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This study explored latent profiles of Health Information-Seeking Behavior (HISB) among stroke patients and analyzed its influencing factors. In this cross-sectional study, 311 stroke participants from two tertiary care hospitals in Gansu Province, China, were recruited between January and May 2025 using convenience sampling. Data were collected using a general information questionnaire, the Health Information-Seeking Behavior Scale, and the Health Behavior Decision-Making Assessment Scale for Stroke Patients. Latent profile analysis (LPA) was employed to identify distinct HISB profiles. Three latent profiles were identified: the high-demand low-barrier positive group, the moderate-balanced group, and the low-demand high-barrier negative group. Key predictors of profile membership included age, education level, monthly personal income, and the presence of comorbid chronic diseases. The identification of three distinct HISB trait types provides an evidence-based foundation for developing personalized health education and tailored decision support interventions. Healthcare professionals can leverage this classification system to customize communication strategies for patients with different traits, deliver tiered information support, and ultimately empower patients to achieve better health behaviors and health outcomes. Show less

To investigate the associations between various patterns of physical activity (PA) and risk of hip fracture in Chinese middle-aged and older adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020. PA levels, including moderate-to-vigorous (MVPA), vigorous (VPA), moderate (MPA), low (LPA), and total physical activity (TPA), were assessed using the International Physical Activity Questionnaire. Cox proportional hazard models were used to estimate hazard ratios (HRs), and a restricted cubic spline analyzed the dose-response relationship between TPA and hip fracture. Among 6,193 participants (mean age 59.3; 54.0% female), 264 hip fractures occurred during follow-up. Meeting WHO-recommended MVPA levels ≥150 min/week) was not associated with reduced risk (HR 1.04, 95% CI 0.80-1.35). Similarly, no significant associations were observed for VPA (≥75 min/week), MPA (≥150 min/week), LPA (≥300 min/week), or TPA (≥600 MET-min/week). Dose-response analysis also showed no association between total PA and hip fracture. This study does not support the WHO recommendation of ≥ 150 min/week of MVPA for reducing hip fracture risk in this demographic. As PA was self-reported and largely work-related, future research should investigate leisure-time and objectively-measured PA. Show less

Classification of physical activity (PA) depends on the cut-point method used to allocate PA counts from accelerometer measurements. This study investigates how three validated cut-point methods affect the time spent in various levels of PA and sedentary behaviour (SB), and how they impact toddlers estimated adherence to PA guidelines. PA was assessed using an ActiGraph wGT3X-BT accelerometer in a cohort of 653 two-year-old children participating in the Toddler Milk Intervention study. Children wearing the ActiGraph for at least four days, with a minimum of six hours wear-time per day, were included. Time spent in SB and different activity levels were estimated according to three cut-point methods and were standardized to individual mean wear-time. We used one cut-point method based on the vertical axis (VA) (Trost VA), with an epoch length of 15 s and two cut-point methods based on either the VA (Costa VA) or on the vector magnitude (VM) (Costa VM) with an epoch length of five seconds. Estimates of SB and PA for each method were compared with repeated measures ANOVA. The time toddlers spent in PA was significantly different depending on the cut-point methods. Costa VM classified on average 62 min (95% CI 61, 64] more per day as SB and 57 min (95% CI -58, -56] less per day as LPA compared to Trost VA (both p < 0.0001). For MVPA, the mean difference between Costa VA and Trost VA was 6.8 min (95% CI -7, -6; p < 0.0001). Concurrently, the proportion of children meeting the WHO recommendation of 180 min of total PA differed between cut-point methods, with 86% according to Costa VM and 97% according to Trost VA. The time toddlers engage in different intensities of PA is significantly determined by the selection of cut-point method. Notably, the use of a different cut-point method leads up to a 10% difference in the estimated time spent in LPA and SB, but only a 1% difference of moderate-vigorous PA. These differences change the estimated adherence to recommendations. Future research is needed to standardize the data processing methods for better comparability between studies analysing toddlers' PA. ClinicalTrials.gov, TRN: NCT02907502, Registration Date: 31 August 2016. Show less

Tuberculosis (TB) remains a major global health challenge. In addition to Mycobacterium tuberculosis (MTB), nontuberculous mycobacteria (NTM) are increasingly recognized as causative agents of mycobacterial infections. However, the limited access to rapid diagnostics often delays appropriate treatment. Accurate and timely differentiation is critical for selecting effective antibiotic regimens. In Indonesia, there is a lack of population-based data comparing MTB and NTM in TB-suspected cases. This study aimed to detect and differentiate MTB and NTM in clinical samples from suspected TB patients in North Sumatra and to assess their drug resistance profiles using a molecular diagnostic approach. We conducted a prospective cohort study using 56 clinical samples (45 smear-positive sputum and 11 fine-needle aspiration biopsies) from suspected TB patients in North Sumatra. DNA was extracted and analyzed using the Genoscholar™ NTM + multidrug-resistant TB (MDR-TB) II line probe assay (LPA) to detect MTB, NTM, and anti-TB drug resistance. Of the 56 samples, 40 (71.4%) were positive for MTB, 2 (3.6%) for Mycobacterium avium, and 5 (8.9%) for other NTM species, while 9 (16.1%) were negative. MDR MTB was detected in 9 (28%) sputum samples and 1 (12.5%) biopsy sample. Both M. avium isolates were susceptible to rifampicin and isoniazid, while resistance profiles for the other NTM species could not be determined. LPA effectively differentiated MTB from NTM and identified drug resistance patterns in clinical samples. Implementation of this rapid diagnostic tool may strengthen TB management in high-burden areas such as North Sumatra, enabling earlier and more targeted treatment. Show less

