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Lipoprotein(a) [Lp(a)] is a causal risk factor for cardiovascular disease, and it is particularly associated with premature acute coronary syndrome (ACS). We investigated whether elevated Lp(a) can predict recurrent cardiovascular events in patients who experienced their first ACS less than or equal to 40 years of age. Within the STudy of eArly Myocardial INfArction registry, we recruited 405 consecutive patients who survived their first ACS less than or equal to 40 years of age; of them 378 had complete follow-up data. Clinical endpoint was the development of major adverse cardiovascular events (MACE; i.e. cardiac death, readmission for ACS or malignant ventricular arrhythmias, ischemic stroke, or coronary revascularization due to clinical deterioration). Multi-adjusted Cox regression was used to assess the association between Lp(a) and first recurrent MACE risk. Of the 378 ACS survivors (33.7 ± 4.3 years), 139 (36.8%) experienced a MACE over a median 8-year (5.2-12.5 years) follow-up. Elevated Lp(a) showed a borderline independent association with higher recurrent MACE [hazard ratio per 1 mg/dl: 1.004, 95% confidence interval (CI): 0.999-1.009, P = 0.051]. Moreover, patients with baseline Lp(a) levels greater than or equal to 50 mg/dl had 82.6% higher risk of MACE as compared with those below (hazard ratio 1.826, 95% CI: 1.141-2.925, P = 0.012); similarly, patients with Lp(a) ≥ 70 mg/dl had 118% higher risk as compared with those below (hazard ratio 2.180, 95% CI: 1.330-3.573, P = 0.002). Elevated Lp(a) concentrations demonstrate an independent association with recurrent MACE among very young ACS survivors. Until targeted Lp(a)-lowering treatments become clinically available, an aggressive lipid-lowering approach may be warranted to partially attenuate Lp(a)-related residual cardiovascular risk. Show less

We compared 16-week wearable activity monitor trajectories of patients receiving hematopoietic stem-cell transplants (SCT) engaged in an activity intervention trial. Forty adults with haematological malignancy scheduled to undergo SCT were randomised to an exercise and sedentary behaviour intervention (INT; n = 22) or usual care (UC; n = 19). Participants were observed continuously for the duration of inpatient hospitalisation for SCT (approximately 4 weeks) and outpatient (12 weeks) care. Between-group differences were determined by 16-week trajectories of Fitbit-derived variables of physical activity and sedentary time (ST). Inpatient hospitalisation for SCT led to higher levels of ST and lower levels of physical activity in both groups relative to pre-admission. Across the ~16-week period, the INT group had significantly higher physical activity and lower ST. During the 16-week study period and independent of intervention group assignment, a higher pre-hospitalisation cardiorespiratory fitness was associated with higher levels of moderate-to-vigorous intensity physical activity, being female had stronger associations with step counts, older age and myeloablative SCT were associated with higher ST, and higher proportions of lean mass were associated with higher levels of LPA. Wearable activity monitors can continuously assess the behavioural impacts of SCT and the efficacy of activity intervention in patients receiving hospital treatment for haematological malignancy. Tracker data showed that the activity intervention protected against declines in physical activity and increases in sedentary time with usual hospital care in SCT. Higher pre-hospitalisation cardiorespiratory fitness and proportion of lean mass were associated with preservation and recuperation of activity levels. Show less

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

Coronary artery disease (CAD) has been associated with elevated Lp(a) levels, yet the mechanism driving the pro-atherogenic and inflammatory effects remains unclear. Proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of lipid metabolism with emerging roles in vascular inflammation. This study explored the relationship between Lp (a) and PCSK9 in an Asian cohort with angiogram-proven premature CAD (AP-pCAD), with and without familial hypercholesterolemia (FH). Patients were recruited from Cardiology and Specialist Lipid Clinics; grouped into pCAD with FH ( Show less

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

BackgroundMultiple sclerosis (MS) is a prevalent, frequently progressive condition of the central nervous system that can significantly affect employment and career participation. Although researchers have extensively catalogued the factors that people with MS face in maintaining employment, the priorities of people working with MS in terms of career resources and information needs have not been extensively evaluated.ObjectiveWe sought (a) to identify the types of career information and resources that employed or recently-employed people with MS prioritize, and (b) to assess the extent to which the need for these career resources may vary among identifiable subgroups.MethodDescriptive statistics and latent profile analysis (LPA) were applied to the responses of 376 iConquerMS members who were either employed ( Show less

