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Structural valve degeneration (SVD) is the leading cause of late bioprosthetic valve failure. Lipoprotein(a) [Lp(a)] contributes to native aortic valve calcification, but its role in SVD is unclear. We investigated whether elevated Lp(a) is associated with SVD after bioprosthetic aortic valve replacement (AVR) and whether this differs between stenotic and regurgitant phenotypes. We studied 174 bioprosthetic AVR patients with available Lp(a) levels over a median echocardiographic follow-up of 7.3 years (1372 studies). SVD was defined by VARC-3 criteria, and associations were analysed with Fine-Gray competing risk models. Lp(a) was evaluated categorically (≤ or > 125 nmol/L) and continuously using spline modelling. During follow-up, 40 patients developed SVD (22 stenotic, 9 mixed, and 9 regurgitant). The 15-year cumulative incidence was 51% with a median onset at 14.8 years. Elevated Lp(a) was associated with a higher risk of overall SVD (62% vs. 47%; SHR 2.06, 95% CI 1.09-3.91; P = 0.026) and specifically with stenotic/mixed phenotypes (SHR 2.57, 95% CI 1.26-5.23; P = 0.009). No association was observed with regurgitant phenotypes (SHR 0.85, 95% CI 0.19-3.92; P = 0.84). After multivariable adjustment, elevated Lp(a) remained an independent predictor of stenotic/mixed SVD (adjusted SHR 3.00, 95% CI 1.48-6.07; P = 0.002). Spline modelling showed a linear dose-response, with each 25 nmol/L increase in Lp(a) conferring 13% higher risk. Elevated Lp(a) is independently associated with long-term risk of stenotic/mixed SVD. These findings highlight Lp(a) as a promising biomarker of prosthetic valve vulnerability and support investigation of emerging Lp(a)-lowering therapies to improve valve durability. Show less

BackgroundLogopenic primary progressive aphasia (LPA) is often associated with Alzheimer's disease (AD) pathology. However, few studies have compared cortical atrophy patterns in LPA and AD and their association with cognitive performance.ObjectiveTo identify atrophy patterns specific to LPA and determine whether those patterns relate to deficits in specific cognitive domains.MethodsElectronic health records from 2014-2024 were retrospectively reviewed to identify patients with LPA who had undergone MRI and neuropsychological (NP) examinations. Patients with LPA (n = 26) were matched in terms of age, sex, education, and symptom duration to patients with amnestic mild cognitive impairment (aMCI; n = 13). Logistic regression was used to assess group differences in MRI measures of cortical volume and thickness. Cluster analysis was used to identify patterns of atrophy that were associated with specific cognitive domains.ResultsThe LPA group performed significantly worse than the aMCI group on NP measures assessing verbal learning, attention/working memory, language, and executive functioning (p < 0.05). Compared to the aMCI group, the LPA group demonstrated both smaller and thinner cortex in the left lateral aspect of the superior temporal gyrus, superior temporal sulcus, and fusiform gyrus (p < 0.05), with the left superior temporal sulcus providing the most accurate measure of discrimination. Severity of language related cognitive deficits was not associated with a specific cluster in the LPA group.ConclusionsPatients with LPA demonstrate specific patterns of cortical atrophy that are distinguishable from atrophy due to aMCI and may be useful for diagnostic purposes. Show less

We examined whether wake-time movement composition was associated with weight loss maintenance among individuals who experienced clinically meaningful weight loss (> 5% of initial weight) using compositional data analysis. This was a secondary analysis from a behavioral weight loss maintenance intervention on weight regain over 12 months following clinically meaningful 3-month weight loss. Body weight was assessed at baseline, after weight loss (3 months), and at end of intervention (15 months). Wake-time behaviors (sedentary time [ST], light physical activity [LPA], and moderate-to-vigorous PA [MVPA]) were assessed at two time points during the maintenance intervention using accelerometry. Compositional data analysis was used to examine associations between wake-time movement composition and weight regain (kg). Among 153 individuals (80.4% female, 69.9% White), wake-time movement composition was related to weight regain (p = 0.001). MVPA was negatively associated with weight regain (p's < 0.05). Reallocating 10 min/day from ST or LPA to MVPA was associated with less weight regain (ST: -0.32 kg [-0.53, -0.12]; LPA: -0.37 kg [-0.59, -0.15]). Individuals who maintained clinically meaningful weight loss and those who did not differed in wake-time movement composition, driven by MVPA (36.1 vs. 24.3 min/day). The composition of wake-time behaviors, specifically MVPA, reduces weight regain after clinically meaningful weight loss in a behavioral weight loss maintenance intervention. ClinicalTrials.gov identifier: NCT01664715. Show less

Childhood overweight/obesity poses a significant public health burden, closely linked to time allocation across various movement behaviors. We aimed to clarify the compositional associations between 24-h time allocation to sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) and overweight/obesity risk among children aged 2-6 years. This cross-sectional study enrolled 5372 children aged 2-6 years from Beijing. Isotemporal substitution modeling and weighted quantile sum (WQS) regression were adopted. Among all children (mean age 4.52 years; 49.9 % girls), 26.13 % were overweight or obese. Each additional 5 min of daily SB was associated with a higher odds of overweight/obesity (odds ratio [OR] = 1.10, 95 % confidence interval [CI]: 1.02-1.19, p = 0.02), while each 5-min increment in sleep was linked to reduced odds (OR = 0.91, 95 % CI: 0.84-0.98, p = 0.02). Isotemporal substitution analyses indicated that replacing 5 min of SB with sleep (OR = 0.81, 95 % CI: 0.67-0.97, p = 0.02), LPA (OR = 0.84, 95 % CI: 0.72-0.98, p = 0.03), or MVPA (OR = 0.87, 95 % CI: 0.76-1.01, p = 0.06) was associated with lower overweight/obesity risk. Replacing SB with sleep or physical activities reduced the risk. Further WQS analyses revealed that sleep exerted the strongest weight in the behavioral mixture influencing childhood overweight/obesity. This study provides evidence that theoretical reallocation of sedentary time to sleep or physical activities was associated with a significantly lower risk of overweight/obesity in children aged 2-6 years. Importantly, sleep appears to be the most potent component in the behavioral mixture, reinforcing the importance of holistic, multi-behavioral approaches in early childhood obesity prevention strategies. Show less