Lysophosphatidic acid (LPA) is a bioactive phospholipid that mediates a variety of biological actions through binding to G protein-coupled receptors known as LPA receptors (LPARs). In mammals, six LPAR subtypes (LPAR1-6) have been identified. This study aimed to determine the expression of LPAR4 in the developing mouse brain. Brains samples were prepared from mice in various stages of development and biochemical and immunohistochemical analyses were conducted using anti-LPAR4. Western blot analysis detected two LPAR4-immunoreactive species at ∼50 kDa and ∼42 kDa from embryonic day 16.5 (E16.5). The ∼50 kDa molecule increased during development, reaching a peak at postnatal day 3 (P3), and then gradually decreased through P22. In contrast, the ∼42 kDa molecule continued to increase up to P22. Immunohistochemical analyses demonstrated strong LPAR4 expression in neural cells in the intermediate zone and cortical plate of the E15.5 cerebral cortex, whereas neural progenitors in the ventricular and subventricular zones exhibited weaker expression. At P15, fiber-like staining resembling the apical dendrites of cortical neurons and hippocampal pyramidal cells was also observed. This study demonstrated dynamic, spatiotemporal changes of LPAR4 expression in the brain from embryonic to postnatal stages. These findings support a potential role for LPAR4 in neural development. Show less

Cardiovascular-kidney-metabolic (CKM) syndrome significantly increases cancer and mortality risks, but the combined effects of CKM syndrome and physical activity (PA) on these outcomes remain poorly understood. This prospective study included 66,650 UK Biobank participants with accelerometry data. CKM syndrome was classified into five stages based on metabolic, kidney, and cardiovascular health. PA was categorized by intensity into light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) levels, and further divided into tertiles by daily duration. Multivariable Cox models were used to estimate hazard ratios. Over a median follow-up of 8.03 years, 4,301 incident cancer cases and 2,442 deaths occurred. Advancing CKM stages were associated with elevated risks of both cancer incidence and all cause mortality, while increasing PA levels reduced these risks. Significant interactions were observed between CKM syndrome and both MPA and MVPA on cancer and mortality risks (P interaction < 0.05). In participants with the lowest tertile of MPA or MVPA, those in stages 2 and 4 had higher cancer risk, while in the highest tertile, this risk was no longer elevated. For all-cause mortality, in participants with the lowest tertile of MPA or MVPA, CKM stage 3 exhibited higher risks, while those in the highest tertile did not. CKM stage 4 remained associated with higher mortality across all PA intensity levels, but risks decreased with increasing MVPA levels. Higher levels of MPA and MVPA may mitigate the elevated risks of both cancer incidence and all-cause mortality associated with CKM stages 2 to 4. Show less

High lipoprotein(a) [Lp(a)] levels are associated with increased coronary artery calcification (CAC) in familial hypercholesterolaemia (FH) patients. However, mechanisms linking high Lp(a) with CAC remain poorly understood. In this study, we have performed a bioinformatics and system biology analysis to identify miRNAs and their target genes involved in Lp(a)-associated atherosclerotic lesion and coronary calcification in FH patients. Patients with a genetic diagnosis of FH ( Forty-two miRNAs had > 1.5-fold difference in their detection levels when grouped by Lp(a) [FH-Lp(a)> 50 ( Our results identify a miRNA signature that regulates atherosclerotic processes associated with high Lp(a) levels and CAC in asymptomatic FH patients. These findings offer new insights into the underlying mechanisms and highlight potential therapeutic targets. Show less