To examine associations between the 24-h composition of movement behaviors (sedentary behavior [SB], light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and sleep) and physical and mental health in older adults using compositional data analysis. Data came from 4,150 adults aged ≥ 60 in the 2015 China Health and Nutrition Survey. Multiple‑balance isometric log‑ratio regression and compositional isotemporal substitution models were used to assess relative associations and the effect of time reallocation. The 24‑hour geometric mean composition was 43.1% sleep, 30.6% SB, 21.8% LPA, and 4.5% MVPA. LPA was positively associated with physical (β = 0.062, Replacing sedentary time or sleep with LPA, even in small amounts, is associated with better physical and mental health in older adults, supporting integrated 24‑hour activity guidelines that emphasize light‑intensity movement. Show less

An 8.5-month-old female British Shorthair (case 1) and a 2-month-old female domestic shorthair (case 2) were referred for dyspnoea and lethargy. Echocardiography was compatible with unrestrictive patent ductus arteriosus (PDA) with continuous left-to-right shunting and concomitant iso-systemic pulmonary hypertension (PH) (case 1) and restrictive PDA with mild PH (case 2). Radiography showed cardiomegaly, increased pulmonary vascular markings and diffuse interstitial-alveolar pattern consistent with congestive heart failure (CHF) in both cats. After testing for pulmonary vascular reactivity (case 1) and treatment for acute CHF (case 2), surgical ligation of the PDA was attempted. In case 1, PDA ligation led to severe hypotension and asystole, prompting loosening of the ligature because of suspected intolerance to PDA closure. Cardiac massage was initiated and successfully restored the sinus rhythm. The procedure was aborted after partial PDA attenuation. Postoperative echocardiography raised suspicion of pulmonary artery ligation and supra-systemic right ventricle. No surgical revision was performed as the cat remained clinically stable; however, she died 10 days after surgery. In case 2, severe bradycardia developed 20 mins after duct ligation, followed by cardiorespiratory arrest unresponsive to resuscitation. Anatomopathological examination revealed main pulmonary artery and PDA ligation (case 1), and complete left pulmonary artery (LPA) ligation (case 2). Inadvertent ligation of the pulmonary artery has been reported in human medicine, and to the best of our knowledge, this is the first report in cats. Prompt recognition and correction of such errors are critical for a favourable immediate perioperative outcome and improved long-term prognosis. Show less

Because the prognostic value of lipoprotein(a) [Lp(a)] levels in Japanese patients remains unclear, we assessed their distribution and association with long-term outcomes in ST-segment elevation myocardial infarction (STEMI). In our retrospective analysis of 868 consecutive patients with STEMI, the median serum Lp(a) level was 15.75 mg/dL at admission, and the median follow-up was 736.5 days. Using restricted cubic spline analysis, we stratified patients into high (≥47.26 mg/dL) and low (<47.26 mg/dL) Lp(a) groups. The high Lp(a) group had a higher proportion of older and female patients, with lower body weight, estimated glomerular filtration rate, and stent use, and higher dyslipidemia prevalence than those in the low Lp(a) group. The 5-year cumulative incidence of the composite primary endpoint (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or any revascularization) was significantly higher in the high Lp(a) group, primarily because of a high rate of any revascularization. Patients with elevated Lp(a) levels demonstrated higher rates of any revascularization for both de novo and restenotic lesions than those with lower levels. After adjusting for confounders, a high Lp(a) level was identified as an independent predictor of the primary endpoint (hazard ratio:1.932; 95% confidence interval:1.255-2.974). In Japanese patients with STEMI, elevated Lp(a) levels were independently associated with worse long-term outcomes. Show less