Physical activity (PA) is an important non-pharmacological intervention that can slow the progression of Chronic Obstructive Pulmonary Disease (COPD). Unfortunately, PA levels in older adults with COPD remain low, and there is substantial heterogeneity within this population. Therefore, identifying potential subgroups is essential for developing targeted interventions. The purpose of this study is to identify latent profiles of PA, and explore the associated factors to inform personalized interventions for this population. This multicenter cross-sectional study was conducted from November 2024 to March 2025 at a tertiary hospital and four community health service centers in the Changning District of Shanghai. The revised International Physical Activity Questionnaire-Long (IPAQ-L) was utilized to assess PA and sedentary behavior. Latent profile analysis (LPA) was employed to classify the subgroups, followed by multinomial logistic regression to explore influencing factors. A total of 423 older adults with COPD (male N = 383; aged 60-89) were included in this study. LPA identified three distinct PA profiles, named the "moderate activity-moderate sedentary-low barrier (C1) group", the "low activity-high sedentary-high barrier (C2) group", and the "high activity-low sedentary-moderate barrier (C3) group". The factors were significantly associated with PA, including Body Mass Index (BMI), disease duration, number of hospitalizations, GOLD stage, COPD Assessment Test (CAT) score, exercise self-efficacy, and exercise social support (p < 0.05). LPA identified three subgroups of PA in older adults with COPD. The results of this research will facilitate targeted interventions for each of the identified subgroups with distinct characteristics, thereby enhancing the management of COPD and reducing healthcare burdens. Show less

Prior studies suggest that TikTok users vary in their engagement behaviors, including passive viewing, participatory interaction, and content creation, and exhibit varying levels of problematic-use risk. Yet it remains unclear which combinations of these engagement behaviors correspond to higher versus lower risk, and which psychological vulnerabilities contribute to high-risk patterns. In a two-wave study of 715 Chinese young adults, we applied latent profile analysis (LPA) to problematic TikTok use and the frequency of passive viewing, participatory, and contributory behaviors at Time 2. We then used multinomial logistic regression with the three-step method to prospectively examine how Time 1 measures of psychopathology and related affective/cognitive vulnerabilities, including depression, social anxiety, life satisfaction, emotion dysregulation, and boredom proneness, predicted TikTok profile membership. Four profiles emerged: Minimal Users (6.7%), Passive Watchers with High Problematic Use Tendencies (38.0%), Moderate Users with Mild Problematic Use Tendencies (42.4%), and Active Users with Low Problematic Use Tendencies (12.9%). Greater life satisfaction, lower social anxiety, and lower boredom proneness at baseline predicted membership in the Active rather than Passive, Moderate, or Minimal profiles. Greater emotion dysregulation predicted membership in the Passive rather than Moderate profile. These findings highlight substantial heterogeneity in TikTok use and suggest that higher baseline psychological wellbeing may increase the likelihood of more active and less problematic patterns of engagement. The current study extends prior LPA research by specifying how risk manifests in everyday use, identifying contributors to high-risk profiles, and extending empirical support for the I-PACE theoretical framework of Internet use disorders. Show less

Accelerometer-derived physical activity is associated with reduced stroke risk. The biological pathways underpinning this relationship, however, are not yet understood. Herein, we aim to identify metabolic signatures associated with accelerometer-measured PA and investigate their relationships with reduced stroke incidence. Utilizing UK Biobank accelerometer data, we derived physical activity into total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), and light physical activity (LPA) and linked them to 249 NMR-quantified plasma metabolites. The metabolomic signatures (TPA-/MVPA-/LPA-metabolomic signatures) were developed through internal validation followed by elastic-net regression modeling. Cox proportional hazards models evaluated activity-stroke associations (adjusted for sociodemographic/genetic factors), followed by mediation analysis to quantify metabolomic signature effects. Through UK Biobank study (N = 29445; 14.1-year follow-up with 513 stroke events), we identified 195 TPA, 173 MVPA, and 164 LPA metabolite associations (FDR < 0.05), with 107, 92, and 15 validated, respectively. Elastic net-derived physical activity-metabolomic signatures (TPA-/MVPA-metabolomic signatures) correlated with physical activity intensities (r = 0.20-0.30, P < 0.001) and were associated with reduced stroke risk: TPA-metabolomic signatures (HR = 0.61, 95% CI: 0.44-0.87); MVPA-metabolomic signatures (HR = 0.50, 95%CI: 0.29-0.88). Mediation analyses showed TPA-metabolomic signatures and MVPA-metabolomic signatures explained 12.2% and 8.5% of physical activity-stroke associations (P < 0.001), implicating specific lipoprotein subclasses and lipids as key mediators. TPA-metabolomic signatures and MVPA-metabolomic signatures, particularly the 11 key metabolites included, significantly mediate the association between accelerometer-derived physical activity and stroke risk. Show less