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

Lipoprotein (a) [Lp(a)] levels are closely related to the development of ischemic heart disease in international studies; however, the impact on the severity of coronary and cardiac involvement in our country has not been described. High levels of Lp(a) are associated with greater involvement of coronary disease and ventricular function compromise. Cross-sectional study among patients with ischemic heart disease admitted to a cardiac intensive care unit after acute coronary syndrome (ACS) or after coronary angioplasty for chronic coronary syndrome. Lipid profile and Lp(a) measurements were performed within the first 24 hours of admission, and echocardiogram with left ventricular ejection fraction (LVEF) measurement was performed within 5 days of admission. The magnitude of coronary disease (number of coronary arteries severely affected) and LVEF were evaluated in patients distributed according to Lp(a) levels considering a cut-off of 30 mg/dL and 50 mg/dL. One hundred and eighteen subjects were recruited, aged 65.9±20.2 years, 74.6% men, and 75% with ACS. Sixty patients (50.8%) were taking statins. Left anterior descending artery involvement was observed in 78.8%, with mean LVEF 49.9±17.5%, LDL 95.6±43.4 mg/dL (LDL >70 mg/dL in 69.4%), non-HDL 120.4±49.1 mg/dL, and Lp(a) 40.5±38.6 mg/dL. Lp(a) levels >30 mg/dL were detected in 42.3% and >50 mg/ dL in 27.9% of subjects. Lp(a) >30 mg/dL was associated with LVEF <40% (OR 2.6, p= 0.02), and values >50 mg/dL were related to LVEF <40% (OR 3.7, p= 0.03) and significant disease of 2 or more coronary arteries (OR 2.4, p= 0.04). Multivariate logistic regression analysis showed that Lp(a) levels >50 mg/dL were related to a higher risk of LVEF <40% (OR 3.8, p<0.01) and multivessel coronary disease (OR 2.8, p= 0.03). In patients with established coronary heart disease, elevated Lp(a) levels are associated with a greater severity of coronary involvement and a lower LVEF. Show less

The 2025 American Society for Preventive Cardiology meeting highlighted evolving strategies in cardiovascular disease prevention, spanning risk models based on traditional risk factors, emerging biomarkers, novel therapeutics, and digital health innovations. Key discussions addressed lipoprotein(a) [Lp(a)] and inflammation as a causal risk factor, their clinical management, and readiness for targeted therapies; optimal systolic blood pressure targets informed by recent randomized controlled trials; and ongoing debate regarding apolipoprotein B versus low-density lipoprotein cholesterol (LDL-C) as the primary lipid target. Advances in digital health emphasized prevention through artificial intelligence, health equity in technology, and the growing role of wearables. Imaging emerged as a central theme, with sessions highlighting its role in risk assessment, monitoring treatment response, and refining prevention strategies, especially in young adults. Sessions on women's cardiovascular health underscored female-specific risk enhancers and limitations of current risk prediction models. Additional debates addressed the use of polygenic risk scores in young adults and strategies for universal screening with LDL-C, hsCRP, and Lp(a). Heart failure prevention was highlighted as a critical frontier, with emphasis on stage-based risk stratification, early identification of subclinical disease, and targeted interventions to avert progression to symptomatic heart failure. Updates on renal denervation reaffirmed its safety, efficacy, and durability as an adjunctive therapy in resistant hypertension. Collectively, these highlights emphasize the rapid evolution of preventive cardiology, integrating precision risk stratification, digital tools, and novel therapies into routine care. Show less

Does preconception mental health status in either partner affect fertility and infertility, and is this association modified by socioeconomic status (SES)? Preconception mental health problems in both partners are associated with lower couple fertility, with the synergistic impact being most pronounced among couples with low SES status. Mental health problems are rising among young adults, and fertility rates are declining. Women's preconception mental health has been linked to lower fertility, but few studies have examined the combined impact of both partners' mental health. The modifying role of SES in these associations is also poorly understood. This couple-based prospective cohort study included 966 preconception couples who sought preconception care and were followed for 12 months in the Shanghai Birth Cohort between 2013 and 2015. The couples' mental health status was evaluated at enrolment using the Center for Epidemiological Studies-Depression Scale, Zung Self-Rating Anxiety Scale, and Perceived Stress Scale. The outcomes included couple fecundability (measured by the TTP) and infertility (i.e. TTP >12 menstrual cycles). In the partner-specific model, Cox proportional hazards models and logistic regression were used to evaluate the associations between each partner's depression, anxiety, and stress levels and couples' fertility. In the couple-based model, cross-classification and quantile g-computation were first applied to identify couples' joint exposure to specific psychological conditions in relation to fertility. Latent profile analysis (LPA) was then conducted to characterize distinct latent profiles of couples' overall mental health statuses, followed by Cox proportional hazards models and logistic regression to examine the corresponding associations. Key symptoms in the couples' depression, anxiety, and stress scales were determined by elastic net regression and least absolute shrinkage and selection operator. To assess the potential effect modification of SES on the association between couples' mental health and fertility, we conducted stratified analyses by male and female partner education levels and household income. In the female partner-specific model, a 1 SD increase in depression score was associated with 10% lower fecundability (FOR = 0.90, 95% CI: 0.82, 0.99). Likewise, a 1 SD increase in the stress score was associated with 13% lower fecundability (FOR = 0.87, 95% CI: 0.79, 0.96). Male anxiety was associated with a higher risk of infertility (OR = 1.19, 95% CI: 1.01, 1.42). Stratified analyses showed that depression, anxiety, and stress were significantly associated with lower fecundability among males with an education level Show less

