, clinically accessible method for the precise prenatal diagnosis of fetal PAS. This integrated imaging approach facilitates definitive diagnosis, enhances parental counseling, enables coordinated multidisciplinary perinatal planning, and ensures timely surgical intervention, all of which are pivotal for achieving favorable long-term outcomes in affected infants. Show less

Health apps designed to monitor, motivate, and educate people towards their health goals are getting more users and features each time. These apps offer valuable support for self-managing health behaviors and achieving long-term objectives. However, there is limited understanding of user preferences regarding essential app features. The aim of the study is to get insights about potential users' preferences, in order to tailor better apps for lifestyle management. We conducted a three-part web survey with 389 respondents from four countries as part of the DigiCare4You European Union (EU) project. In the first part, we collected the socioeconomic characteristics and health status of each respondent. In the following stage, we asked five questions on a Likert scale to ascertain the individual level of usage and general attitude towards technology. Finally, we performed a discrete choice experiment (DCE) using an unlabeled design and estimated the odds ratio for each feature using conditional logit analysis. We also ran alternative estimations stratifying by non-communicable disease (NCD) patients and non-NCD patients, and explored latent profile analysis (LPA) to understand whether the general attitude towards technology impacts the preference pattern between users. The DCE revealed that respondents showed a clear preference for monitoring physical health over emotional status. They favored receiving lifestyle achievement notifications weekly rather than daily, and daily rather than more frequently. Similarly, respondents preferred uploading body weight measurements on a weekly or monthly basis rather than daily. Users expressed a preference for collaborating with their doctors to set exercise and diet goals, rather than either deciding independently or delegating entirely to their doctors. End-users also show a pattern of preferring notifications for goals instead of challenging other users. Preferences regarding the subjects of health content between workout routines, food recipes, and new scientific evidence were not significant; also, no statistical significance was found for the decision between follow-up visits with their doctor in person or remotely. LPA returned two groups regarding their general attitude towards technology: a lower, an intermediate, and a higher usage in their private life based on their responses to the questionnaire. Stratified DCEs have shown heterogeneity of users' preferences according to their specific attitude towards technology. Our study indicates that potential mobile health (mHealth) app users managing chronic conditions prefer platforms that enable shared responsibility with their doctors in defining health goals while having an intermediate level of interaction frequency with the app. These findings are key to tailoring mHealth apps that can optimize motivation triggers, support healthier lifestyles, and empower patients with chronic conditions. Show less

Occupational stress in nursing is a critical issue that can have significant implications for both workforce stability and personal health. This study aimed to identify subgroups of occupational stress among Chinese female clinical nurses using latent profile analysis, compare sociodemographic differences across these subgroups, and examine their associations with premenstrual syndrome (PMS). A cross-sectional study was conducted among female nurses in tertiary hospitals in Huai'an City, Jiangsu Province, China, from November to December 2023. We recruited participants via convenience sampling, and 400 valid questionnaires were collected. Data were collected using a researcher-developed general information questionnaire, the standardized Chinese Nurses Stressor Scale (35 items), and the Premenstrual Syndrome Scale. Latent profile analysis (LPA) was performed with Mplus 8.0 to identify occupational stress subtypes. Sociodemographic predictors of these subtypes were explored using chi-square tests and multivariate logistic regression in SPSS 25.0. The association between stress subtypes and PMS symptoms was assessed using ANOVA. A Three clinical female nurse occupational stress subtypes were identified: overall low-stress (38.3%, This study identified significant heterogeneity in occupational stress among clinical female nurses, categorized into three distinct subtypes differing in stress levels and demographic characteristics. These findings highlight the importance of considering individual differences when developing interventions to address occupational stress. The study advocates for the implementation of intervention strategies targeting different types of stress in nursing education and organizational reform to better support nurses in fulfilling their responsibilities. Show less

Lipoprotein(a) (Lp(a)) is increasingly recognised as an independent and causal risk factor for atherosclerotic cardiovascular disease. Although the underlying mechanisms remain incompletely defined, evidence supports a multifactorial role for Lp(a) in atherogenesis. Lp(a) contributes to endothelial dysfunction, promotes vascular inflammation and enhances lipid retention and oxidation within the arterial wall. These changes drive foam cell formation and smooth muscle cell activation, hallmarks of early plaque development. In addition, Lp(a) exerts prothrombotic effects through structural homology with plasminogen, interfering with fibrinolysis and promoting thrombosis, which may increase the risk of plaque rupture and acute events. Collectively, these overlapping mechanisms underscore the unique contribution of Lp(a) to both the development and progression of atherosclerosis. As novel targeting therapies emerge, a deeper understanding of Lp(a) biology will be essential for translating these insights into clinical benefit. Show less