The mutual effects of different activity intensities in daily life, such as sedentary behavior (SB) and physical activity (PA), on dementia onset are not yet fully understood. The purpose of this study was to examine the association between replacing SB with PA and the risk of dementia in older adults by using the isotemporal substitution (IS) model. Prospective cohort study. Community-dwelling older adults living without dementia in Takahama, were enrolled, interviewed, and physically examined. Follow-up data were collected from the Japanese Public Health Insurance and/or Long-Term Care Insurance system databases during follow-up. SB and PA data [light-intensity PA (LPA) and moderate-to-vigorous PA (MVPA)] were measured using a triaxial accelerometer for 14 days, and the average daily time for SB and PA was calculated in 10-minute increments. Participants were followed up monthly for new-onset dementia over 5 years. Cox proportional-hazards regression analysis was performed by using IS to estimate the effect of replacing one activity with another on the dementia onset. We included 1664 participants (mean ± standard deviation age, 73.1 ± 5.9 years) in this study. Over 5 years, 128 of 1664 participants developed dementia. Replacing 10 min/d of SB with LPA (hazard ratio, 0.86; 95% CI, 0.75-0.99) or MVPA (0.84; 0.74-0.96) was associated with a lower risk of dementia. Replacing 10 minutes of SB with LPA or MVPA was associated with a lower risk of dementia. Feasible behavioral changes in daily life may lead to a healthy life expectancy. Show less

To use compositional data analysis to examine the associations of daily movement behaviors with body composition, and to predict changes in body composition after reallocating time among behaviors in preschool-aged children. 268 preschoolers were included in the cross-sectional study. An accelerometer was used to assess sedentary behavior (SB), light and moderate-to-vigorous physical activity (LPA and MVPA). A parental report was used to collect sleep time. Bioelectrical impedance analysis was employed to assess body composition. Compositional linear regression analysis was employed to explore how daily movement behaviors were associated with body composition. Compositional isotemporal substitution analysis was employed to estimate changes in body composition after reallocating time among behaviors. 24-h movement behaviors composition significantly predicted fat-free mass index (FFMI), soft lean mass index (SLMI), and skeletal muscle mass index (SMMI), but not fat mass index, percent body fat, and bone mineral content index. The compositional isotemporal substitution analyses consistently showed that increasing MVPA at the expenses of SB was positively associated with FFMI (+0.328 kg/m The findings highlight the importance of MVPA in improving preschoolers' body composition. Increasing MVPA at the expenses of SB may be a strategy to improve body composition in preschoolers. Show less

This study aimed to assess the knowledge, attitudes, and practices (KAP) of patients with lower limb arteriosclerosis obliterans (ASO) toward their disease. This cross-sectional study was conducted at 3 tertiary hospitals in Chengdu between August 2023 and January 2024 and included patients with lower limb ASO. Data were collected using an interviewer-administered questionnaire that captured demographic information and KAP scores. A latent profile analysis (LPA) was used to identify the KAP patterns among participants. A total of 515 nonproblematic questionnaires were collected, yielding an effective response rate of 95.72%. Among the respondents, 395 (76.85%) were male, with a disease course of 15.96 ± 17.55 months. The knowledge, attitude, and practice scores were 5.27 ± 4.69 (possible range: 0-22), 17.65 ± 2.86 (possible range: 5-25), and 107.63 ± 17.15 (possible range: 33-165), respectively. LPA identified 4 participant profiles: Profile 1 (high attitude, low practice), Profile 2 (low attitude, high practice), Profile 3 (low attitude, low practice), and Profile 4 (high attitude, high practice). Significant differences were found among profiles in residence (P = 0.028), medical insurance (P = 0.043), self-efficacy (P < 0.001), and patient activation (P < 0.001). Patients with lower limb ASO demonstrated inadequate knowledge but moderate levels of attitude and practice. Residence, medical insurance, self-efficacy, and patient activation may affect the KAP patterns of the patients. These findings suggest that tailored interventions targeting distinct patient profiles, while considering broader social determinants of health, may be critical to improving self-management and outcomes. Show less

Lipoprotein(a) [Lp(a)] is a genetically determined, independent risk factor for atherosclerotic cardiovascular disease (ASCVD), unaffected by conventional lipid-lowering therapy. This study assessed the prevalence of elevated Lp(a) in a large, multiethnic cohort in Dubai, United Arab Emirates (UAE), analyzed its distribution across ethnicities, and evaluated its independence from low-density lipoprotein cholesterol (LDL-C). In a single-center multiethnic cohort study, 746 consecutive patients from Mediclinic Parkview Hospital, Dubai, were included. Serum Lp(a) was measured using a standardized immunoturbidometric assay. Positive Lp(a) was defined as ≥75 nmol/L. Levels were stratified by ethnic subgroups and categorized based on ESC/EAS quartiles and risk thresholds (≥105 nmol/L for high risk; >190 nmol/L for very high risk). The correlation between Lp(a) and directly measured LDL-C was assessed using Spearman's rank correlation in both patients receiving optimal lipid-lowering therapy and in those not receiving therapy. The prevalence of positive Lp(a) levels (≥75 nmol/L) was 30.2 %. At higher thresholds, 13.4 % had high-risk levels (≥105 nmol/L) and 9.9 % had very high-risk levels (>190 nmol/L). Ethnic variations were notable: South Asians (32.4 %) and White/Europeans (32.1 %) had the highest prevalence, while East Asians had the lowest (21.6 %) but the highest median level (200.5 nmol/L). Crucially, there was no correlation between Lp(a) and treated LDL-C in patients on optimal lipid-lowering therapy (Spearman's rho = 0.07, p = 0.38). We identified a high prevalence of elevated Lp(a) in a multiethnic cohort in Dubai, with nearly a quarter at high or severe risk. This risk is entirely independent of LDL-C, revealing a significant hidden burden not captured by standard lipid panels. These findings support integrating Lp(a) screening into regional cardiovascular prevention protocols. Show less