Lipoprotein (a) (Lp(a)) is a largely genetically determined (70-90%) independent risk factor for cardiovascular disease (CVD). However, clinicians often encounter adults/elder adults with elevated Lp(a), who are otherwise healthy and asymptomatic for atherosclerosis. We aimed to identify additional risk factors and conditions, apart from elevated Lp(a), which lead to atherosclerosis progression and CVD, and whether any protective factors mitigate Lp(a)-related risk. In the STAR (Specialist Care Patients) Lp(a) study, we prospectively enrolled 2,594 consecutive patients aged over 50 years, who had elevated Lp(a), referred to two outpatient cardiology clinics. These patients were either healthy, or had established CVD or three or more cardiovascular risk factors. Lp(a) concentration was measured by enzyme-linked immunosorbent assay. Among adults > 50 years with Lp(a) ≥ 30 mg/dl (75 nmol/l) (mean Lp(a), 65.4 vs. 72.7 mg/dl, In adults > 50 years with elevated Lp(a), Lp(a) - related risk of atherosclerosis progression can be substantially mitigated by addressing modifiable CVD risk factors, such as obesity, diabetes, inflammation, and dyslipidemia, preferably by early preventive measures. In our study cohort, Lp(a) was independently associated with atherosclerosis progression in the patient group only. Show less

This study aims to explore the latent profile characteristics of cognitive function in older adults living with diabetes and analyze the influencing factors, providing theoretical evidence for early intervention. A cross-sectional study design was used to select older adults living with diabetes hospitalized at a tertiary hospital as the study population. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Demographic characteristics, disease-related data (such as duration of diabetes, BMI, and HbA1c levels), and lifestyle factors (such as sleep quality, physical activity, and social support) were collected. Latent profile analysis (LPA) was employed to classify cognitive function, and ordered multinomial logistic regression was performed to analyze the influencing factors of each cognitive profile. A total of 564 patients were included. Latent profile analysis of cognitive impairment identified three categories: complete cognitive impairment (12.82%), partial cognitive impairment (54.74%), and at-risk cognitive impairment (32.44%). Logistic regression analysis revealed that gender, education level, duration of diabetes, HbA1c, diverse intellectual activities, and nutrition were independent factors influencing cognitive impairment (P<0.05). Cognitive impairment in older adults living with diabetes exhibits distinct profile characteristics and is influenced by multiple factors. Interventions should focus on improving blood glucose control, promoting diverse intellectual activities, and enhancing social support to delay the decline in cognitive function. Show less

Cardiovascular-Kidney-Metabolic (CKM) syndrome is characterized by the interrelatedness of chronic kidney disease, cardiovascular disease, and metabolic disorders. Although physical activity is widely acknowledged as an effective intervention for improving the prognosis of chronic diseases, its impact on all-cause mortality among patients with CKM syndrome remains unclear. To investigate the impact of physical activity on all-cause mortality among patients with CKM syndrome. Data from the 2011 wave of the China Health and Retirement Longitudinal Study were used as the baseline, with follow-up conducted until 2013. According to the International Physical Activity Questionnaire criteria, weekly physical activity levels were divided into three categories: light-volume physical activity (LPA), moderate-volume physical activity (MPA), and vigorous-volume physical activity (VPA). Cox proportional hazards regression models were employed to assess the impact of varying levels of physical activity on all-cause mortality. Restricted cubic spline analysis was used to explore possible nonlinear relationships. A total of 3343 patients with CKM syndrome were enrolled in this study. During the 2-year follow-up period, 44 deaths were recorded. After adjusting for potential confounders, VPA was associated with a 54% lower risk of all-cause mortality (adjusted hazard ratios, 0.46; 95% confidence interval: 0.24-0.89). Dose-response relationships demonstrated that all-cause mortality decreased as physical activity increased, with a 5.8% reduction in all-cause mortality risk for every 1000 MET-min/week increment in physical activity levels. VPA was significantly associated with reduced all-cause mortality in patients with CKM syndrome. Encouraging patients with CKM syndrome to engage in increased physical activity may improve clinical outcomes. Key messages What is already known on this topic: Cardiovascular-Kidney-Metabolic (CKM) syndrome involves a complex interplay between cardiovascular disease, metabolic disorders, and chronic kidney disease. While prior studies have established that physical activity can decrease mortality risk in the general population as well as in patients with cardiovascular and metabolic syndromes, the evidence regarding its impact on individuals with CKM syndrome remains limited. Additionally, there is a lack of detailed dose-response analyses of physical activity specifically targeting this high-risk population. What this study adds: This study provides novel evidence indicating that vigorous-volume physical activity (>3000 MET-minutes/week) significantly decreases all-cause mortality by 54% among patients with CKM syndrome, whereas moderate-volume, and light-volume physical activities show no significant effects. Notably, a linear dose-response relationship was established, demonstrating that each 1000-MET increment corresponds to a 5.8% reduction in mortality risk. These findings address a critical knowledge gap by quantifying both the threshold and incremental benefits of physical activity specifically for individuals with CKM syndrome, a population characterized by unique multisystem pathophysiology. How this study might affect research, practice, or policy: The findings of this study have the potential to substantially impact clinical practice by offering evidence-based thresholds for physical activity recommendations in the management of CKM syndrome. The benefits associated with vigorous-volume physical activity (>3000 MET-minutes/week) may encourage guideline committees to formulate more precise exercise prescriptions tailored to this high-risk population. Additionally, these results can be incorporated into a multidisciplinary care framework designed for managing complex chronic conditions. Show less

