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Even when people with diabetes mellitus (DM) meet their cholesterol goals, they still face a higher risk of heart and blood vessel problems. One major reason is a particle called lipoprotein(a), or Lp(a), which is similar to LDL cholesterol. Raised levels of Lp(a) are inherited rather than caused by lifestyle. Lp(a) can build up in the body and make it easier for blood clots to form because it closely resembles a protein called plasminogen, reducing its ability to form plasmin that dissolves blood clots. At the same time, chemical changes like oxidation and glycation can make blood vessels more inflamed, adding to the risk. Elevated concentrations of Lp(a) (>30 mg/dL; 75 nmol/L), and particularly >50 mg/dL (125 nmol/L), are independently associated with coronary artery disease, ischemic stroke, diabetic nephropathy, retinopathy, and neuropathy. Conventional lipid-lowering therapies exert neutral or modest effects on Lp(a), in contrast to RNA-based targeted agents (antisense oligonucleotides and siRNA [Small Interfering RNA]), which achieve reductions of 70-95% and show consistent results in Phase 2 clinical trials. In this review, we bring together findings from laboratory research and clinical studies, and highlight why it is important to measure Lp(a) levels-at least once in a person's life, and especially in those with diabetes-to help doctors better assess risk and plan more effective treatments. In diabetic populations, the adaptation of Lp(a)-targeted therapies could redefine the management of residual risk and improve both cardiovascular and microvascular outcomes. Show less

Chronic diseases have become a major public health challenge facing the world. Identifying key factors and developing effective management strategies to promote proactive health behaviors in patients is crucial for improving health outcomes. This study aims to construct a comprehensive model of proactive health behaviors in chronic disease patients, elucidate multilevel determinants, and guide targeted policy interventions in China. A cross-sectional survey was conducted among 805 patients with chronic diseases in China. Latent profile analysis (LPA) was conducted to identify distinct profiles of proactive health behaviors among patients. Binary logistic regression analysis was used to verify and analyze the determinants affecting the proactive health behaviors of patients. Among the 805 participants, 471 were classified as highly proactive, and 334 were classified as less proactive. The average score for proactive health behaviors was 70.37 ± 10.93. Several factors positively predicted proactive health behaviors: patients aged > 74 years (AOR = 8.85, 95% CI 2.06-39.45), married patients (AOR = 1.78, 95% CI 1.02-3.11), urban residents (AOR= 1.33, 95% CI 1.04-1.70), those with stronger health intentions (AOR = 1.42, 95% CI 1.28-1.60), higher self-efficacy (AOR = 1.12, 95% CI 1.04-1.20), positive health beliefs (AOR = 1.21, 95% CI 1.09-1.34)), and greater community support (AOR = 1.18, 95% CI 1.07-1.32). Regarding policy support, perceiving an adequate upper payment limit for drugs was associated with twice the odds of proactive health behaviors (AOR = 2.61, 95% CI 1.44-4.78). Additionally, age and the medication reimbursement policy for drug expenses exerted negative effects on proactive health behaviors (β = -0.507, P < 0.01). Governments should transform medical insurance from a passive payer into an active health investor. By incorporating behavioral economics principles, such a reform reallocates policy design, resources, and decision-making power toward disadvantaged populations. This shift breaks the "well-intentioned policy trap", achieving lower medical costs alongside improved population health. Show less

Evidence has linked self-reported sedentary behaviors with dementia and cognitive impairment; however, the underlying mechanisms remain poorly understood. We investigated the associations of accelerometer-measured sedentary behavior patterns with gray matter atrophy patterns in rural-dwelling older adults, while taking into account the manner in which sedentary time is accrued (in short or long bouts). This community-based study involved 911 dementia-free older adults (age ≥ 60 years, 59% women) who participated in both ActiGraph and brain MRI substudies within MIND-China (2018-2020). Sedentary behavior parameters (total sedentary time, mean sedentary bout duration, and sedentary breaks) were recorded with accelerometers. Regional gray matter volumes (GMV) were measured using voxel-based morphometry (VBM) methods. Data were analyzed using the general linear regression models, restricted cubic spline curves, and VBM analysis. There was an inverted U-shaped association between daily sedentary time and GMV in temporal, cingulate, and medial temporal cortex, while longer mean sedentary bout duration was linearly related to decreased GMV in total, frontal, temporal, insula, cingulate, and medial temporal cortex. Greater daily time spent in light or moderate-to-vigorous physical activity (LPA and MVPA) was correlated with larger insula GMV. The VBM analysis suggested that prolonged daily total sedentary time and mean sedentary bout duration were significantly associated with smaller GMV in extensive brain regions, especially in thalamus and insula. In conclusion, gray matter atrophy associated with sedentary behavior in older adults is characterized by reduced GMV in global, frontal, temporal, medial temporal, and cingulate cortex, especially in the insula and thalamus regions. Show less