Depression and anxiety were not only common but also with serious consequence in inflammatory bowel diseases (IBD) patients. The current study endeavors to define distinct depression and anxiety profiles of IBD patients and identify central symptoms within different profiles to facilitate targeted interventions. The research employed K-means Clustering to delineate the depression and anxiety profiles, followed by a repetition of the analysis using Latent Profile Analysis (LPA). Furthermore, network analysis was utilized to identify central symptoms within the various profiles. K‑means Clustering identified Cluster 1 (38.89%), Cluster 2 (45.33%) and Cluster 3 (15.78%), while LPA yielded the low-risk group (39.56%), the mild-risk group (44.22%) and the high-risk group (16.22%). A majority of patients in the three clusters were predominantly in a single LPA-derived patient class (96.1-99.0%). Network analysis revealed that connections within each symptom in PHQ-9 and GAD-7 were stronger than those between symptoms. Furthermore, PHQ 6 ("guilt"), PHQ2 ("sad mood")and GAD 7 ("feeling afraid") were identified as the central symptoms in Cluster 1. PHQ2 ("sad mood"), GAD 3("excessive worry") and GAD 1 ("nervousness") emerged as the central symptoms in Cluster 2. Additionally, GAD3 ("excessive worry"), GAD 4 ("trouble relaxing") and GAD 6("irritability") were identified as the central symptoms in Cluster 3. We defined three distinct depression and anxiety profiles among IBD patients and pinpointed central symptoms within each profile. These findings underscore the importance of directing research towards those central symptoms within each profile in order to develop targeted intervention strategies. Show less

Inadequate childbirth readiness can adversely affect the birthing experience of pregnant women and may even influence their willingness to have further children. This study aimed to explore the determinants of childbirth readiness and the network relationships among these factors, thereby providing evidence to improve childbirth readiness. This cross-sectional study surveyed 350 pregnant women attending Wuxi Maternity and Child Health Care Hospital. Latent profile analysis (LPA) was first performed using the four domains of the Childbirth Readiness Scale to identify subgroups of childbirth readiness, and potential associated factors were then screened using univariate analysis and multinomial logistic regression. A Bayesian network model was employed to construct the structural relationships of factors influencing childbirth readiness. Childbirth readiness was categorised into three levels: poor (26%), good (30.9%), and complete (43.1%). Univariate analysis revealed significant differences across the three categories in relation to age, parity, pregnancy complications, antenatal exercise, planned pregnancy, self-efficacy, eHealth literacy, fear of childbirth, and family support ( Previous studies on childbirth readiness have mainly relied on regression models, which are unable to elucidate the intrinsic interconnections among influencing factors. By constructing a Bayesian model, this study demonstrated that women with high self-efficacy, no fear of childbirth, high eHealth literacy, and multiparity had the highest probability of achieving complete childbirth readiness (83.3%). Show less

Elevated lipoprotein(a) [Lp(a)] is an inherited, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Despite guideline endorsement, its measurement is inconsistently adopted within the UK healthcare setting. Understanding whether identifying raised Lp(a) alters real-world management and lipid outcomes is key to guiding policy. To evaluate the distribution of Lp(a) levels in a UK lipid clinic, quantify management changes across clinically relevant thresholds and explore the relationship between Lp(a) and final non-HDL-cholesterol (non-HDL-C) attainment. This retrospective observational study included 337 patients attending a specialist lipid clinic. Demographics, atherosclerotic cardiovascular (ASCVD) disease status, HEART UK Lp(a) testing criteria, management actions, and final non-HDL-C values were analyzed. Lp(a) concentrations were initially grouped into five descriptive categories (<30, 30-49, 50-89, 90-179, and ≥180 mg/dL) for baseline characterization. For management-change analyses, categories <50 mg/dL were combined to reflect the ESC/EAS-defined threshold for elevated Lp(a), which served as the clinical reference point for assessing management impact. Management changes were observed in 3.5% of patients with Lp(a) < 50 mg/dL, 56% with 50-89 mg/dL, and 79% and 83% of those with 90-179 mg/dL and ≥180 mg/dL, respectively. Interventions involved medication up-titration, reinforcement of lifestyle measures, or strengthened clinical emphasis on the importance of lifelong lipid-lowering therapy. Family cascade screening was initiated exclusively among patients with Lp(a) ≥ 90 mg/dL, representing around one-third of this subgroup. Mean final non-HDL-C increased with Lp(a) category, while target attainment (<2.5 mmol/L) declined, likely reflecting the biochemical contribution of Lp(a)-cholesterol to the non-HDL-C fraction rather than suboptimal management. Routine Lp(a) testing meaningfully alters management and reveals a form of residual dyslipidaemia resistant to standard therapy. These findings, combined with recent cost-effectiveness modelling showing NHS and societal savings from one-time testing, support incorporation of Lp(a) measurement into universal cardiovascular risk assessment. Show less