Aim: To review information sources on this issue in order to provide up-to-date knowledge on the pathogenesis of this condition. Materials and Methods: The PubMed, Embase, and the Cochrane Library databases were searched for studies from inception to April 16, 2022, without language restrictions. Databases were searched for studies from inception 2010 to December, 2024, without language restrictions. Key words for search: Lipoprotein(a), Lp[a], dyslipidemia, classical vascular risk factors, cardiovascular disease, cardiovascular risk, cardiovascular risk factor, cerebral atherosclerosis. More than 37 sources was analyzed. Conclusions: Cardiovascular diseases remain the leading cause of disability and mortality globally. While dyslipidemia is a well-established risk factor for coronary atherosclerosis and myocardial infarction, its role in the development of intracranial atherosclerosis is less well characterized. Current evidence suggests that plasma measurement of lipoprotein(a) [Lp(a)] using validated assays is sufficient for cardiovascular risk stratification, obviating the need for genetic testing of Lp(a). Advanced diagnostic methods have demonstrated that elevated Lp(a) levels are associated with increased vascular wall inflammation, reinforcing its causal role in atherogenesis. Intracranial atherosclerosis, a major cause of ischemic stroke, is linked to a heightened risk of recurrent cerebrovascular events and the progression of vascular cognitive impairment. Although Lp(a) is a recognized risk factor for stroke, its predictive value appears to be lower than that for coronary heart disease or composite cardiovascular outcomes. Therefore, the clinical implications of elevated Lp(a) levels in relation to carotid and intracranial atherosclerosis merit further investigation, particularly in the context of stroke prevention and vascular dementia. Show less

Disrupted diurnal rest-activity rhythms (RAR), that is, daily 24-h patterns of rest and activity, have been associated with fatigue and decreased quality of life among survivors of colorectal cancer (CRC). To identify potential targets for interventions to improve RAR, we investigated longitudinal associations of time spent in sedentary behavior and physical activity with RAR parameters after CRC treatment. In a prospective cohort study, repeated measurements were performed among 268 survivors of stage I-III CRC at 6 weeks, 6 months, and 1, 2, and 5 years after treatment. Thigh-worn accelerometers were used to determine hours/day spent in sedentary behavior, standing, and total physical activity during waking time, as well as RAR parameters including mesor, amplitude, circadian quotient (CQ), dichotomy index (I < O) and 24 h-autocorrelation (R24). Self-reported light-intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were determined via the validated SQUASH questionnaire. Longitudinal associations were analyzed using confounder-adjusted linear mixed models. More sedentary time was statistically significantly associated with a lower mesor, amplitude, I < O and R24 over the 5-year post-treatment period. More standing time was associated with a higher mesor, amplitude, CQ, and I < O but not with R24. Higher levels of objectively assessed total physical activity as well as self-reported MVPA were associated with higher values for all RAR parameters. LPA was not associated with any of the RAR parameters. In the years after CRC treatment, less sedentary behavior and more standing and physical activity were generally associated with higher RAR parameters indicating a more robust rhythm. Future studies should provide more insight into causality of these associations as RAR may be a potential new target for interventions to reduce fatigue after CRC.Trial registration: EnCoRe study NL6904 (https://www.Onderzoekmetmensen.nl/). Show less

To explore the dynamic evolution of symptom clusters in patients with gynecologic malignancies during the early postoperative period and identify key transition points and influencing factors, providing evidence for precision symptom management in clinical nursing. A longitudinal study was conducted among 324 patients using the MDASI-PeriOp-GYN on postoperative days 1 (T1), 5 (T2), and 7 (T3). Exploratory factor analysis identified symptom clusters at each time point, and growth mixture modeling (GMM) was applied to examine trajectory patterns. Latent profile analysis (LPA) and network analysis were performed at T2 to identify patient subgroups, influencing factors, and core symptoms. Five symptom clusters were identified: disease behavior, gastrointestinal, endocrine, neurological, and emotional. The emotional cluster, independent at T1 and T3, merged with the disease behavior cluster at T2. GMM indicated that all clusters declined from T1 to T2, followed by divergence after T2. LPA identified high- and low-symptom subgroups. Patients with ovarian cancer and those with KPS₁ were more likely to belong to the high-symptom group. Network analysis revealed "poor appetite" as the most central symptom at T2. Postoperative day 5 (T2) represents a critical transition point in symptom evolution. Ovarian and KPS₁ are at higher risk for severe symptoms, and "poor appetite" plays a key driving role. Targeted assessment and intervention at T2 may reduce symptom burden and improve recovery outcomes in patients with gynecologic malignancies. Show less