The global distribution of lipoprotein(a) [Lp(a)] levels varies due to racial and ethnic differences. However, the clinical relevance of Lp(a) levels in Japanese patients has not been fully explored. We investigated the association of Lp(a) levels, the Suita score, and the presence of high-risk plaque (HRP) as well as that of ≥ 50% stenosis, quantitative plaque volume, and the value of coronary artery calcium score in coronary computed tomographic angiography (CCTA), among 272 Japanese patients (mean age: 65 years) in whom serum Lp(a) levels were measured due to suspected coronary artery disease. HRP was defined as positive remodeling and/or low attenuation. Plaque volume was quantified as the percent plaque volume. HRP was identified in 33 (12.1%) patients. The prevalence of HRP, ≥ 50% stenosis, and percent plaque volume progressively increased with higher Lp (a) levels and Suita scores. In multivariate analyses, Lp(a) and the Suita score independently predicted HRP when assessed as continuous (p = 0.02, p＜0.001, respectively) or categorical variables (p = 0.005, p = 0.007, respectively). Patients in the highest tertile of Lp(a) and classified as high- or intermediate-risk by the Suita score had the highest HRP risk, whereas those in the lower 2 tertiles and low-risk group had the lowest. Incorporating Lp(a) into the Suita score improved the prediction of HRP beyond the Suita score alone (p = 0.005). The combinatorial value of assessing Lp(a) levels and Suita score may provide useful insight regarding Japanese patients undergoing CCTA for the prediction of HRP. Show less

The Accreditation Review Commission on the Education of the Physician Assistant, which accredits all US Physician Assistant (PA) programs, published standards in 2019 which specifically required programs to include instruction on medical care with respect to gender identity. The purpose of this study was to compare trends in the delivery of transgender content in US PA programs pre- and post-accreditation standard implementation. Data were drawn from 2 separate national surveys of PA programs. The first was administered in 2018 (n = 236, response rate 100%) and the second in 2021 (n = 286, response rate 71.8%). Both included questions on hours spent and courses in which transgender health content was included. Chi-square tests were conducted to compare results between 2018 and 2021. There were statistically significant differences in PA programs reporting inclusion of transgender content between 2018 and 2021, with all courses reporting percent increases between the 2 timepoints. The largest percentage changes were in medical interviewing (43.6% in 2018, 75.5% in 2021) and infectious diseases (6.4% in 2018, 38.7% in 2021). The number of PA programs reporting <1 hour of transgender content decreased from 14.5% in 2018 to 1.6% in 2021. While accreditation standards are not the only contributing factor to the increases in transgender health curricular content in this study, the increases in curricula and delivery methods are pronounced. Findings suggest that accreditation standards may be a powerful strategy in ensuring health professionals receive the content necessary to care for people who are transgender. Show less

Pulmonary embolism is a potentially fatal cardiovascular condition that demands prompt and accurate diagnostic imaging. Traditional single-energy computed tomography pulmonary angiography (CTPA), while widely used, is associated with high radiation doses and substantial volumes of contrast agents, which may increase the risks of radiation-induced tissue damage and contrast-induced nephropathy (CIN), respectively. Dual-energy CTPA (DE-CTPA) presents a promising alternative, though challenges, including elevated image noise at low kilo-electron volt (keV) levels (e.g., 40 keV), persist. The primary aim of this study is to evaluate and compare the image quality of 40 keV virtual monoenergetic images (VMI) reconstructed using deep learning image reconstruction (DLIR) and Adaptive Statistical Iterative Reconstruction-V (ASIR-V) algorithms within the context of low-dose DE-CTPA protocols. This prospective study enrolled patients who underwent DE-CTPA between January and April 2025. Using a Revolution CT scanner, 40 keV VMI were reconstructed with four distinct algorithms: ASIR-V 50%, ASIR-V 70%, Deep learning image reconstruction with medium setting (DLIR-M), and deep learning image reconstruction with high setting (DLIR-H). Iodixanol (350 mgI/mL) was administered at a dose of 0.4 mL/kg. The image quality was assessed through both objective measures [image noise, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR)] and subjective evaluation via a Likert scale. Statistical analysis was conducted using SPSS 27.0, employing analysis of variance (ANOVA) for normally distributed data and the Kruskal-Wallis test for non-normally distributed data. A total of 75 patients with clinical suspicion of pulmonary embolism were included in the study. The mean effective dose (ED) was 3.76±1.02 mSv, with a mean CT volume dose index (CTDIvol) of 6.13±1.69 mGy and a mean dose-length product (DLP) of 221.12±59.85 mGy·cm. The mean contrast agent volume was 26.0±5.0 mL. Statistical analysis of image quality revealed significant differences between the four groups in terms of image noise, CNR, and SNR, measured at the levels of the main pulmonary artery, left pulmonary artery, and right pulmonary artery (P<0.001). Post-hoc analysis demonstrated that the DLIR-H algorithm provided the highest image quality, significantly reducing noise while enhancing CNR and SNR relative to both ASIR-V and DLIR-M (P<0.001). Compared with ASIR-V 50%, DLIR-H reduced image noise by 45% at the PA [24.25±16.18 The DLIR-H algorithm significantly enhances the image quality of 40 keV VMI images under low-dose DE-CTPA scanning protocols. It outperforms DLIR-M, ASIR-V 50%, and ASIR-V 70%, making it a promising tool for improving image quality in CTPA, particularly in clinical settings where minimizing radiation dose and contrast agent volume is essential. Show less