How schoolchildren distribute their time between movement behaviours may be impacted by the neighbourhood environment. Few studies have investigated the associations between the physical and social environment and the full movement behaviour composition, including times spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour, and sleep, and their findings are inconsistent. Therefore, our aim was to investigate this association in a large, national-representative sample of schoolchildren from major cities and regional/remote areas. We used data from the Longitudinal Study of Australian Children and the Child Health CheckPoint study, collected among 1230 child-parent pairs (child age range: 10–12 years). Parents were asked about neighbourhood general safety, access to destinations and services, and social capital and cohesion. Children’s time spent in MVPA, LPA, sedentary behaviour, and sleep was assessed using wrist-worn GENEActiv accelerometers. The associations between the physical and social environment characteristics (independent variables) and movement behaviour composition expressed as isometric log ratio coordinates (dependent variables) were examined using multiple linear regression analyses, adjusted for age, body mass index, pubertal status, sex, and socioeconomic position. Among schoolchildren from regional/remote areas, access to destinations and services (Pillai’s trace = 0.030; These findings highlight the importance of access to destinations and services, as well as social capital and cohesion, in shaping the movement behaviour composition among schoolchildren from regional/remote areas. More research is needed to draw conclusions about the association between neighbourhood environment and movement behaviour composition among schoolchildren from major cities. The online version contains supplementary material available at 10.1186/s12966-026-01879-z. Show less

Yucha, a traditional fermented rice-fish product, faces challenges in inconsistent quality and safety. In this study, 69 lactic acid bacteria (LAB) were isolated from Yucha and shrimp paste in Hainan, China. Four strains, Lactiplantibacillus plantarum Lpl-YC37, Lacticaseibacillus paracasei Lpa-XJ120, and Pediococcus pentosaceus Ppe-YC39 and Ppe-XJ37 were selected as starters based on probiotic property and safety evaluation. Inoculation with these LAB starters significantly enriched beneficial metabolites, with Ppe-XJ37 showing a four-fold increase in acetic acid, the dominant short-chain fatty acids. Additionally, all LAB inoculation enhanced free amino acids, particularly L-glycine, improving flavor and nutritional value. Crucially, LAB inoculation drastically suppressed biogenic amines, reducing putrescine from 55.23 μg g Show less

National epidemiologic data are needed to inform country-specific healthcare policies for prevention and new developing treatments. We aimed to analyze Greek epidemiologic data in clinically relevant special populations for targeted treatments and to evaluate the utility of lipoprotein(a) [Lp(a)] as a risk enhancer METHODS: Two independent cohorts were included in this analysis: (1) consecutively recruited patients assessed in a tertiary outpatients' lipid clinic (Athens Angiometabolic cohort [AAC], n = 1106) with available peripheral vascular markers, and (2) sample of the Greek general population (ATTICA study [AS], n = 2682) with available 20-year follow-up data for atherosclerotic cardiovascular disease (ASCVD) events. Increased Lp(a) was found in 8.3% of the AS (≥50 mg/dL) and in 18.9% of the AAC (≥125 nmol/L) (16.0% without ASCVD and 22.1% with ASCVD, P = .006). Elevated Lp(a) levels were associated with increased carotid, coronary artery, and lower extremity atherosclerosis (P < .05 for all). Both the European Atherosclerosis Society (EAS) recommendations (net reclassification index [NRI]: 0.170) and a derived sex-specific inflation factor for HellenicSCOREII+ (NRI: 0.176) were efficient in incorporating Lp(a) as a risk enhancer over HellenicSCOREII+ for 20-year major adverse cardiovascular events. For 10-year cardiovascular death, only the EAS consensus provided significant reclassification. Finally, Lp(a) conferred increased eligibility for more aggressive primary prevention measures both by EAS recommendations (23.6% in AAC/13.6% in AS) and by sex-specific inflation factors (25.6% in AAC/22.3% in AS). Elevated Lp(a) levels were observed in 8.3% of the general population cohort and up to 23.9% in participants with ASCVD from the lipid clinic cohort, highlighting a risk gradient across ASCVD categories. Incorporating Lp(a) as a risk enhancer improves ASCVD risk reclassification beyond the validated HellenicSCOREII+. Show less