To investigate longitudinal changes in pelvic floor support in primiparous women with pelvic organ prolapse (POP) after vaginal delivery, focusing on single- and multiple-compartment involvement. Two hundred primiparas after vaginal delivery were prospectively enrolled and underwent pelvic floor MRI at six weeks postpartum. POP was diagnosed and classified into subgroups (single or multiple compartments involved) based on MRI findings. Primiparas with POP underwent repeat MRI at four months postpartum. Pelvic floor measurements, including injury score and functional parameters of the levator ani muscle (puborectal hiatus line, H line; muscular pelvic floor relaxation line, M line; levator hiatus area, LHA; iliococcygeus angle, ICA; levator plate angle, LPA), were assessed on MRI. Measurements were compared among POP subgroups and a normal control group (without POP) at six weeks postpartum. Additionally, changes between six weeks and four months postpartum were analyzed within POP subgroups. Based on MRI criteria, approximately 41.5% of primiparas were diagnosed with POP, predominantly cystoceles commonly associated with uterine prolapse. Functional parameters of the levator ani, except for LPA at rest, were significantly increased in POP subgroups compared to controls. At four months postpartum, M line, H line, and LPA significantly decreased, and prolapsed organs were elevated in cases with multiple compartments involved, compared to six weeks postpartum. No significant changes were observed in cases with single-compartment involvement during follow-up. A substantial proportion of primiparas experienced postpartum POP. Impaired levator ani function contributed to POP. Pelvic floor support improved during early postpartum in cases with multiple-compartment involvement. Show less

Quality of life (QoL) subtypes were identified via latent profile analysis (LPA), and their correlations with social support and self-efficacy were assessed in 284 patients with hematologic malignancies (HMs). The results were as follows: (1) LPA revealed three QoL subtypes of patients with HMs, namely, the high-QoL group, the medium-QoL group, and the low-QoL group. (2) The high-QoL group had higher levels of social support than the medium-QoL group did, and they also had higher levels of self-efficacy than both the medium- and low-QoL groups did. These results contribute to the identification of heterogeneous QoL features among patients with HMs and their correlations with social support and self-efficacy. Moreover, this study has clinical implications for improving the QoL of patients with HMs and promoting their physical and mental health. Show less

This study aimed to identify phenotypes of subtle variation in multidomain cognitive performance and examine their longitudinal associations with Alzheimer's disease and related dementias (AD/ADRD) biomarkers and cognitive outcomes. Among 1192 cognitively unimpaired (CU) older adults from the Baltimore Longitudinal Study of Aging, latent profile analysis (LPA) identified phenotypes based on baseline patterns of neuropsychological test performance. Mixed-effects and Cox models examined longitudinal differences in cognitive status and AD/ADRD biomarkers (phosphorylated tau-181 [pTau181], amyloid-beta 42/40 ratio [Aβ42/Aβ40], neurofilament light [NfL], and glial fibrillary acidic protein [GFAP]) across phenotypes. LPA identified the following cognitive phenotypes: Subtle variations in neuropsychological performance among CU older adults have implications for long-term cognitive health and may help inform Alzheimer's disease and related dementias diagnosis and disease monitoring. Significant cognitive heterogeneity exists in CU older adults.LPA identified phenotypes based on cognitive performance.Personality and psychosocial characteristics differed by cognitive phenotype.Cognition over time and risk of cognitive impairment differed by cognitive phenotypes.The phenotype with greatest executive dysfunction had the fastest increase in NfL. Show less

Demyelination diseases are characterized by injury to large (A-type) myelinated nerve fibers, and by secondary damage to small (C-type) sensory fibers, which leads to chronic pain symptoms, such as allodynia. The mechanisms underlying the interactions between the two fiber types are not clear. This study aims to investigate the role of lysophosphatidic acid (LPA) signaling in satellite glial cells (SGCs) within the dorsal root ganglia (DRG) in demyelination-induced chronic pain. A demyelination model was established by injecting cobra venom into the tibial nerve of 8-10-week-old Sprague-Dawley rats to selectively damage A-fiber myelin. Myelin morphology was observed via transmission electron microscopy (TEM) at 1, 3, 7, and 14 days post-injection. Pain behaviors (mechanical hypersensitivity, thermal hyperalgesia, and spontaneous pain) were assessed to evaluate progression. In vivo electrophysiology was performed to analyze sensory conduction and excitability changes in A- and C-type neurons. Immunofluorescence staining assessed SGC activation, LPA1 receptor (LPA1R) expression, and connexin 43 (Cx43) dynamics in the L4 DRG over time. Pharmacological interventions targeting LPA1R and SGC activation were applied to evaluate their effects on pain behaviors, cytokine release, and neuronal excitability using RT-PCR, ELISA, and spinal electrophysiology. Cobra venom induced a selective A-fiber demyelination and persistent pain in rats. It also upregulated the expression of LPA1R on SGCs that surround large DRG neurons, which normally mediate non-noxious input, and increased gap junction-mediated coupling via Cx43, leading to the activation of SGCs surrounding small nociceptive neurons. The activated SGCs released inflammatory mediators that increased nociceptive neuron excitability, driving chronic pain. In support of these results, pharmacological inhibition of LPA1R-mediated SGCs activation reversed this process. Our study demonstrates that LPA-LPA1R signaling in SGCs drives A-fiber demyelination-induced neuropathic pain by promoting Cx43-mediated SGC-neuron crosstalk and cytokine release. Targeting this pathway may represent a promising strategy to alleviate demyelination-associated chronic pain. Show less