Pulmonary artery (PA) dilatation is a common feature of pulmonary hypertension (PH). While lung transplantation (LTx) leads to significant hemodynamic improvements, the effect on PA diameter remains unclear. This study aims to evaluate changes in PA diameter following LTx in patients with preexisting PH and determine whether structural vascular changes regress alongside pulmonary pressure normalization. We retrospectively assessed 18 patients with PH who underwent LTx between 2002 and 2023. Main PA, right PA (RPA), and left PA (LPA) diameters were measured via computed tomography (CT) imaging pre-transplant and annually post-transplant (up to 12 years). Systolic pulmonary arterial pressure (SPAP) was assessed by echocardiography. Despite a significant reduction in SPAP, PA diameter remained largely unchanged (mean pre-LTx: 29.7 mm; post-LTx: 30.0 mm, P=0.670). The aorta diameter increased slightly (P=0.0027), and the PA-to-aorta (PA/Ao) ratio decreased (from 1.08 to 1.00; P=0.027). RPA and LPA showed no significant dimensional changes. Correlation between PA size and SPAP was weak and not significant both pre- and post-LTx (r=0.087 and 0.388, respectively). In contrast to some previous reports suggesting vascular remodeling post-LTx, our findings suggest that PA diameter may remain dilated in some PH patients, even after normalization of pulmonary pressures. This could reflect the presence of structural changes that are less responsive to hemodynamic improvements and warrants a careful interpretation of persistent PA dilation on chest CTs following LTx. Show less

While most patients with stage I non-small cell lung cancer (NSCLC) remain recurrence-free after resection, some still develop recurrent disease. The surgical curative time window concept, defined as no recurrence through 5-year follow-up, helps identify potentially cured patients, yet predictive clinicopathologic features in stage I invasive NSCLC need clarification. This study sought to identify such features to enable risk-adapted surveillance. We analyzed a prospectively collected dataset of patients with stage I invasive NSCLC who underwent R0 resection between 2008 and 2015. Cox regression analysis was used to evaluate the association between clinicopathologic features and disease recurrence, aiming to identify independent prognostic factors. A total of 1,817 patients met the inclusion criteria. The 5-year cumulative incidence of recurrence was 14.6%. Female sex, tumor size ≤2 cm, lepidic-predominant adenocarcinoma (LPA) histologic type, presence of a ground-glass opacity (GGO) component, and solid component size ≤10 mm were identified as independent prognostic factors. A risk stratification system was subsequently developed, classifying patients into two groups: a low-risk group (with ≥4 factors; n=341) and an elevated-risk group (with <4 factors; n=1,476). Kaplan-Meier analysis revealed statistically significant differences in recurrence-free survival (RFS), overall survival (OS), and lung cancer-specific survival (LCSS) between the two groups (P<0.001). The low-risk group is considered to represent the population within the surgical curative time window. Patients with stage I invasive NSCLC who meet at least four of the following five criteria-female sex, tumor size ≤2 cm, solid component ≤10 mm, presence of a GGO component, and LPA histologic type-may be considered within the "surgical curative time window" and may therefore qualify for reduced surveillance intensity. Show less

Exposure to emotional maltreatment is related to adolescent prosocial behavior, but it remains unclear whether this relationship is related to basic psychological needs satisfaction and self-talk patterns. This study investigated the mediating role of basic psychological needs satisfaction in the relationship between childhood emotional maltreatment and prosocial behavior, as well as the moderating role of self-talk and relevant demographic variables. Data were drawn from a sample of 2,058 Chinese students ( Show less

Coronary heart disease (CHD) is a prominent cause of mortality and disability worldwide. Like most complex diseases, the risk of CHD in individuals is regulated by the interaction between genetic factors and lifestyle. To investigate the influence of A total of 324 patients with CHD and 143 control participants were involved in this study. Single nucleotide polymorphisms rs429358 and rs7412 in the In the CHD group, the frequencies of In the Teochew population, the Show less

Drug resistant Tuberculosis (DR-TB) continues to be a major concern for public health, particularly in countries like India with high disease burden. Recognizing resistance trends and appropriate therapeutic approach is critical for improving patient outcomes and updating national treatment protocols. This study aims to analyze drug resistance patterns and assess treatment modifications made in accordance with National Tuberculosis Elimination Programme (NTEP). The study was conducted in our institute in western Maharashtra over a period of 18 months after approval from ethics committee which included microbiologically confirmed pulmonary and extrapulmonary DR-TB cases and resistance patterns were studied using molecular and phenotypic drug susceptibility testing (DST) including line probe assays (LPA). Initial treatment regimens and subsequent modifications were documented and assessed. Out of 83 DR-TB patients the most prevalent pattern was Isoniazid monoresistance (H Mono DRTB) (45.78 %), followed by Rifampicin resistant TB (RR-TB) (21.69 %) and Pre - extensively drug resistant TB (Pre XDR-TB) (24.10 %). Majority were initiated on an All Oral Longer Regimen (49.40 %) or an H Mono/Poly DR-TB regimen (48.19 %). Modifications were required in 28.92 % of the cases with fluoroquinolones being the most frequently substituted drug due to resistance. Out of 83 individuals, only 55 were assigned outcomes since the remaining were on treatment. Among these 55, 72.7 % were assigned outcome as cured, 5.4 % as treatment completed, 10.9 % defaulted, 3.6 % as treatment failed and 7.27 % died. The study highlights the evolving resistance pattern in DR-TB patients and need for patient specific treatment to achieve optimal outcomes. It also provides valuable insights for effective management protocols, contributing to improved patient prognosis and informing public health strategies. Show less