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

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

Lipoprotein(a) (Lp(a)) is a causal risk-factor for atherosclerotic cardiovascular disease including acute ischemic stroke (AIS). The underlying pathomechanisms mediating this risk are less well understood, especially in AIS caused by large artery atherosclerosis (LAA). In this observational cohort study, we evaluated the association of Lp(a) with markers of LAA, namely carotid intima media thickness (cIMT) and the presence of extra- or intracranial vessel narrowing plaques. Among participants of the BIOSIGNAL cohort study we determined Lp(a) levels within 24 h after symptom onset in 1161 AIS patients from the single center of Zurich. cIMT was determined using a semi-automated computerized edge tracking software, internal carotid artery (ICA) stenosis was graded according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, intracranial ultrasound was performed by transcranial color-coded duplex (TCCD). Higher Lp(a) levels were not associated with an increased cIMT in univariable or multivariable regression models containing known cardiovascular risk factors. Higher Lp(a) levels were not associated with the presence of neither extracranial high-grade ICA-stenosis nor significant intracranial stenosis assessed by neurovascular ultrasound. In AIS patients higher Lp(a) levels were not associated with clinical markers of atherosclerotic burden despite its association with LAA-stroke etiology and an increased risk for stroke recurrence. Date of registration: 17–10-2014. Registration-URL: http://www.clinicaltrials.gov; Unique identifier: NCT-02274727. The online version contains supplementary material available at 10.1186/s12944-026-02913-6. 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

Problematic social media use (PSMU) has emerged as a societal and behavioral concern, especially among young adults. However, individual differences in symptom manifestation remain understudied. The present study adopted a person-centered approach to identify distinct profiles of PSMU and to examine the predictive roles of fear of missing out (FoMO), problematic smartphone use (PSU), age, and sex among a sample of 625 Italian university students aged 18 to 40 years ( Show less

Conflicting data have explored the association between lipoprotein(a) [Lp(a)] and atherosclerotic cardiovascular disease (ASCVD) among individuals with different glucose metabolism statuses. We aimed to prospectively evaluate this association and to assess whether it is modified by C-reactive protein (CRP). This population-based cohort study was derived from the UK Biobank database. Lp(a) and CRP were measured between 2006 and 2010. Cox proportional hazards models and restricted cubic spline curves were employed to assess the relationship between Lp(a) levels and time to ASCVD events. A total of 307 269 participants without prevalent ASCVD were included, comprising 253 746 individuals with normal glucose regulation (NGR), 38 020 with prediabetes, and 15 503 with diabetes. The mean age was 57 years (Q1-Q3: 50-63), and 55.3% were female. Over a median follow-up of 13.2 years, 29 521 ASCVD events occurred. Higher Lp(a) levels were associated with an increased risk of ASCVD across all glucose metabolism statuses. In fully adjusted models, the hazard ratio (95% confidence interval) for ASCVD comparing participants in the top 10% of Lp(a) with those in the bottom 33% was 1.28 (1.22-1.34) among those with NGR, 1.23 (1.12-1.35) among those with prediabetes, and 1.16 (1.02-1.31) among those with diabetes. No significant interactions were observed after stratification by CRP (<2/≥2 mg/L) across glucose metabolism groups (P for interaction >0.05). Elevated Lp(a) levels were associated with a higher risk of ASCVD across different glucose metabolism statuses, particularly among individuals with NGR and prediabetes, independent of baseline CRP levels. 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