This study presents the phylogenetic and antimicrobial susceptibility characterization of Mycobacterium monacense, a rare nontuberculous mycobacterium (NTM), cultured from clinical extrapulmonary samples. Eight Mycobacterium monacense isolates were identified between 2019 and 2023 in the Western Cape province of South Africa. Whole-genome sequencing (WGS) was applied to assess phylogenetic relatedness, identify virulence factors, and characterize the resistome of the isolates. Antimicrobial susceptibility testing (AST) was performed using the GenoType NTM-DR line probe assay (LPA), Sensititre minimum inhibitory concentrations (MIC) plates, and the proportional method based on critical concentrations. Spatial distribution of cases was mapped using ArcGIS software. Spatiotemporal distribution patterns indicated the presence of circulating clones confined within specific geographical areas. Plasmids coding for ferredoxin and cytochrome P450 genes were identified in one cluster, which notably lacked the chromosomal mbtH gene involved in siderophore biosynthesis for iron acquisition. In contrast, isolates grouped in a second cluster harbored the mbtH chromosomal gene but lacked these plasmid-associated elements. LPA and broth microdilution showed that all Mycobacterium monacense isolates were susceptible to aminoglycosides, fluoroquinolones, and macrolides, but generally exhibited elevated MICs against β-lactam antibiotics. Phenotypic AST indicated that drugs commonly used to treat Mycobacterium tuberculosis complex (MTBC), namely bedaquiline, linezolid, and rifampicin, are effective against Mycobacterium monacense. Mycobacterium monacense in extrapulmonary cultures accentuates the need for improved diagnostics and enhanced clinical awareness of infections with rare NTM. WGS highlights the potential significance provided by plasmid-encoded genes. Current treatment regimens for MTBC exhibit therapeutic efficacy against Mycobacterium monacense isolates. Show less

Childhood trauma is a well-established risk factor for poor clinical outcomes in bipolar disorder (BD), yet most studies have relied on cumulative trauma scores, potentially overlooking heterogeneity in trauma exposure and its differential impact on psychopathology. This study employed latent profile analysis (LPA) to identify distinct subtypes of childhood trauma based on the Childhood Trauma Questionnaire (CTQ) among 725 individuals with BD in a Chinese clinical sample. Differences across trauma profiles were examined in relation to demographic features, psychiatric symptoms (anxiety, depression, mania), and suicidal ideation (Beck Scale for Suicide Ideation, BSSI). A four-class solution was identified, and the relationship with mental health outcomes was analyzed. Class 4 group, characterized by the most severe emotional abuse and physical neglect, along with the lowest emotional neglect, reported the highest levels of anxiety (HAMA), depression (HAMD), and suicidal ideation (BSSI). In contrast, manic symptoms (YMRS) were present across all groups but did not differ significantly between trauma profiles. Logistic regression indicated that emotional abuse was the strongest predictor of trauma class membership. Distinct trauma profiles in BD are differentially associated with symptom severity and suicide risk. These findings highlight the clinical value of moving beyond cumulative trauma scores to identify trauma-specific subtypes. Early identification of high-risk trauma configurations may inform personalized assessment and intervention strategies for individuals with BD. Show less

Physical inactivity post-stroke increases risk of recurrent stroke. Adaptive physical activity (PA) interventions are recommended, and alternative designs, such as sequential multiple assignment randomized trials (SMARTs) can be used. This SMART investigates the feasibility of a mobile health (mHealth) PA intervention post-stroke. People post-stroke are randomized to 12-week online exercise (EX) or lifestyle PA (LPA). Six-week daily step count data are used to classify participants as responders or nonresponses. Nonresponders are re-randomized to switch or augment their mHealth intervention, responders continue unchanged. Primary outcomes include recruitment, retention and adherence rates. Secondary outcomes include PA, sedentary behavior, fatigue, quality of life, psychological distress, and activities of daily living. General linear models estimate trends regarding first-stage interventions, nonresponse strategies, and adaptive interventions are examined using weighted and replicated regressions. Fifty participants are included. Recruitment, retention, and adherence rates are 85%, 84%, and 82%. Positive trends are seen for nonresponse strategies, switching interventions, on step count, fatigue, and quality of life. Starting with EX and switching to LPA show potential benefits for fatigue, quality of life and return to normal living. Potential benefits of these interventions are preliminary and require validation in a full-scale trial. This SMART offers novel evidence supporting the design of adaptive mHealth PA interventions post-stroke, confirming the feasibility of a definitive SMART. Show less

Lp(a) is a cardiovascular risk factor influenced by the LPA gene and apo(a) isoforms. Their relationship is not always linear and there are discordant phenotypes, for this reason in our work we evaluated the association between apo(a) isoforms and Lp(a) levels in patients with acute coronary syndrome (ACS). To this end, 43 patients with ACS and Lp(a) >50mg/dL were studied. The isoforms were characterized in 12bands by Western blotting. The association between bands and Lp(a) concentrations was evaluated by statistical analysis. It was observed that the intermediate molecular weight bands (b5-b8) were the most frequent, with band 8 predominating. No significant association was found between isoform size and Lp(a) levels (P>.05). We conclude that in this cohort no correlation was observed between apo(a) and Lp(a) isoforms. Other genetic or regulatory mechanisms could explain the observed variability, supporting the need for larger studies. Show less