India accounts for 26 % of global tuberculosis (TB) cases, with delayed diagnosis of Mycobacterium tuberculosis (MTB) and drug resistance exacerbating disease transmission. Conventional drug susceptibility testing (DST) remains time-consuming, while molecular tools like the Xpert MTB/RIF assay-though rapid-are limited to detecting MTB and rifampicin (RIF) resistance. Testing for isoniazid (INH) and second-line drugs requires the costly Xpert MTB/XDR assay. Although line probe assays (LPAs) identifies first- and second-line drug resistance, their accessibility is restricted to specialized laboratories. This underscores the need for a rapid, cost-effective alternative to diagnose resistance to INH and fluoroquinolones (FQs). A cross-sectional study was performed at the Department of Microbiology, AIIMS Bhubaneswar, and the Intermediate Reference Laboratory (IRL), Cuttack, from March 2022 to April 2023. MTB isolates (n = 123) were analyzed using LPAs (Hain Lifescience's Genotype MTBDRplus and Genotype MTBDRsl) and multiplex allele-specific (MAS) PCR. The MAS-PCR targeted mutations in katG codon 315 and the inhA-15 promoter region for INH resistance, and gyrA codon 94 for FQ resistance. MAS-PCR identified INH resistance in 28/123 (22.76 %) isolates. Compared to LPA, MAS-PCR demonstrated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 80.77 %, 93.81 %, 77.78 %, 94.79 %, and 91.06 %, respectively, for INH resistance. For FQ resistance, MAS-PCR identified 19/123 (15.44 %) resistant isolates, with sensitivity, specificity, PPV, NPV, and accuracy of 87.50 %, 95.33 %, 73.68 %, 98.08 %, and 94.31 %, respectively, relative to LPA. MAS-PCR offers a rapid, technically feasible, and cost-effective method for detecting resistance to INH and FQs. Its high accuracy and affordability position it as a viable alternative in resource-limited settings, facilitating timely TB diagnosis and resistance management. Show less

Multidrug-resistant tuberculosis continues to be a major threat to mankind and is a major social and economic burden to society. Line probe assay (LPA) is a method for detecting Mycobacterium tuberculosis (MTb) in combination with resistance to rifampicin and isoniazid by first-line LPA, resistance to fluoroquinolones (FQ) and second-line injectable drugs (SLID) by second-line LPA in sputum smear-positive specimens (direct testing) and cultured isolates (indirect testing). LPA uses a DNA-based reverse hybridization method, which determines the drug resistance profile through the pattern of binding of DNA amplicons to probes that target specific areas of the MTb genome for MTb detection and to most common mutations conferring resistance to various drugs and/or the corresponding wild-type DNA sequence. LPA is endorsed by the National Tuberculosis Elimination Programme (NTEP), but very limited data are available, especially from high-burden areas such as Bihar, where a rapid, accurate, cost-effective technique like LPA can play a crucial role in early diagnosis and initiation of treatment and ultimately contribute to the effective elimination of the disease. This cross-sectional study was performed at Indira Gandhi Institute of Medical Sciences, Patna, a tertiary care centre, and aimed at the molecular characterization of Rifampicin resistant tuberculosis (RR-TB) isolates using the line probe assay method. The study was conducted between November 2022 and May 2024 with 116 samples obtained from both pulmonary tuberculosis(PTB) and extrapulmonary tuberculosis(EPTB) cases that were found to be rifampicin-resistant on CBNAAT (Cartridge based nucleic acid amplification test-Gene Xpert Mtb/RIF). In this study, 116 patients were enrolled, of whom 80(68.9 %) were pre-XDR-TB cases and 36(31 %) were MDR-TB cases. The most common pattern of mutation associated with rifampicin rpoB gene was WT8 MUT3 S531L and, Isoniazid inhA gene was WT1 MUT1 c-15 t. High-level isoniazid resistance involving KatG mutation was present in 111 (95.7 %) cases and the most common mutation associated was MUT1 -S315T1. Overall prevalence of fluoroquinolone resistance in this study was 68.9 %. There is a wide prevalence of high-level isoniazid resistance and fluoroquinolone resistance among RR-TB patients, indicating the rapid emergence and transmission of resistant strains in the community. This underscores the need for enforced interventions, such as screening for MDR-TB before starting therapy and surveillance of fluoroquinolone susceptibility. Molecular characterization of RR-TB strains by Line probe assay method can play a critical role in the rapid determination of pattern of resistance in the circulating strains and hence guide tailored therapy at the earliest opportunity especially in high burden setting with limited infrastructure. Show less

This study investigates the mechanisms by which digital mindfulness training promotes meaning in life among social workers and explores individual heterogeneity in this process. A parallel mediation model was used to test the pathways from digital mindfulness training to meaning in life. Latent Profile Analysis (LPA) was employed to identify distinct subgroups among the participants. All five proposed hypotheses received strong empirical support. Our analysis revealed that social workers who participated in digital mindfulness programs reported a stronger meaning in life. The parallel mediation model identified two distinct pathways: digital mindfulness training was associated with (1) reduced perceived social exclusion and, separately, (2) fewer psychotic-like experiences. Both of these factors, in turn, independently contributed to a greater meaning in life. The LPA identified five distinct subgroups: the "Flourishing Professional," "Socially Isolated yet Resilient," "Typical Practitioner," "Internally Struggling but Connected," and "High-Risk and Distressed." These groups differed significantly in meaning in life, with the "High-Risk and Distressed" category scoring the lowest. Viewed together, these patterns form a coherent explanatory structure that helps clarify how mindfulness interventions may operate. The findings also point to the importance of tailoring program content and delivery to address the particular vulnerabilities and strengths of each subgroup, rather than relying on a single, generic format. Show less