To evaluate the effect of inclisiran therapy on the blood lipid profile 90 days post-injection and to describe the baseline structural and ultrasound characteristics of carotid and femoral plaques in high- and very high-risk patients who failed to achieve low-density lipoprotein cholesterol goals despite ongoing lipid-lowering treatment. This prospective observational single-center study included 22 patients (mean age 50.9±8.6 years, 50% men) with dyslipidemia and atherosclerotic plaques in peripheral arteries narrowing the lumen by 25-49%. Familial hypercholesterolemia was diagnosed in 59% of patients, and statin intolerance in 36%. Duplex scanning of the carotid and femoral arteries was performed. The gray-scale median (GSM) method is currently used for the quantitative assessment of carotid artery (CA) plaque echogenicity. Inclisiran was administered on day 1, day 90, and then every six months. Blood lipid profiles, including low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides, and lipoprotein (a) [Lp(a)], were assessed. At baseline, median concentrations were 3.7 [2.5; 5.4] mmol/l for LDL-C, 5.4 [4.4; 6.8] mmol/l for TC, and 22.0 [5.0; 108.0] mg/dl for Lp(a). Carotid artery evaluation showed a median of 4.0 [2.0; 4.0] plaques, total stenosis of 110% [63.8; 118.8], and a GSM of 38.6 [28.6; 52.4], with a predominance of heterogeneous plaques (59%). Femoral artery assessment revealed a median of 2.0 [2.0; 3.0] plaques, 75% [42.5; 111.3] total stenosis, and a minimum echogenicity of 41.5 [33.4; 57.4] gray-scale units, with 65% heterogeneous plaques. Ninety days post-initiation of inclisiran, LDL-C was reduced by 65% (to 1.3 [1.2; 2.9] mmol/L, p<0.01), TC by 30% (p<0.01), triglycerides by 35%, and Lp(a) by 33%. Inclisiran demonstrated high efficacy in reducing LDL-C levels in patients at high and very high risk of cardiovascular disease who failed to reach targets with standard therapy. The identified plaque characteristics indicate a high risk of atherothrombosis in this cohort. The dynamics of these structural plaque changes will be assessed after completing the one-year follow-up. Show less

Research focused on adult eating styles would benefit from investigating whether latent profiles of appetitive and emotion-related impulsivity traits differ in eating disorder (ED) and general psychopathology. This study identified and validated latent eating profiles based on appetitive and emotion-related impulsivity traits. We conducted a cross-sectional study in a non-clinical sample of 232 adults who completed an online battery of questionnaires assessing appetitive traits, emotion-related impulsivity, ED symptomatology, anxiety, depression, stress, and other clinical and background characteristics. We fitted latent profile analysis (LPA) models with 2-8 classes on the dataset without multivariate outliers (N = 223). After retaining the best profile solution, we compared latent classes using ANCOVAs and Tukey post-hoc tests, controlling for age. The best-fitting model revealed four distinct profiles: Resilient Eaters (23.30%), with the lowest food responsiveness and emotion-related impulsivity; Moderate Eaters (46.27%), showing higher food avoidance and behavioral emotion-related impulsivity; Hedonic Eaters (14.03%), characterized by the highest enjoyment of food and lower emotion-related impulsivity; and Impulsive Eaters (16.40%), with the highest food responsiveness and emotion-related impulsivity. Resilient Eaters exhibited the most adaptive profile, with higher general and ED-specific flexibility and lower general ED psychopathology, depression, anxiety, and stress, compared to Moderate and Impulsive Eaters. Moderate and Hedonic Eaters showed intermediate levels of ED symptomatology and psychological distress, whereas Impulsive Eaters displayed the most maladaptive profile. Classifying eating profiles based on appetitive and impulsive traits has the potential to advance screening for complex forms of ED psychopathology. Show less