Spinocerebellar ataxia type 3 (SCA3) is one of the most common dominantly inherited ataxias worldwide. Despite research advances, no approved disease-modifying treatment exists, and management focuses on symptom alleviation and functional capacity maximization. Symptomatic treatment guidelines are scarce, leaving decisions to physicians' discretion. The lack of studies on SCA3 symptom management hinders therapy standardization. The aim of this study was to investigate medication-usage patterns among SCA3 mutation carriers and controls included in the multicentric European Spinocerebellar Ataxia Type-3/Machado-Joseph Disease Initiative (ESMI) cohort. We conducted a retrospective cross-sectional analysis of the medication taken by ESMI participants enrolled in the study between 2016 and 2023. Medication being used at the most recent follow-up visit available was categorized according to the Anatomical Therapeutic Chemical system. Comparisons between groups were performed using nonparametric tests for continuous variables and Fisher's exact test for categorical variables. In addition, a retrospective longitudinal analysis was conducted to study the impact of medication subclasses on disease progression, using linear mixed-effects models adjusted for relevant covariates. A total of 474 participants were included, comprising 344 SCA3 mutation carriers and 130 controls. Compared with controls, SCA3 subjects took more vitamins, mineral supplements, muscle relaxants, and medications targeting the nervous system. Psychoanaleptics and vitamins were introduced early in the disease course, whereas most other subclasses were initiated in mid-to-late stages, coinciding with the onset of neurological symptoms. Substantial disparities in medication usage were observed across the study centers. None of the medication subclasses commonly used by patients with SCA3 showed a significant impact on disease progression. This is the first study to explore medication usage patterns in SCA3 mutation carriers. Our study provides a comprehensive overview of the medications administered in SCA3 and underscores the importance of collaborative efforts toward achieving standardized clinical practices in the management of this disease. Show less

Lipoprotein(a) [Lp(a)] is a highly atherogenic particle that significantly increases overall cardiovascular risk. Evidence regarding concentrations of Lp(a) in the Polish general population remains limited, as well as the association between Lp(a) and various clinical characteristics. The aim in this study was to analyze Lp(a) concentration in a Polish population hospitalized in a tertiary referral hospital, compare clinical characteristics between patients with low and high Lp(a) and find the predictors of increased Lp(a) concentrations. This was an observational, cross-sectional study. All patients hospitalized in the Clinical Department of Internal Medicine, Endocrinology, Diabetology, and Nephrology in the Czerniakowski Hospital between 01.03.2024 and 08.10.2024 and with measured Lp(a) concentration were consecutively included. Patients were divided into two groups: those with high Lp(a) (≥ 30 mg/dL) and those with low Lp(a) ( < 30 mg/dL). The groups were compared in terms of multiple clinical characteristics. Multiple logistic regression was used to determine independent predictors of high Lp(a). The p-value below 0.05 was considered statistically significant. Out of 562 patients, 117 had high Lp(a) concentration (20.8%). The groups did not differ in terms of age, sex, or clinical examination findings. In a multiple logistic regression, male sex was associated with a decreased odds ratio of high Lp(a) (OR = 0.2857, 95% CI: 0.1107 to 0.6468, p = 0.01). High Lp(a) is prevalent in the Polish population, and thus it is important to measure it routinely in each individual at least once in a lifetime and control all other known cardiovascular risk factors to decrease the overall risk. Show less

Pregnant women have a high incidence of perinatal mood and anxiety disorders (PMADs). To explore the influence factor on perinatal psychology, we analysed the SCFAs, lipids, cognition, emotion, and cytokines in the late pregnant women. The mood, cognition, SCFAs of the non-pregnant group were compared to those in the late pregnancy. The differences in SCFAs, lipids, cognition, and cytokines between the high-risk and low-risk groups for affective disorders among women in the late pregnancy were analysed, and the risk factors were sought. Compared with the non-pregnant group, the pregnant group scored lower on the SDMT (P < 0.001), DST (P = 0.035), VRT (P = 0.001), and VFT (P < 0.001), and took longer on the TMTA (P = 0.004). Acetate (P = 0.001) and butyrate (P = 0.002) were higher, while propionate (P < 0.001) and isobutyrate (P = 0.001) were lower in the pregnant group than in the non-pregnant group. Among the pregnant women, CRP was higher in the high-risk group for mood disorders than in the low-risk group (P = 0.048). Meanwhile, HDL was positively associated with DST (P = 0.000), VRT (P = 0.015), and VFT (P < 0.001). Longer TMTA completion times were associated with reduced propionate (P = 0.072) and LPa (P = 0.022). Longer TMTB completion time was associated with lower life satisfaction (P = 0.037), as well as decreased cholesterol (P = 0.026). Pregnant women experience changes in cognition and SCFAs. CRP is a sensitive indicator for monitoring affective disorder. Regulation of SCFAs and lipids may be beneficial for cognition and affect. Show less

Although many studies have indicated that problematic smartphone use and depressive symptoms are closely associated and frequently co-occur in adolescence, little is known about their heterogeneous co-occurrence profiles and how these profiles evolve over time. Using person-centered approaches (LPA and RT-LTA), this study identified the co-occurrence patterns of problematic smartphone use and depressive symptoms, examined their transitions, and investigated the roles of social support and self-control on transitions. A total of 8969 Chinese adolescents (49.3% girls; T1: M Show less