High-stakes testing has become increasingly prominent phenomenon in teacher training institutions across the Global South. Despite its psychological implications, limited studies have investigated the stress experiences associated with this phenomenon, thereby constraining the design of appropriate interventions. Guided by the Lazarus and Folkman's Transactional Stress Model, this study examined the examination-related stress patterns and associated factors among pre-service teachers in an exam-oriented high-stakes setting in Ghana. An online survey, using the Perceived Stress Scale (PSS-10), was administered to 984 pre-service teachers at the University of Education, Winneba. The data were analysed using the LPA and multivariate ordinal logistic regression analysis. The results discovered three examination-related stress profiles (i.e., highly stressed, moderately stressed and low-stress groups), with the majority of the pre-service teachers (50.9%) failing into the high-stress cluster. Subsequent analysis revealed that religious affiliation, study level, age, course load (number of registered courses) and the study hours per week were significant predictors of examination-related stress levels. In line with the extended interpretation of the Transactional Stress Model, the study demonstrates how stress appraisal and coping mechanisms are embedded within broader contextual realities, particularly in collectivist cultures where family and community expectations influence academic outcomes. The study concludes that there is a substantial mental health burden associated with examination practices in teacher education programmes under exam-oriented high-stakes testing environment. The findings call for differentiated, culturally responsive interventions to address the specific needs of pre-service teachers with varied stress profiles. Show less

To explore the categories of flourishing in patients undergoing postoperative chemotherapy for ovarian cancer and analyse the influencing factors for each category. A cross-sectional survey was conducted with 260 patients who underwent postoperative chemotherapy at the gynaecological oncology ward of a tertiary hospital in Shanxi Province between May 2024 and May 2025. Participants completed the General Information Questionnaire, Flourishing Scale, Learned Helplessness Scale, Index of Autonomous Functioning Scale, and Perceived Social Support Scale. Latent profile analysis (LPA) was used to identify the flourishing profiles. Subsequently, univariate and multivariate logistic regression analyses were conducted to examine the factors associated with profile membership. Among the 237 patients who completed valid questionnaires (recovery rate: 91.2%), the mean age was 59.48 ± 9.70 years. The LPA revealed three distinct latent categories of flourishing: low flourishing group (38.1%, n = 90), moderate flourishing group (34.2%, n = 80), and high flourishing group (27.7%, n = 67). Illness duration, comorbidity burden, learned helplessness, autonomous functioning, and perceived social support were significant factors influencing latent flourishing profiles ( Significant heterogeneity exists in flourishing levels among patients with ovarian cancer undergoing postoperative chemotherapy. Healthcare professionals can tailor interventions based on these distinct flourishing profiles and their key characteristics. This approach aims to promote patient flourishing, thereby improving their quality of life. Show less

Peripheral arterial disease (PAD) is a global atherosclerotic disease which can lead to acute limb ischemia, chronic limb-threatening ischemia, and limb amputation. It has similar risk factors to coronary artery disease (CAD). Elevated lipoprotein A (Lp[a]) is associated with CAD, myocardial infarction, and PAD. Patients with PAD can have CAD and polyvascular disease. An extensive PubMed and Cochrane library search was performed in April 2025 using the words "Lipoprotein A and PAD", "Elevated lipoprotein A and PAD", and "High Lipoprotein A and PAD" to obtain relevant English articles for this systematic review. An elevated Lp(a) may enhance the risk of PAD. Elevated Lp(a) can amplify the risk of CAD, PAD, and polyvascular disease. It may portend worse outcomes in patients with CAD and PAD. It can increase the risk of acute limb ischemia, coronary revascularization, peripheral revascularization, cardiovascular death, and all-cause mortality. Hence, elevated Lp(a) may serve as a risk factor for patients with CAD who could potentially develop PAD. No currently approved medical therapy aimed at Lp(a) reduction exists; only lipoprotein apheresis is approved to lower Lp(a) levels in these patients. This systematic review discusses the role of an elevated Lp(a) in PAD, clinical research in PAD with elevated Lp(a), and the current treatment for PAD and elevated Lp(a). Show less

Psoriasis is a chronic inflammatory condition related to an increased atherosclerotic cardiovascular disease (ASCVD) risk. To investigate whether lipoprotein (a) [Lp(a)] levels are increased in patients with psoriasis. A comprehensive literature search up to January 30, 2025 was conducted utilizing PubMed and Cochrane Library databases. A qualitative synthesis and a meta-analysis on Lp(a) mean differences (MD) between psoriasis cases and healthy controls (HC) was performed. The protocol of this meta-analysis has been registered to PROSPERO (No. CRD420250652465). Eighteen studies with 1650 psoriasis patients and 1621 HC were eligible for qualitative synthesis. Pooled analysis from 16 studies (1401 psoriasis patients and 1320 HC) demonstrated that psoriasis patients had significantly higher Lp(a) levels compared with the HC group (MD: 6.72 mg/dL, 95%CI: 4.32-9.12, Our findings suggest that Lp(a) levels are significantly elevated in psoriasis patients, further adding to their ASCVD risk. Show less

Anxiety is significantly correlated with levels of physical activity in university students. This research assessed the effects of anxiety on engagement in physical activity and explored the potential mediating function of psychological resilience. Additionally, latent profile analysis (LPA) was employed to identify distinct subtypes based on anxiety and resilience levels, and to explore their associations with physical activity. Utilizing a non-probability convenience sampling approach, this cross-sectional study recruited a total of 1,436 collegiate participants from multiple universities. Data collection was carried out with the Generalized Anxiety Disorder Scale (GAD-7), the abbreviated Connor-Davidson Resilience Scale (CD-RISC-10), and the Physical Activity Rating Scale (PARS-3). Data analysis included mediation effect analysis via Bootstrap methods (Model 4) and latent profile analysis (LPA). Anxiety demonstrated a significant negative association with physical activity ( Results demonstrated that anxiety affects physical activity both directly and indirectly, with the latter effect occurring through the channel of psychological resilience. Latent profile analysis identified three distinct profiles among college students based on anxiety and psychological resilience: High Anxiety-Low Psychological Resilience, Moderate Anxiety-Moderate Psychological Resilience, and Low Anxiety-High Psychological Resilience. Marked variations in physical activity levels were observed among these subgroups. The results underscore the complex relationships among mental health indicators and health behaviors within the collegiate population. The delineation of distinct profiles offers practical implications for designing tailored intervention strategies. Show less