Lipoprotein(a) [Lp(a)] is a potent, independent causal risk factor for coronary artery disease (CAD). This study aimed to assess the association between Lp(a) and the diagnosis, clinical presentation, and angiographic characteristics of obstructive CAD and occurrence of myocardial infarction (MI). We included 446 individuals with very high Lp(a) (>230 nmol/L) who underwent routine lipid profiling, matched 2:1 by age and sex using nearest-neighbor propensity matching to 223 controls with low Lp(a) (≤7 nmol/L). Kaplan-Meier analysis was used to assess CAD- and MI-free survival. Multivariable ORs were calculated for multivessel disease and the SYNergy Between percutaneous coronary intervention with TAXus and Cardiac Surgery-1 score. Median follow-up time, defined by age at last follow-up, was 60 years (Q1-Q3: 50-71). Individuals with very high Lp(a) had significantly lower event-free survival time for the diagnosis of obstructive CAD and occurrence of MI (P = 0.006 and P = 0.012, respectively). In multivariable analysis, Lp(a) was associated with multivessel CAD (adjusted OR: 1.43 [per 100 nmol/L]; 95% CI: 1.04-1.96; P = 0.028), but not with an intermediate or high SYNergy Between percutaneous coronary intervention with TAXus and Cardiac Surgery-1 score (adjusted OR: 1.28 [per 100 nmol/L]; 95% CI: 0.82-1.99, P = 0.279). Individuals with very high Lp(a) levels had a 2.4-fold higher risk of ST-segment elevation MI and a 15.9-fold higher risk of recurrent MI compared to those with low Lp(a). Very high Lp(a) is associated with earlier diagnosis of obstructive CAD and MI, predominantly ST-segment elevation MI. In addition, individuals with very high Lp(a) levels seem at a particular high risk of recurrent MI. Show less

The cornerstone of treating lower extremity deep venous thrombosis (LEDVT) lies in anticoagulation therapy to prevent thrombus progression and recurrence. However, patient adherence to medication is a critical factor influencing treatment efficacy. Traditional research often simplifies adherence into binary categories of "adherent" and "non-adherent," which fails to comprehensively reflect the complex behavioral patterns. Based on latent profile analysis (LPA), medication adherence in LEDVT patients can be categorized into distinct classes, enabling more precise identification of their characteristics. Therefore, exploring these latent classes and their influencing factors holds significant importance for optimizing intervention strategies and improving prognosis. A cross-sectional survey was used to study LEDVT. From March 14, 2024 to September 20, 2024, a random sampling method was used to recruit 469 patients with LEDVT from four grade-A tertiary hospitals in Urumqi, China. Participants completed questionnaires on general demographic information, the Medication Adherence Scale, the Perceived Health Competence Scale, the Herth Hope Index, the Patient Activation Measure, the Beliefs about Medicines Questionnaire-Specific. LPA was conducted to analyze the medication adherence characteristics of patients with LEDVT. Univariate analysis and multivariate logistic regression were used to identify the influencing factors of their latent profiles. Data analysis was performed using Mplus 8.3 and SPSS 25.0 software. LPA was employed to investigate medication adherence in LEDVT patients, revealing three distinct latent classes: the poorest adherence group (44.99%), the moderate adherence group (19.83%), and the good adherence group (35.18%). The logistic regression results demonstrated that, perceived health competence, hope, activation, beliefs about medication necessity, and concerns about medication were influential factors affecting the potential profile of medication adherence (all p < 0.05). LEDVT patients exhibit significant individual differences in medication adherence. Personalized intervention strategies can be designed based on different adherence classes to enhance medication adherence. Additionally, targeted interventions addressing perceived health competence, hope, positive affect, and medication beliefs can effectively improve adherence. Show less

To investigate the association between vaginal microbiota structure in early pregnancy and gestational diabetes mellitus (GDM) and to characterize microbial signatures for early screening for GDM. The present study was a nested case-control study recruiting pregnant women from the Nanjing Gulou Maternal-Child Health Center, China. Vaginal swabs were collected before 20 weeks of gestation for 16S rRNA sequencing. Following 1:3 propensity score matching, 45 GDM cases and 135 controls were enrolled. The final analysis included 42 GDM cases and 121 controls. A random forest model was used to explore the genera of vaginal differential microbiota associated with GDM. Based on these findings, latent profile analysis (LPA) was conducted to explore potential types of vaginal microbiota, and logistic regression was used to analyze the association between vaginal microbiota types and GDM. The GDM group exhibited elevated alpha diversity (Chao1 index, The composition and structure of vaginal microbiota in early pregnancy are different in the two groups. The vaginal microbiota in early pregnancy, which is characterized by co-dominated by The online version contains supplementary material available at 10.1186/s12866-026-04910-2. Show less