Lipoprotein(a) [Lp(a)] is a primarily genetically determined, causal and independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Lp(a) levels are stable, unaffected by lifestyle, and best measured using isoform-insensitive, molar-based assays. Current guidelines from the European Atherosclerosis Society and U.S. National Lipid Association recommend a one-time Lp(a) measurement in all adults. Cascade testing is advised in affected families. Elevated Lp(a) levels are associated with increased risk of coronary artery disease, myocardial infarction incidence and recurrence, and aortic stenosis onset and progression. In cerebrovascular disease, high Lp(a) is linked to large artery ischemic stroke incidence and recurrence, as well as poor functional outcomes. Associations with venous thromboembolism are limited to prothrombotic states and extreme Lp(a) concentrations. Elevated levels (≥50 mg/dL or ≥125 nmol/L) should prompt intensified risk factor modification. There are no currently approved lipid-lowering therapies that substantially reduce Lp(a) levels. Novel agents to lower Lp(a) include antisense oligonucleotides, small interfering ribonucleic acid and small molecules, all of which have shown promising results in phase 2 trials. Ongoing phase 3 trials will evaluate the causal relationship between Lp(a) and ASCVD, and whether lowering Lp(a) reduces cardiovascular outcomes. Show less

Left pulmonary artery (LPA) sling is a rare congenital anomaly in which the LPA abnormally originates from the right pulmonary artery (RPA) and courses between the trachea and esophagus to reach the left pulmonary hilum. This anomaly is frequently associated with tracheobronchial and other cardiovascular anomalies and patients may manifest with varying airway and cardiovascular symptoms. Surgical repair is often required for symptomatic patients. Clinical outcomes largely depend on the extent and severity of coexisting anomalies, particularly tracheobronchial abnormalities. We report 2 autopsy cases of LPA sling, 1 pre- and 1 post-surgical repair. Comprehensive autopsy examination was crucial for confirmation of the clinical diagnoses and identification of a rare surgical complication. Show less

Lipoprotein(a) [Lp(a)] is a primarily genetically determined, low-density lipoprotein-like particle that plays an important role in atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease (CAVD). Despite optimal control of traditional lipid levels, elevated lipoprotein(a) [Lp(a)] remains a significant contributor to residual cardiovascular risk, affecting up to 20% of the global population. We performed a literature search of PubMed/Medline and Google Scholar until July 2025 to provide a comprehensive overview of the genetics, structure, metabolism, and molecular mechanisms underlying Lp(a)'s pathogenicity. Structurally, Lp(a) consists of an LDL-like core covalently bound to apolipoprotein(a) [apo(a)], a polymorphic glycoprotein characterized by kringle IV type 2 (KIV-2) repeat variability. This copy number variation is the primary determinant of apo(a) isoform size and plasma Lp(a) levels. Small isoforms are produced more efficiently, resulting in higher concentrations. Lp(a) is synthesized in hepatocytes, and its plasma levels are predominantly governed by production rather than clearance. It carries a high burden of oxidized phospholipids (OxPLs), which confer pro-inflammatory and pro-atherogenic properties. Lp(a) promotes arterial inflammation, endothelial dysfunction, monocyte activation and impaired fibrinolysis via competition with plasminogen. It also plays a direct pathogenic role in valvular calcification by delivering OxPLs and autotaxin to valve interstitial cells, triggering osteogenic signaling cascades. While environmental factors such as inflammation and hormonal status can transiently modulate levels, genetic variation overwhelmingly dictates lifelong Lp(a) burden. As novel agents targeting Lp(a) enter late-stage clinical trials, mechanistic insights into Lp(a) biology will be essential to risk stratification and future clinical management. Show less

In premature infants, patent ductus arteriosus (PDA) can lead to hemodynamic instability and prematurity-related complications. The conventional left atrial-to-aortic (LA/Ao) ratio for evaluating hemodynamically significant PDA (hsPDA) has demonstrated limited accuracy. We aimed to investigate the correlation between mitral inflow E-wave velocity, left pulmonary artery (LPA) end-diastolic velocity, and hsPDA in preterm infants. Single-center, retrospective cohort study included neonates born at a gestational age (GA) between 24 and 30 weeks. The echocardiographic parameters, including mitral E-wave velocity, LPA end-diastolic velocity and LA/Ao ratio were assessed with hsPDA requiring treatment. Forty-nine infants were included, of whom 30 were diagnosed with hsPDA. The mitral E-wave (95% CI: 4.6-18.2, p = 0.0016) and LPA end-diastolic velocities (95% CI: 4.14-15.15, p = 0.0010) were significantly higher in infants with hsPDA, while the LA/Ao ratio exhibited no difference. Multivariate analysis revealed that lower GA, higher mitral E-wave, and LPA end-diastolic velocities were predictive of hsPDA. The receiver operating characteristic (ROC) analysis showed that these parameters offered better diagnostic accuracy than the LA/Ao ratio. Our findings suggest that mitral E wave and LPA end-diastolic velocities are more reliable echocardiographic markers for evaluating hsPDA in preterm infants than the conventional LA/Ao ratio. Assessment of dynamic blood flow is more reliable than the left atrium chamber size in evaluating the hemodynamic status of a PDA. Our result provides new criteria for assessing the hemodynamic significance of PDA. Utilizing this technique may yield evidence to assist clinical decision-making regarding PDA treatment. Multifactorial assessment, including birth gestational age and increased intracardiac or pulmonary blood flow velocity, provides more accurate prediction for a hsPDA. Show less