The Parent-Child Relationship plays a crucial role in the development of adolescents' psychological behaviors. Previous studies have confirmed its association with adolescents' cognitive development, academic performance, and emotional regulation, and have identified gender differences in this association. However, current research lacks a systematic integrated analysis of multi-dimensional variables such as physical-psychological-social adaptation. It also fails to identify the heterogeneity of the Parent-Child Relationship from a gender perspective and has not conducted in-depth and systematic discussions on the differential impacts on adolescents of different genders. This study aims to systematically explore the types of Parent-Child Relationship among adolescents of different genders using Latent Profile Analysis (LPA) and regression mixture models, and to conduct an in-depth analysis of the psychological and behavioral characteristics of adolescents corresponding to various types of Parent-Child Relationship. A multi-stage stratified cluster sampling method was adopted. In May 2023, a questionnaire survey was conducted among 3,922 students from 10 middle schools in 5 regions of Xinjiang. The measurement tools used included the Parent-Child Relationship Intimacy Scale, the Depression-Anxiety-Stress Scale, the Psychological Resilience Scale, and the School Adjustment Scale. The average age of the study subjects was 16.06 ± 0.98 years, including 1,884 males (48%) and 2,038 females (52%). Two types of Parent-Child Relationship were identified among adolescents in Xinjiang: the poor group and the good group. Among females, the "poor group" accounted for 38.86% (n = 792), and the "good group" accounted for 61.14% (n = 1,246). Among males, the "poor group" accounted for 43.68% (n = 823), and the "good group" accounted for 56.32% (n = 1,061). There were gender differences in the behavioral and psychological characteristics of adolescents under different Parent-Child Relationship patterns.In the female group, Anxiety, Depression, and Stress of all severity levels were predictive factors for the poor Parent-Child Relationship group (all OR > 1, P < 0.05). In the male group, only moderate Anxiety (OR = 0.463, 95% CI [0.296, 0.724]) and moderate Depression (OR = 0.436, 95% CI [0.292, 0.652]) reached a significant level.In terms of Psychological Resilience, females with poor Psychological Resilience had an approximately 5.87-fold higher probability of being classified into the "poor group" (OR = 6.874, 95% CI [4.500, 10.501]). In contrast, males with poor Psychological Resilience were more likely to be classified into the "good group" (OR = 0.116, 95% CI [0.069, 0.194]).In terms of School Adjustment, females in the "good group" scored higher than those in the "poor group" in School Attitudes and Emotions, Routine Adaptation, Academic Adjustment, Peer Relationship, and Teacher-Student Relationship (all P < 0.001), with chi-square test values ranging from 116.613 to 208.797. In the male group, although the "poor group" also scored significantly lower than the "good group" in the five dimensions (all P < 0.001), with chi-square values ranging from 20.632 to 102.774, the difference between the groups was smaller than that in females. There is heterogeneity in the Parent-Child Relationship patterns of adolescents. Under different Parent-Child Relationship patterns, there are gender differences in the behavioral and psychological characteristics of adolescents, which are specifically reflected in Anxiety, Depression, Stress, Psychological Resilience, and School Adjustment. However, these characteristics are not related to physical indicators (Sleeping Hours, Myopia) or demographic characteristics (age, Father's Education Level, Mother's Education Level, etc.). This study provides empirical evidence from Xinjiang, China, for the differentiated intervention of adolescents' health status. Show less

Subclinical atherosclerosis is a key predictor of cardiovascular events. While inflammation plays a crucial role in atherosclerosis, the involvement of Human Neutrophil Peptides 1-3 (HNP1-3) in its progression remains unclear. The study investigates the association of HNP1-3 and PCSK9 with coronary atherosclerotic burden and explores the potential mediatory role of PCSK9 in HNP1-3's effect on atherogenesis. Patients who underwent coronary computed tomographic angiography (CCTA) and had subclinical atherosclerosis (luminal stenosis < 50%) or normal coronary arteries were included in this cross-sectional study. HNP1-3 and PCSK9 levels were measured using ELISA, and coronary plaque burden was quantified using the modified Gensini score. Patients with subclinical atherosclerosis had significantly higher levels of HNP1-3 (p < 0.001), PCSK9 (p < 0.001), and lipoprotein(a) [Lp(a)] (p < 0.001) compared to controls. HNP1-3 was an independent predictor of subclinical atherosclerosis (p < 0.001), and its levels positively correlated with the modified Gensini score (p < 0.001). In multinomial logistic regression, higher levels of HNP1-3, PCSK9, and Lp(a) were independently associated with higher modified Gensini score tertiles. Mediation analysis revealed that PCSK9 mediated 48.7% of the effect of HNP1-3 on the modified Gensini score. After adjusting for hsCRP and cardiovascular risk factors, the direct effect of HNP1-3 became statistically insignificant, while the indirect effect via PCSK9 remained significant, suggesting that PCSK9 fully mediates the pro-atherogenic effects of HNP1-3. In conclusion, HNP1-3 is a novel independent predictor of subclinical atherosclerosis and coronary plaque burden, with its effects being mediated through PCSK9. These findings suggest that targeting PCSK9 could mitigate the inflammatory actions of HNP1-3, offering potential therapeutic insights for atherosclerosis prevention. Show less