Oxypeucedanin (OPD) showed anti-allodynia against neuropathic pain (NeuP) in our previous study. In the present study, we aimed to further investigate whether lysophosphatidic acid receptor (LPAR) signaling mediated OPD-induced antinociception against NeuP models. Single OPD treatment dose-dependently reduced pain hypersensitivity, and repeated OPD treatment maintained sustained antinociception without the development of tolerance. Importantly, OPD exhibited a significant curative effect on different stages of NeuP. ROCK and RhoA agonists prevented the therapeutic effect of OPD, while the inhibitors of LPAR, ROCK, and RhoA mimicked OPD-induced antinociception. Notably, OPD treatment attenuated the increases of LPA content and protein expression of LPAR1, RhoA, and Show less

Parenting behaviors, including autonomy support and psychological control, have been shown to significantly influence adolescent non-suicidal self-injury (NSSI). However, the underlying mechanisms linking heterogeneous parenting behavior profiles to adolescent NSSI remain unclear. This two-wave longitudinal study (with a one-year interval) of 742 Chinese adolescents (52.7% girls; Mage at Time 1 = 13.40 years) identified four distinct parenting profiles using latent profile analysis (LPA): Supportive (43.6% of the sample), Controlling (17.4%), Moderate Mixed Parenting (33.1%) and High Mixed Parenting (5.9%). Multicategorical serial mediation analysis revealed that adolescent emotion regulation difficulties and depressive symptoms serially mediated the relationship between parenting profiles and NSSI for adolescents in the Controlling, Moderate Mixed Parenting and High Mixed Parenting Profiles. Notably, these mediating effects were significant only for girls. These findings underscore the importance of adopting person-centered and sex-sensitive intervention strategies to mitigate the adverse effects of detrimental parenting behaviors on adolescent NSSI. Show less

We show an exceptional case of a right aortic arch (RAA) in a patient with DiGeorge syndrome, breaking the rule that the first epiaortic vessel courses to the contralateral side of the aortic arch. This is a RAA with an aberrant left subclavian artery (ALSA) and an isolated left carotid artery (ILCA) arising from the left pulmonary artery (LPA) via a left anterior ductus arteriosus (LADA), along with bilateral ductus arteriosus. This unique case highlights educational pitfalls in using a simple rule to define arch sidedness. Although challenging, echocardiographic diagnosis of such vascular anomalies is feasible in expert hands. The color-flow and Doppler pattern of the epiaortic vessels provide important information about their arrangement and connection to the aortic arch. Bilateral ductus arteriosus is often a marker of complex vascular anomalies, which are frequently associated with genetic syndromes. Show less

Lipoprotein(a) [Lp(a)] is a genetically determined and independent risk factor for atherosclerotic cardiovascular disease, including acute coronary syndrome, peripheral arterial disease, and stroke, as well as calcific aortic stenosis. Despite its high prevalence, affecting an estimated 20% of Canadians, Lp(a) remains under-recognized and undermeasured in clinical practice. This report provides guidance on the assessment and management of Lp(a) in primary and secondary prevention in the Canadian context. It outlines when and how to measure Lp(a), with a recommendation for universal, one-time testing in adulthood. The report summarizes the pathophysiologic role of Lp(a) in promoting atherosclerosis, thrombosis, and aortic stenosis, and highlights significant ethnic variability in Lp(a) levels and associated risk. It also addresses the limitations of existing cardiovascular risk calculators that omit Lp(a) and discusses the potential role of emerging imaging and treatment strategies, including novel Lp(a)-lowering therapies. Special attention is given to clinical interpretation of Lp(a) values, the role of cascade screening in families, and recommendations for preventive interventions, with an emphasis on current approaches for managing patients with elevated Lp(a) level while awaiting the availability of targeted therapies. The goal of this report is to support clinicians in identifying at-risk individuals earlier and guiding appropriate risk reduction strategies in primary and secondary prevention settings. Show less