Insulin resistance (IR) and lipoprotein(a), Lp(a), are established contributors to cardiovascular disease (CVD) risk. Whether IR modifies the association between Lp(a) and CVD in primary prevention remains uncertain. This prospective cohort study included UK Biobank participants without baseline CVD. IR at enrollment was assessed using the triglyceride-glucose index (TyG). The primary outcome was first major adverse cardiovascular event, defined as peripheral arterial disease, coronary artery disease, myocardial infarction, ischemic stroke, or cardiovascular death. Cox models estimated adjusted hazard ratios (aHRs) with 95% CIs for log-transformed Lp(a) and TyG, adjusting for each other. Lp(a) was categorized as <125 or ≥125 nmol/L; high IR was TyG ≥75th cohort percentile. Participants were stratified into 4 joint Lp(a)/IR groups using low Lp(a)/low IR as reference. Among 328 031 participants (mean age 56.4 years; 54.7% women), 26 865 CVD events occurred over 14.6 years median follow-up (interquartile range 13.7-15.4). Per 1-SD increase, aHRs were 1.08 (95% CI, 1.06-1.09) for log-Lp(a) and 1.06 (95% CI, 1.04-1.07) for TyG, each adjusted for the other. The Lp(a) and IR each independently contribute to cardiovascular risk, with a combination offering improved risk stratification. This suggests that accounting for IR may enhance the assessment of Lp(a)-associated risk in the context of primary CVD prevention setting. Show less

To identify latent family resilience profiles among families of patients with first-episode stroke in the intensive care unit (ICU) and examine factors associated with resilience heterogeneity, with the aim of informing targeted family-support interventions. A cross-sectional study was conducted among 335 ICU patients with first-episode stroke and their primary caregivers. Family resilience was assessed using the Chinese version of the Family Resilience Assessment Scale (FRAS-C). Latent profile analysis (LPA) was used to identify subgroups of family resilience, while LASSO regression and multiple binary logistic regression were applied to determine influencing factors. Two distinct resilience profiles were identified: Developing Families, characterized by lower levels of communication, resource utilization, and positive outlook; and Optimized Families, characterized by higher resilience across all dimensions. ICU admission count (OR = 2.299, 95% CI: 1.066-4.960), frequency of care and support from relatives or friends (OR = 1.851, 95% CI: 1.068-3.206), and number of additional organ system dysfunctions (OR = 0.233, 95% CI: 0.122-0.445) were significantly associated with family resilience profiles (all Family resilience among ICU first-episode stroke patients shows notable heterogeneity, with two typical resilience patterns. Early identification of high-risk families-particularly those with limited social support or higher disease complexity-can guide clinicians in delivering targeted communication support, psychological counseling, and resource linkage interventions. Tailored resilience-enhancing strategies may contribute to better patient recovery and improved family adaptation during critical care. Show less

Nurses' voice behavior is critical for patient safety and organizational improvement. However, its manifestation is not uniform among nurses. This study aimed to identify latent profiles of nurses' voice behavior using Latent Profile Analysis (LPA) to understand this heterogeneity and explore its influencing factors, with a specific focus on differences across work motivation dimensions (rooted in Self-Determination Theory, SDT). A multicenter cross-sectional design was adopted. Data from 701 clinical nurses across six hospitals in Guangxi Province were analyzed: LPA identified four distinct profiles, and Multinomial Logistic Regression was used to examine predictors. Work motivation was measured by the Multidimensional Work Motivation Scale (MWMS), and voice behavior by the Voice Behavior Scale (VBS). LPA identified four distinct profiles (Conservative, 5.42%; Balanced Risk-Taker, 26.39%; Transitional, 34.38%; Challenging, 33.8%), and Multinomial Logistic Regression was used to examine predictors. Work motivation was measured by the Multidimensional Work Motivation Scale (MWMS), and voice behavior by the Voice Behavior Scale (VBS). Results showed autonomous motivation (e.g., intrinsic drive) strongly predicted active voice behavior, while amotivation predicted conservative profiles. Nurses exhibited high work motivation (MWMS: 93.02 ± 21.09) and moderately high voice behavior (VBS: 39.27 ± 8.736). The research found that nurses exhibited high work motivation and moderately high voice behavior, with autonomous motivation being a pivotal predictor. Differentiated strategies targeting intrinsic motivation enhancement are critical for fostering nursing innovation and improving care quality. Show less