ObjectiveRespect for older adults (ROA) is shaped by multiple ecological systems and personal factors. However, little is known about the potential subgroups that may differ in their constellation of influencing factors and their association with ROA.MethodsThis cross-sectional study included 1,476 community-dwelling Chinese adults aged 18-83 years ( Show less

Individuals who experience adverse events during their early life stages are more likely to face negative consequences across various life domains throughout their lifespan. While latent profile analysis has been increasingly applied to adverse childhood experiences (ACEs) worldwide, simultaneous prospective investigations of negative and positive posttraumatic outcomes in Chinese emerging adults remain scarce. The present study aimed to extend prior literature by: (a) assessing the latent profile groupings of ACEs among emerging adults, and (b) analyzing the prospective associations between latent profiles of ACEs and posttraumatic outcomes over a six-month interval, including complex posttraumatic stress disorder (CPTSD) symptoms and posttraumatic growth (PTG). From 3,994 college students who participated in 2 surveys 6 months apart, 1,814 participants (mean age: 18.93 ± 1.45) who reported ACEs were selected. The sample included 901 males (49.7%) and 913 females (50.3%). Data were collected through a two-wave online survey measuring ACEs, CPTSD symptoms, and PTG. The Latent Profile Analysis identified five ACE profiles: High neglect (14.9%), Moderate family dysfunction (46.3%), Moderate abuse (25.1%), High risk (8.5%), and Moderate maltreatment/High family dysfunction (5.2%). Moderate family dysfunction (Profile 2) and Moderate maltreatment/High family dysfunction showed better posttraumatic adaptation than others. The High-risk group had the worst outcomes, while the High neglect and Moderate abuse groups fared better than the High-risk group. This study provides valuable insights into the concurrent examination of ACEs and their impact on the CPTSD symptoms and PTG of emerging adults. It offers a foundation for developing tailored intervention strategies for affected groups. Show less

To determine whether lipoprotein(a) [Lp(a)] and cumulative Lp(a) (CumLp(a)) are associated with adverse outcomes in patients with acute myocardial infarction (AMI). This cohort study included 2,634 hospitalized patients diagnosed with AMI who underwent coronary angiography at Zhongda Hospital, Southeast University, from July 2013, to December 2021. The main outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as cardiovascular (CV) death, non-fatal myocardial infarction, non-fatal stroke, or unplanned revascularization—occurring singly or in combination. We used Cox proportional hazards models, with subgroup and sensitivity analyses, restricted cubic spline (RCS) modeling, and threshold-effect assessment to evaluate the relationships between Lp(a), CumLp(a), and prognosis. Across a median 55.2-month follow-up, 907 participants (34.40%) experienced a MACCE, 342 (13.00%) patients had CV death, 177 (6.70%) patients had non-fatal MI, 202 (7.70%) patients had non-fatal stroke, 399 (15.10%) patients underwent unplanned revascularization, and all-cause death occurred in 547 (20.80%) patients. Multivariable Cox regression models demonstrated a significantly increased risk of MACCE, CV death, non-fatal MI, and non-fatal stroke in both the higher Lp(a) and higher CumLp(a) groups compared with the lower groups (HRs for Lp(a): 1.652, 2.157, 3.455, and 1.930; HRs for CumLp(a): 1.697, 1.675, 3.759, and 2.032), and every one-unit rise in CumLp(a), the risk of MACCE, CV death, non-fatal MI and non-fatal stroke increased by 1.3%, 1.4%, 1.9% and 1.2%, respectively. The majority of subgroup and sensitivity checks consistently supported a stable link between Lp(a)/CumLp(a) and the risks of MACCE, CV death, non-fatal MI, and stroke. Analyses using RCS and threshold models revealed that Log Higher levels of Lp(a) and CumLp(a) are linked to a greater risk of poor outcomes among patients with AMI as the index event, highlighting their potential value for risk stratification and guiding clinical decision-making. The online version contains supplementary material available at 10.1186/s12944-025-02800-6. Show less