Parents play a critical role in influencing their young children's physical activity (PA) and sedentary time (ST). Despite this, many young children (aged 3-4y) and their parents are insufficiently active and engage in high amounts of ST. M-health interventions targeting PA and ST have seldom been tested in this population. The objective of this study was to examine the effectiveness and acceptability of the Active Family m-health intervention on the PA and ST of young children and their parents. Twenty-five stay-at-home parent-child dyads from Canada took part in the 2-week just-in-time micro-randomized controlled trial. Parents received seven text message prompts per day, where they were randomized to receive either a micro-intervention (activity suggestion) or control (no suggestion). Parents and children wore ActiGraph accelerometers to measure ST, light [LPA], and moderate-to-vigorous physical activity [MVPA]. Parents also completed a short online acceptability survey. A centred and weighted least square regression was used to analyze the effect of activity suggestions on the 60-min ST, LPA, and MVPA of parents and children following suggestion randomization. Descriptive statistics and content analysis were used to analyze acceptability survey responses. Micro-interventions were not effective at changing children's or parent's proximal ST (d = 0.01, p = .878; d = -0.09, p = .485, respectively), LPA (d = 0.03, p = .714; d = 0.03, p = .729, respectively), or MVPA (d = -0.05, p = .511; d = 0.10, p = .480, respectively). Interventions became more effective at increasing MVPA over time for parents (b = 0.47, 95%CI = 0.12, 0.83, p = .013). Among children, intervention effectiveness varied by contextual factors (e.g., weather). The intervention was largely acceptable, appropriate, and feasible for parents, though they did offer suggestions for improvement. Overall, micro-interventions did not significantly change parents or young children's proximal movement. Though, this approach showed promise for increasing parent's MVPA over time and for supporting children's activity under specific conditions. Show less

Lysophosphatidic acid acyltransferase (LPAAT) is a pivotal enzyme in the de novo biosynthesis of phosphatidic acid (PA), playing a central role in glycerophospholipid assembly and triacylglycerol (TAG) accumulation. Myrmecia incisa is a green microalga notable for its high content of arachidonic acid (ArA), yet the molecular mechanism underlying ArA enrichment in TAG remains unclear. In this study, a putative LPAAT gene from M. incisa, designated MiLPAAT, was identified and cloned, followed by systematic structural and functional characterization. Sequence analysis revealed that MiLPAAT contains a conserved PlsC domain and the characteristic H(X)₄D and EGTR motifs. Bioinformatic predictions identified at least one transmembrane domain at the N-terminus, supporting its identity as an integral membrane protein. This was further confirmed by membrane fractionation and Western blot analysis, which demonstrated its association with the membrane fraction. Phylogenetic analysis further demonstrated its close evolutionary relationship to LPAAT homologs in other green algae. Heterologous expression in Escherichia coli, coupled with in vitro enzymatic assays, confirmed that the recombinant MiLPAAT protein possesses LPAAT activity, catalyzing the acylation of LPA with various acyl-CoAs. Among the substrates tested, MiLPAAT exhibited the highest catalytic efficiency toward ArA-CoA (104.8 ± 3.2 nmol/mg/min), followed by oleoyl-CoA (81.5 ± 2.7 nmol/mg/min) and palmitoyl-CoA (68.4 ± 2.1 nmol/mg/min), consistent with the ArA-rich TAG composition observed in M. incisa. Immunogold labeling and immunohistochemical localization experiments revealed that MiLPAAT is predominantly localized at the plasma membrane. Findings of the present study suggest that MiLPAAT plays a critical role in PA biosynthesis and assembly of ArA into TAG in M. incisa, providing a novel target for microalgal lipid metabolic engineering. Show less

Sequence alignment is essential for genomic research and clinical diagnostics, yet detecting complex rearrangements such as inversions, duplications, and gene conversions remains challenging due to allele complexity and limitations of current methods. We introduce VACmap, a non-linear mapping approach to enhance the detection and representation of all genetic variations. VACmap improves duplication detection from 20% to 90% in the Challenging Medically-Relevant Genes (CMRG) benchmark and improves characterization of complex inversions in repetitive regions and gene conversion events. It improves resolving clinically significant loci, including the LPA gene (with repetitive KIV-2 units linked to coronary heart disease), GBA1 and STRC genes (risk factors for Parkinson's disease and hearing loss, respectively, affected by pseudogene recombination with GBAP1 and STRCP1). Here, we show that VACmap delivers better alignment accuracy and SV detection, providing a robust tool for genomic analysis and clinical insights, with potential to advance understanding of genetic diversity and disease mechanisms. Show less