Suicidal ideation and attempts as well as eating disorders (EDs) are common among Iranian individuals. Additionally, ED symptoms are associated with suicidality. According to the interpersonal-psychological theory of suicide (IPTS), factors such as thwarted belongingness, perceived burdensomeness, and capability for suicide must combine for suicidality to occur. The tenets of IPTS have been supported among individuals with ED symptoms from Western countries. However, no study has yet explored how ED symptoms might co-occur with IPTS factors and potentially relate to suicidal ideation and attempts using latent profile analysis (LPA). Participants (N = 773) were Iranian community members who completed a battery of scales assessing ED symptoms, suicide-related risk factors, as well as suicidal ideation and suicide attempts. The LPA revealed that a six-class solution best fit the data. The classes with the highest levels of IPTS and binge/purge related symptoms also had the highest odds of suicide attempts. Our findings suggest that the measurement of thwarted belongingness, perceived burdensomeness, and capability for suicide is particularly important for individuals with binge/purge type eating disorder symptoms. Overall, IPTS factors should be incorporated into assessments of clients presenting with ED symptoms and suicidality. Show less

Prior studies have demonstrated the existence of cognitively-defined subgroups among dementia free older adults, however, it is unclear whether such subgroups are characterized by distinct neuroimaging measures of brain function and structure. To address this gap, the current study used latent profile analysis (LPA) to identify cognitively-defined subgroups in a sample of 167 (mean age = 69 years) dementia-free older adults with cognitive testing, amyloid PET, and multimodal brain MRI scans. The cognitive test scores covered the domains of episodic memory, executive function, language, and visuospatial processing. Linear regression models tested the associations between subgroup membership and neuroimaging measures, adjusting for age, sex, and years of education. Based on the LPA, three cognitive subgroups were identified: (1) high-average cognition (n = 61, 36%), (2) average cognition (n = 88, 53%), and low-average cognition (n = 18, 11%). Compared to the high-average group, the low-average group had lower volumes in cortical regions sensitive to Alzheimer's disease, lower global white matter microstructural integrity measured by diffusion tensor imaging, and higher global white matter hyperintensity burden. There were no group differences in global PET amyloid burden. Additionally, the high-average group tended to have higher resting-state functional connectivity within large-scale cognitive networks than the other two groups. These results suggest that cognitively-defined subgroups among older adults without dementia are associated with several measures of brain structure and function. Evaluating brain structure/function differences among dementia-free older adults may help identify individuals at greatest risk for future cognitive decline. Show less

Lipoprotein(a) [Lp(a)] is established as an independent risk factor for atheromatous cardiovascular disease and aortic valve stenosis. Currently available lipid-lowering pharmacotherapies have limited effects on elevated levels of Lp(a), and several new therapies are in development to lower Lp(a). This article reviews the novel therapies in development to reduce Lp(a) in patients with elevated levels. These were identified by a PubMed search and mainly focus on the drugs that are at an advanced stage of development. The N-acetylgalactosamine (GalNAc)-conjugated antisense oligonucleotide (ASO) pelacarsen and the small-interfering RNA (siRNA) agents olpasiran, lepodisiran, and zerlasiran have all been shown to be safe and effective in lowering Lp(a) levels between 80% and almost 100%. Pelacarsen, olpasiran, and lepodisiran are being tested in phase 3 cardiovascular outcome studies, and the first results may be available in 2026. Muvalaplin is a small molecule given orally once daily and reduces Lp(a) by up to 65%. It is also being assessed in a cardiovascular outcome study. It will be essential to identify what baseline level of Lp(a) is needed, and what degree of Lp(a) lowering is required to produce a cardiovascular benefit and whether aggressive lowering of Lp(a) has any adverse effects. Show less

Physical activity benefits health, whereas physical inactivity increases the risk of age-related conditions and adverse health outcomes. Kyotango City in Japan is known for its residents' longevity, and many centenarians live there. This study investigated the physical activity associations with physical function and body composition in older adults living in this area. Community-dwelling older adults (n = 727; mean age 74.1 years; 59.4% women) participated in this study. Multiple linear regression analyses were carried out to examine objectively-measured physical activity associations with physical function (handgrip strength, knee extension strength and maximum gait speed) and body composition (skeletal muscle mass index and whole-body phase angle), adjusting for potential confounders. Additionally, isotemporal substitution models were applied to estimate changes resulting from replacing sedentary behavior with light-intensity physical activity (LPA) and moderate-to-vigorous-intensity physical activity (MVPA). All physical function and body composition indicators were significantly associated with SB and MVPA (all P < 0.050). However, LPA was associated with only handgrip strength and body composition indicators. Replacing 30 min of SB per day with LPA was associated with a 0.176 kg increase in handgrip strength, 0.018 kg/m Older adults in a region of Japan known for longevity might maintain physical function and favorable body composition through engaging in abundant physical activity. Public health strategies should prioritize MVPA promotion while recognizing LPA's complementary role for physically inactive older adults. Geriatr Gerontol Int 2025; 25: 1511-1517. Show less