High-density lipoprotein(a) (Lp(a)) is a well-established independent risk factor for atherosclerotic cardiovascular diseases (ASCVD). However, the interaction between Lp(a), low-density lipoprotein cholesterol (LDL-C), and polygenic risk score (PRS) in cardiovascular diseases has been the subject of relatively limited research. The present study included a total of 346,751 participants from the UK Biobank. According to the guideline of Lp(a), the study subjects were divided into 3 groups: the first group was <75 mmol/L (n = 272,643), the second group was 75 to 125 mmol/L (n = 35,792), and the third group was >125 mmol/L (n = 38,316). Elevated Lp(a) levels were associated with a progressively increased risk of overall cardiovascular events (CVEs), including ischemic stroke (IS), coronary heart disease (CHD), angina pectoris, and myocardial infarction (MI). In contrast, the risks of atrial fibrillation (AF) and heart failure (HF) decreased with higher Lp(a) levels. Additive interaction analyses revealed significant synergistic effects between Lp(a) and LDL-C for CHD (relative excess risk interaction [RERI] = 0.081, attributable proportion of interaction [AP] = 0.046, synergy index [SI] = 1.117), angina pectoris (RERI = 0.112, AP = 0.055, SI = 1.121), and MI (RERI = 0.183, AP = 0.079, SI = 1.161), with MI showing the strongest synergy. Incorporating PRS further amplified these effects, and the RERI (CHD: RERI = 0.721; angina pectoris: RERI = 0.781; MI: RERI = 1.318) and SI (CHD: SI = 2.218; angina pectoris: SI = 1.97; MI: SI = 2.326) were significantly higher than those of the interaction model containing only Lp(a) and LDL-C. In conclusion, Lp(a) and LDL-C show a significant synergistic effect in ASCVD, and this effect is more prominent in individuals with a higher PRS, suggesting that dual lipid management should be strengthened for such populations. While AF and HF may require alternative risk factor management. Show less

Electronic health records will increasingly aggregate longitudinal laboratory results from multiple providers, but availability alone does not guarantee safe interpretation. We present guidance, developed by laboratory professionals with the DGKL medical informatics division, for cumulative displays that are clinically meaningful. The core principle is to group medically comparable analyses while preserving laboratory provenance so that clinicians can follow true patient trends without conflating them with laboratory-induced variation. Comparability is defined algorithmically from Logical Observation Identifiers Names and Codes (LOINC) axis: analyses estimating the same patient property (allowing serum/plasma system equivalence and mathematically convertible properties such as substance vs. mass concentration) are grouped; coding of units is harmonized via Unified Code for Units of Measure (UCUM) with consistent conversion of numeric results and corresponding reference intervals, including inequality qualifiers. Analyte-specific conversion factors should come from authoritative sources; for poorly standardized measurands (e.g., tumor markers) or when conversions are inappropriate (e.g., Lp(a)), results remain separated. Methodological distinctions that affect interpretation - such as screening vs. confirmatory drug testing and point-of-care testing - are displayed independently to signal potential analytical discontinuities. A standardized, medically meaningful default result sequence - derived from LOINC metadata and clinical nomenclatures, with alphabetic naming as a pragmatic fallback - supports cross-laboratory aggregation; rare or novel tests lacking robust standardization remain as free text. The rules-based approach updates seamlessly with LOINC releases and remains compatible with the Nomenclature for Properties and Units (NPU), facilitating cross-border exchange within the European Health Data Space. While harmonized presentation improves trend analysis, true comparability ultimately requires measurement procedures traceable to reference methods and materials. Show less

To develop a deep-learning model for segmenting and classifying adrenal nodules as either lipid-poor adenoma (LPA) or nodular hyperplasia (NH) on contrast-enhanced computed tomography (CECT) images. This retrospective dual-center study included 164 patients (median age 51.0 years; 93 females) with pathologically confirmed LPA or NH. The model was trained on 128 patients from the internal center and validated on 36 external cases. Radiologists annotated adrenal glands and nodules on 1-mm portal-venous phase CT images. We proposed Mamba-USeg, a novel state-space models (SSMs)-based multi-class segmentation method that performs simultaneous segmentation and classification. Performance was evaluated using the mean Dice similarity coefficient (mDSC) for segmentation and sensitivity/specificity for classification, with comparisons made against MultiResUNet and CPFNet. From per-slice segmentation, the model yielded an mDSC of 0.855 for the adrenal gland; for nodule segmentation, it achieved mDSCs of 0.869 (LPA) and 0.863 (NH), significantly outperforming two previous models-MultiResUNet (LPA, p < 0.001; NH, p = 0.014) and CPFNet (LPA, p = 0.003; NH, p = 0.023). Classification performance from per slice demonstrated sensitivity of 95.3% (95% confidence interval [CI] 91.3-96.6%) and specificity of 92.7% (95% CI: 91.9-93.6%) for LPA, and sensitivity of 94.2% (95% CI: 89.7-97.7%) and specificity of 91.5% (95% CI: 90.4-92.4%) for NH. The classification accuracy for patients from external sources was 91.7% (95% CI: 76.8-98.9%). The proposed multi-class segmentation model can accurately segment and differentiate between LPA and NH on CECT images, demonstrating superior performance to existing methods. Question Accurate differentiation between LPA and NH on imaging remains clinically challenging yet critically important for guiding appropriate treatment approaches. Findings Mamba-Useg, a multi-class segmentation model utilizing pixel-level analysis and majority voting strategies, can accurately segment and classify adrenal nodules as LPA or NH. Clinical relevance The proposed multi-class segmentation model can simultaneously segment and classify adrenal nodules, outperforming previous models in accuracy; it significantly aids clinical decision-making and thereby reduces unnecessary surgeries in adrenal hyperplasia patients. Show less