To investigate the relationship between different physical activity (PA) patterns and stroke incidence among middle-aged and elderly populations in China. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative prospective cohort encompassing 2011 to 2020. PA was calculated based on the International Physical Activity Questionnaire. Different patterns of PA included moderate-to-vigorous PA (MVPA, ≥ 150 min/wk vs. < 150 min/wk), vigorous PA (VPA, ≥ 75 min/wk vs. < 75 min/wk), moderate PA (MPA, ≥ 150 min/wk vs. < 150 min/wk), light PA (LPA, ≥ 300 min/wk vs. < 300 min/wk), and total PA (TPA, ≥ 600 metabolic equivalent of task [MET]-min/wk vs. < 600 MET-min/wk). Cox proportional hazards models evaluated stroke risk associations, while restricted cubic splines (RCS) characterized TPA dose-response effects. There were 5090 participants in total (mean age, 59.23 [standard deviation, 9.43] years; 54.5% were female), and 378 (7.4%) incident stroke cases were documented at a 9-year follow-up. Achieving the World Health Organization (WHO) guideline of ≥150 min/wk MVPA was associated with a 24% lower stroke risk (adjusted hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.62-0.96, p = 0.019). No significant association was observed between VPA (HR = 0.79, 95% CI 0.63-1.01), MPA (HR = 0.82, 95% CI = 0.67-1.01), LPA (HR = 0.86, 95% CI = 0.70-1.07), or TPA (HR = 0.84, 95% CI = 0.65-1.08) and stroke risk. Additionally, RCS analysis demonstrated a non-significant dose-response relationship between TPA and stroke risk. This study validates WHO's MVPA guidelines (≥ 150 min/wk) for stroke prevention in Chinese elders. However, the predominantly self-reported and occupation-based PA in this cohort highlights the need for future research focusing on objective measurements of leisure-time PA. 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

This study aimed to identify latent classes of adherence for serum phosphorus control and their influencing factors among patients receiving Peritoneal Dialysis with hyperphosphatemia. This cross-sectional study using convenience sampling was conducted among patients receiving peritoneal dialysis with hyperphosphatemia between December 2024 and May 2025. Participants were assessed using the Phosphate Control Adherence Scale, Self-Efficacy Scale, and Family Care and Social Support Scale. Demographic and clinical data were also collected. Latent profile analysis (LPA) was used to identify adherence subgroups. Univariate analysis and multicollinearity diagnostics were performed, followed by binary logistic regression to determine predictors of adherence. Blood phosphorus control adherence can be classified into two categories: the low-level medical adherence group, characterized by poor dietary self-control (19.93%), and the high-level medical adherence group, marked by effective medication adherence (80.07%). The results indicated that residence conditions, types of medication, and self-efficacy significantly influenced blood phosphorus control adherence among patients with various forms of PD hyperphosphatemia (all p < 0.05). Patients with hyperphosphatemia undergoing peritoneal dialysis exhibit heterogeneity in adherence to serum phosphorus control. This indicates that healthcare providers should identify the adherence characteristics of different patient groups at an early stage and implement targeted intervention strategies to enhance patients' adherence to serum phosphorus management. Show less

This cross-sectional study aimed to examine the associations between the 24-h movement behaviors and mental health among university students in China, and to determine the optimal behavioral balance based on the top 5% of model-predicted mental health outcomes using compositional data analysis. A total of 6,084 university students aged 17–24 years in Southwest China self-reported their daily durations of moderate-to-vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA), sedentary behavior (SED), and sleep (SLP). They were stratified by gender and then randomly and equally assigned to the “recommendation” group and the “validation” group. Using compositional data analysis, time-use compositions (MVPA, LPA, SED, SLP) were transformed into isometric log-ratios (with quadratic terms as needed) and subsequently used in regression models to predict the three mental health outcomes. All possible combinations of motion components were examined to determine the combination with the highest correlation (top 5%) for each outcome. Through research and analysis of the recommendation groups, the optimal combination of average (range) time usage is determined as follows: for males, MVPA 92 (60–110) min/day, LPA 361 (310–400) min/day, SED 372 (350–480) min/day, SLP 614 (530–680) min/day; for females, MVPA 58 (40–90) min/day, LPA 290 (180–390) min/day, SED 445 min (400–560), SLP 665 (580–740) min/day. The recommended durations served as benchmarks for the validation group. Participants who met the optimal 24-h movement behavior time showed significantly lower depression (males: β = –1.290, The optimal 24-h movement behavior time differs between men and women. Males tend to require a longer optimal MVPA duration than females, while females require a longer optimal SLP duration than males. The findings provide valuable reference for developing 24-h movement guidelines and promoting healthy and balanced lifestyles among university students. [Image: see text] The online version contains supplementary material available at 10.1186/s12889-026-26534-x. Show less