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

Timely diagnosis is crucial for managing neurodegenerative conditions. This study investigated whether time from symptom onset to diagnosis differs by clinical syndrome and sex. This retrospective, cross-sectional study included 591 participants with Alzheimer's disease (AD), frontotemporal dementia (FTD) subtypes (behavioral variant FTD [bvFTD], semantic dementia [SD], and progressive non-fluent aphasia), logopenic progressive aphasia (LPA), and syndromes associated with movement disorders (corticobasal syndrome, FTD with motor neuron disease [FTD-MND], and progressive supranuclear palsy). Bayesian regression models were used to compute diagnostic timelines. Compared to AD (3.35 years; 95% credible interval [CrI]: 3.03-3.72), SD and bvFTD had additional delays of 9.7 (95% CrI: 1.96-20.64) and 14.82 months (95% CrI: 6.94-25.42), respectively, while FTD-MND was shorter by 11.62 months (95% CrI: -15.7 to -4.68). Men with bvFTD had 23.64 month longer delays than women (95% CrI: 10.35-44.33). Diagnostic delays may reflect syndrome-specific clinical features, diagnostic complexity, and sociocultural factors. Findings highlight the need for improved diagnostic pathways and pre-clinical biomarkers to facilitate earlier identification. Bayesian analyses revealed that diagnostic delays differ by syndrome and sex.Alzheimer's disease (AD) was diagnosed on average 3.35 years after symptom onset.Diagnoses were delayed in semantic and behavioral variant frontotemporal dementia (bvFTD) compared to AD.Men with bvFTD had longer delays than women.Findings support need for improved diagnostic pathways and pre-clinical biomarkers. Show less

Lipoprotein(a) (Lp(a)) is a genetically determined, lifelong cardiovascular risk factor strongly associated with atherosclerotic cardiovascular disease (ASCVD) despite optimal low-density lipoprotein cholesterol (LDL-C) lowering. The current management is challenged by the absence of outcome-proven Lp(a)-specific therapies. Statins, ezetimibe, bempedoic acid, and lifestyle interventions have little or no effect on Lp(a). Statins may modestly raise levels; niacin is now contraindicated as it has not been shown to reduce cardiovascular or all-cause mortality, while PCSK9 (Proprotein Convertase Subtilisin/Kexin type 9) inhibitors and inclisiran reduce Lp(a) concentrations by approximately 20 to 30%, though this effect remains secondary to their LDL-C-lowering effect. The only U.S. Food and Drug Administration (FDA)-approved therapy specifically addressing Lp(a) is lipoprotein apheresis, which reduces Lp(a) levels by 60 to 75%, but is restricted to specific patient populations due to invasiveness, high cost, and limited availability. Future promise lies in RNA-based therapies, including antisense oligonucleotides (pelacarsen) and small-interfering RNAs (olpasiran, lepodisiran, SLN360), which achieve 80 to 95% sustained Lp(a) reductions. Large outcome trials will determine whether this biochemical efficacy translates into tangible clinical benefits. Current guidelines now recommend one-time lifetime Lp(a) measurement, treating ≥125 nmol/L (≥50 mg/dL) as a risk-enhancing factor. High or extreme elevations, especially with ASCVD, mandate aggressive LDL-C lowering, optimization of modifiable risk factors, family cascade screening, and apheresis or referral to RNA-therapy trials in select cases. Thus, while therapeutic options remain limited, systematic measurement and risk stratification are ethically justified to prepare for the imminent arrival of Lp(a)-targeted therapies. Show less

Colorectal cancer (CRC) constitutes a significant public health burden in both China and the United States of America (USA), with low physical activity (LPA) identified as a key modifiable risk factor. This study aimed to characterize temporal trends in CRC burden attributable to LPA in these 2 nations from 1990 to 2021. Using data from the 2021 global burden of disease database, age and sex-specific disparities in CRC burden attributed to LPA were evaluated in both countries. Trend analyses of age-standardized mortality rates and age-standardized disability-adjusted life year rates were performed using joinpoint regression. Decomposition analysis was applied to disentangle contributions from demographic aging, population growth, and epidemiological transitions. The age-period-cohort model was employed to quantify the independent effects of age, period, and birth cohort. Bayesian age-period-cohort modeling was utilized to project future CRC burden attributed to LPA through 2036. In 2021, LPA-attributable CRC mortality cases in China reached 16,698 (95% uncertainty interval: 10,065-24,626), exhibiting a 191.16% increase from 1990. The number of disability-adjusted life years attributed to LPA totaled 3,20,464 (95% uncertainty interval: 1,92,275-4,74,070), reflecting a 149.67% rise over the same period. Conversely, the USA reported more moderate increases of 18.26% in LPA-attributable CRC deaths and 20.28% in disability-adjusted life years. The age-period-cohort model revealed that the disease burden in both countries is shifting towards younger age groups. Further analysis of each state in the USA revealed that in 2021, the burden on low-income groups was heavier. The Bayesian age-period-cohort model predicts that the burden of CRC caused by LPA in the 2 countries will show a significant upward trend by 2036. As the burden of CRC caused by LPA becomes increasingly severe in China and the USA, there is an urgent need to raise public awareness about how physical activity can help prevent CRC and for policymakers to create targeted public health policies to lower this disease burden. Show less