24 h behaviours (sleep, time awake in bed, moderate-to-vigorous physical activity [MVPA], light physical activity [LPA], and sedentary behaviour [SB]) may influence long-term mental health through their associations with affective experiences in everyday life. Here, we investigated the daily, prospective associations between 24 h behaviours and affect. Actigraphy-measured 24 h behaviours and self-reported affect data were collected across 7-15 consecutive days in healthy, community-dwelling adults (N = 354, M Associations between 24 h behaviours and next-day affect emerged at the within-person, not between-person level. Relative to the remaining behaviours, more LPA predicted 0.14 [95 % CI 0.03, 0.26] higher high arousal positive affect, whereas less SB predicted lower high and low arousal positive affect (-0.14 [-0.25, -0.02] and -0.12 [-0.24, -0.01], respectively) higher high arousal negative affect (0.13 [0.03, 0.23]). Further, within-person 30-min reallocation to LPA from SB, sleep, and time awake in bed also predicted ≥0.03 [0.00, 0.06] higher high arousal positive affect. 30-minute reallocation of time to LPA and MVPA from SB predicted 0.04 [0.01, 0.06] higher high arousal positive affect and -0.02 [-0.04, -0.00] lower low arousal negative affect. Findings provide stepping stone evidence for identifying optimal daily compositions of 24 h behaviours for affective enhancements in healthy individuals. Replacing time in SB with LPA and MVPA for improving affect should be experimentally tested in daily settings and clinical populations, to inform diagnostic and intervention strategies for better daily affect and mental health. Show less

In this paper, we present the design of a new automatic fluorescence monitoring system (AUTOFLUO) for real-time control of pesticide contamination in natural waters. This system was used to analyse two fluorescent pyrethroid insecticides, phenothrin (PHE) and permethrin (PER), currently used in the Niayes agricultural district in Senegal. The results were then compared with those obtained using the classical fluorescence method (FLUO). The analytical parameters (λex, λem, and pH) were optimised. Phenothrin exhibits maximum excitation and emission wavelengths of 221 and 321 nm, respectively, whereas permethrin has these values at 210 and 297 nm. The optimum pH value was determined to be 7 for PHE and 8 for PER. The linearity of both the calibration and standard addition curves was validated through variance analysis. A Student's t-test demonstrated that the intercept values of the calibration curves were not significantly different from zero (p > 5 %). The limit of detection (LOD) ranges from 0.02 to 5.16 ng mL Show less

Accumulating research has demonstrated a significant association between early-life inflammation and behavioral disorders later in life. However, the effects of early-life inflammation on aggressive behavior in adulthood remain poorly understood. Here, we show that early-life inflammation induced by lipopolysaccharide (LPS) upregulated neuronal dynamin-related protein 1 (DRP1) and impaired mitochondrial function in medial prefrontal cortex (mPFC) of adult mice, thereby increasing aggressive behavior in adulthood. We further identify that CCAAT/enhancer binding protein β (C/EBPβ) is the transcription factor of Dnm1l, which was activated by an increased release of lysophosphatidic acid (LPA) induced by early-life inflammation. Moreover, the overproduction of LPA was due to a specific increase in astrocyte-secreted autotaxin (ATX). Specific knockdown of astrocytic ATX reduced early-life inflammation-induced aggression in wild-type mice, but not in Thy1-C/EBPβ transgenic mice. Remarkably, coenzyme Q10 decreased early-life inflammation-induced aggressive behavior in adult mice. Altogether, these findings provide new insights into the molecular mechanisms by which early inflammation promotes aggressive behavior in adulthood. Show less

To explore latent profiles of social isolation in maintenance haemodialysis (MHD) patients and to analyse the factors influencing different latent profiles. Multicentre cross-sectional study. Between November 2024 to March 2025, 305 MHD patients from the haemodialysis centres of three hospitals in Henan Province, China, were recruited using a convenience sampling method. All participants completed the general information questionnaire, Lubben Social Network Scale 6 (LSNS-6), UCLA Loneliness Scale-6 (ULS-6) and Personal Mastery Scale. Latent Profile Analysis (LPA) was used to classify the participants into potential subgroups with different types of social isolation. The influencing factors of profiles were explored by univariate analysis and multiple logistic regression analysis. Social isolation of 305 patients can be divided into three profiles: the family-friend dual isolation group (14.10%), friend isolation-only group (47.54%), and social network well-being group (38.36%). Multivariable logistic regression analysis revealed that monthly personal income, living arrangement, social participation, dialysis time, post-dialysis fatigue, number of comorbidities, loneliness and personal mastery were identified as factors influencing the profiles. There is heterogeneity in social isolation among MHD patients. It is therefore necessary to implement targeted intervention measures based on the distinct characteristics of each subgroup to facilitate their social reintegration. Nurses should identify differences in social isolation among MHD patients. It is necessary to establish tripartite connections between families, hospitals and communities, and develop personalised psychosocial interventions to alleviate social isolation. The study identified distinct subgroups of social isolation among MHD patients, while emphasising the impact of psychological resources such as loneliness and personal mastery on social isolation. This may offer critical insights for nurses to develop targeted interventions for patients' social health. The study followed the STROBE guidelines for cross-sectional studies. No patient or public involvement. Show less