Depression is prevalent among colorectal cancer (CRC) survivors. Although various physical activity intensities are differentially associated with depressive symptoms, the underlying mediator and moderator involving interoception and mindfulness, remain unclear. This study aims to examine whether interoceptive accuracy differentially mediates the relationship between various physical activity intensities and depressive symptoms and whether mindfulness moderates these pathways. In this multicenter cross-sectional study, 395 CRC survivors completed validated questionnaires assessing depressive symptoms, physical activity participation, interoceptive accuracy, and mindfulness. Mediation and moderated mediation analyses via PROCESS version 4.1 for SPSS tested whether interoceptive accuracy mediated associations between light and moderate-to-vigorous physical activity (LPA vs. MVPA) and depressive symptoms, and whether mindfulness moderated these pathways. Both LPA and MVPA are negatively associated with depressive symptoms (p < 0.001). Interoceptive accuracy significantly mediated these associations, accounting for 49.09% of the total effect for LPA and 20.56% for MVPA. Mindfulness moderated the LPA-interoceptive accuracy (B = -0.004, p = 0.031), interoceptive accuracy-depression (B = -0.022, p = 0.004), and MVPA-depression pathways (B = -0.001, p = 0.034), suggesting differential, intensity-dependent associations. LPA showed negative associations with depressive symptoms, with interoceptive accuracy fully mediating this association. In contrast, MVPA demonstrated both direct and indirect associations with depressive symptoms, partially mediated by interoceptive accuracy. Mindfulness strengthened these relationships through complementary and synergistic moderation, highlighting the dynamic interaction between bodily awareness and physical activity in psychological recovery. Tailoring gentle, mindful movement to enhance interoception may offer a feasible, integrative rehabilitation strategy to reduce depression among CRC survivors. Show less

Retrospective cohort study of patients undergoing single-level L5-S1 anterior or transforaminal lumbar interbody fusion between 2012 and 2024 at a single academic institution, with preoperative and one-year postoperative radiographic assessment of sagittal alignment parameters. To quantify changes in lumbar pelvic angle (LPA), pelvic tilt (PT), global lumbar lordosis (L1-S1), regional lumbar lordosis (L4-S1), and segmental lumbar lordosis (L5-S1) among single-level L5-S1 ALIF and TLIF patients. Restoration of sagittal alignment is a primary goal of lumbar fusion. While ALIF is regarded as superior to TLIF in restoring segmental lordosis, its effect on global and regional alignment remains uncertain, and few studies directly compare their impact on spinopelvic parameters. The electronic medical record was queried for patients who underwent single-level L5-S1 ALIF or TLIF with preoperative and one-year postoperative imaging. Sagittal parameters were measured using Surgimap software. Group comparisons were assessed with unpaired t-tests or Wilcoxon signed-rank tests. Radiographic measurements were available for 174 patients (ALIF n=73, TLIF n=101). ALIF patients had significantly greater improvement in L4-S1 (+4.2° vs. -1.1°, P=0.002) and L5-S1 lordosis (+4.6° vs. -4.8°, P<0.001). No significant differences were observed in postoperative changes for L1-S1 lordosis (+2.2° vs. -1.4°, P=0.250), LPA (-1.9° vs. -1.4°, P=0.743), or PT (-0.9° vs. +0.4°, P=0.093). Permutation testing confirmed that the observed difference in LPA improvement between cohorts (-0.51°) was not statistically significant (P=0.673), and post hoc analysis confirmed adequate power to detect a difference of 3.37°. Sensitivity analyses using ANCOVA, adjusting for baseline radiographic values and covariates, were concordant. ALIF provided superior regional and segmental lordosis but did not improve global alignment compared with TLIF. This study is the first to quantify the effect of ALIF versus TLIF on LPA, highlighting the limited impact of single-level fusion on global spinopelvic alignment. Show less

Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS), with plasma levels largely unaffected by lifestyle modification or conventional lipid-lowering therapy. Although international guidelines increasingly recognize Lp(a) as a risk-enhancing factor, in many Asian populations thresholds for high Lp(a) and treatment strategies remain undefined. This Korean position paper, developed by the Lp(a) Task Force of the Korean Society of Lipid and Atherosclerosis, presents an evidence-based summary of the pathophysiology, clinical relevance, and therapeutic landscape surrounding Lp(a), with a focus on Korean-specific data. It reviews the genetic architecture of Lp(a), ethnic variability in concentrations, and its mechanistic roles in inflammation, thrombosis, and calcification. Based on large Korean cohorts, a 3-tiered classification is proposed of normal (<30 mg/dL), borderline high (30-49 mg/dL), and high (≥50 mg/dL), harmonizing global thresholds with local data. The document also highlights the limitations of current Lp(a) assays in Korea, and calls for standardized, isoform-insensitive testing. Novel therapeutics, including antisense oligonucleotides, small interfering RNAs, and small molecular inhibitors, have shown promising Lp(a)-lowering effects, with multiple phase 3 trials currently ongoing, or in planning. Given the unmet clinical need, the paper recommends incorporating Lp(a) into cardiovascular risk assessment, and calls for Korean-specific longitudinal studies, national screening strategies, and participation in clinical trials. These efforts will help clarify Lp(a)-associated risk in Korean patients and guide the adoption of future targeted therapies. Show less

Child maltreatment measurement has been a longstanding issue, with discrepancies across administrative records, parent-reports, and self-reports. One proposed solution is "triangulation," or integrating data from multiple reporters and sources. However, it remains unclear how best to operationalize this concept. This study examines the concept of "triangulation" by employing different analytic methods to determine whether these methods reveal a common underlying construct of physical abuse and whether they predict adult depression. Data come from the Lehigh Longitudinal Study, a 40+ year prospective study that began in the 1970s with children ages 18 months to 6 years of age. Data were collected in early childhood, middle childhood, adolescence, and adulthood (ages 36 and 46, on average). We applied five analytic approaches - network analysis, ordinary least squares (OLS) regression, structural equation modeling (SEM), latent profile analysis (LPA), and a cumulative index regression - to assess the relationships among multiple reporters of childhood physical abuse and adult depression. SEM best modeled the latent construct of physical abuse and significantly predicted adult depression, with adult self-reports playing a particularly strong role. Network analysis also highlighted strong intercorrelations among self-reports and meaningful links with depression. SEM and network analysis were the most informative for triangulation and prediction of adult depression. Adult self-reports of abuse were most related and most predictive of adult depression. Show less

Our understanding of the genetic regulation of lipoprotein(a) [Lp(a)] is hindered by the complex structure of the LPA gene, limited non-European datasets and its elusive cellular receptor(s). This review summarizes recent efforts and advances providing new insights on its genetic architecture, variability across ancestries and regulators beyond the LPA gene. Impressive advances in DNA sequencing and bioinformatics now resolve LPA variants and kringle IV-type 2 copy number at scale. This provides new reference datasets and enables tools that unlock hidden variation also from already available sequencing datasets. In parallel, genetic studies broaden our understanding of the regulation of Lp(a) across ancestries and improve genetic risk scores. Finally, while recent studies implicate new mechanisms for Lp(a) uptake, upcoming genome-wide gene knockout screens allow comprehensive, agnostic scans for regulators and receptors. Puzzlingly, this still converges on the LDL receptor, whose exact role in Lp(a) uptake remains enigmatic. Technological advances establish a foundation for more accurate genetic risk assessment across ancestries. These advances are enhancing our understanding of Lp(a) regulation and build a framework for future integrative genetic studies, which may shed new light on the evolution of the Lp(a) trait, adding important context for its physiological and clinical relevance. Show less

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

Although no model can fully capture the complexity of the human experience, some simplify it in ways that yield meaningful insight. This adage raises critical questions: How do we decide which modeling approaches to adopt and evaluate their translational utility? Recent years have seen a surge in the use of sophisticated statistical methods and large datasets to disentangle complex interactions across ecological systems. In this issue, Ramduny et al. Show less