To investigate the impact of 24-h movement behaviors-sleep (SP), sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)-on preschool children's learning ability, with emphasis on inhibitory control as a mediating variable. Data were collected from 328 preschoolers (182 boys and 146 girls) using accelerometers and sleep questionnaires. Inhibitory control was assessed using the Early Years Toolbox, while learning ability was evaluated through the Learning Ability Test. A 15-min daily increase in MVPA, replacing SP, SB, or LPA, was associated with improvements in preschoolers' inhibitory control (0.038, 0.038, and 0.041, respectively) and learning ability (1.93, 1.87, and 2.52, respectively). Conversely, reallocating time in the opposite direction was associated with declines in both measures. Inhibitory control partially mediated the relationship between MVPA and learning ability across various demographic groups. For LPA, inhibitory control fully mediated its effect on learning ability in girls, while it fully mediated the impact of SP and MVPA on learning ability in boys. These findings collectively highlight the importance of 24-h movement behaviors in enhancing learning ability in preschool children through improved inhibitory control. Show less

Image-Based Sexual Abuse (IBSA) represents a significant and growing public health concern, yet individuals affected by IBSA exhibit diverse experiences of risk, victimization, and resilience. This study aimed to identify distinct profiles among individuals exposed to IBSA, childhood victimization and adversity, online risk behavior, and delinquency. Using Latent Profile Analysis (LPA), we analyzed data from 2,630 young adults (ages 18-28) recruited through an online survey, oversampling sexual and gender minorities and individuals with IBSA experiences prior to the age of 18. Seven distinct profiles emerged, reflecting varying levels of risk engagement. The largest group Show less

Sarcopenic obesity (SO) is characterized by the presence of both obesity and sarcopenia and is related to disability and loss of independence in older adults. The extent to which time spent in light physical activity (LPA), or moderate-to-vigorous physical activity (MVPA) is associated with SO risk in older adults remains unclear. The aim of this study was (a) to examine the association between the level of adherence to recommended amounts of MVPA and the risk of SO in older adults and (b) to determine whether time spent in LPA is associated with SO risk independently of time spent in MVPA. This cross-sectional study involved 862 community-dwelling older adults (58% women; aged 65-79 years) from four European countries. Accelerometer-determined time in MVPA was categorized as follows: inactive (< 75 min/week), moderately active (75-149 min/week), active (150-299 min/week) and highly active (≥ 300 min/week). Time in LPA was expressed in tertiles. The outcome measure SO risk was determined based on appendicular lean mass, waist circumference, handgrip strength and the 5-times sit-to-stand test. Odds ratios (OR) with a 95% confidence interval (95% CI) of high SO risk across levels of MVPA and LPA were determined by binary logistic regression adjusted for the level of systemic inflammation (high-sensitivity C-reactive protein) and dietary protein intake. Compared to the inactive group, ORs of having a high SO risk were about 50%-80% lower, depending on the MVPA level, with the largest risk reduction in the highly active group (OR: 0.23, 95% CI: 0.13-0.39; p < 0.05). The likelihood of having a high SO risk was significantly lower among the highly active group compared to the active group (OR: 0.50; 95% CI: 0.33-0.77; p < 0.05). More time in LPA was associated with a significantly lower likelihood of having high SO risk (highest vs. lowest tertile: OR: 0.52, 95% CI: 0.30-0.89; p < 0.05) only in participants with low amounts of MVPA. In contrast, LPA was not associated with SO risk among participants meeting the MVPA recommendation. MVPA is strongly associated with a lower likelihood of having a high SO risk in older adults, independently of the level of systemic inflammation and intakes of dietary proteins. LPA is related to SO risk in sedentary older adults, which supports the promotion of physical activity regardless of intensity for mitigating SO. Show less

Low physical activity (LPA) is associated with cardiovascular and cerebrovascular pathologies. This study aimed to assess the prevalence of several noncommunicable diseases relating to LPA. Using the 2021 Global Burden of Disease data set, we modelled LPA-related disease burdens across 204 countries and territories, quantifying mortality counts, age-standardised mortality rates, and disability-adjusted life years (DALYs) for five noncommunicable diseases. We conducted multivariable stratification analyses to assess variations by gender, age, and sociodemographic index (SDI) quintiles. We used age-period-cohort modelling to project burden trajectories, while applying counterfactual decomposition frameworks to delineate synergistic interactions between LPA and risk factors. We found that LPA accounted for 555 101 related deaths globally in 2021 across the five studied pathologies, mostly among individuals aged 60-94 years. Association between LPA-related disease burden and SDI followed a U-shaped distribution across regions and diseases. Among individuals aged 60-89 years, LPA-related deaths were significantly higher in women than in men, indicating a disproportionate burden on elderly females. Ischaemic heart disease (IHD) trends stabilised in low- and middle-SDI regions but declined significantly in high-SDI regions, underscoring global health disparities. From 2007 to 2011, LPA DALYs and mortality risk ratios for IHD, stroke, and lower extremity peripheral arterial disease declined from >1 to <1, whereas diabetes mellitus exhibited an opposite trend, highlighting LPA's persistent and significant impact on diabetes-related morbidity. Demographic shifts and epidemiological transitions were primary drivers of LPA-related disease burden across five pathologies. In high-SDI regions, epidemiological changes predominated, whereas population growth was a key factor in low- and middle-SDI regions. Synergistic interaction of these factors with LPA is projected to substantially amplify future disease burden. Physical activity should be increased among elderly women to address health risks associated with LPA. Likewise, urgent public health interventions are needed for LPA-related diabetes. As IHD burden rises in low- and middle-SDI regions, vascular disease care strategies require optimisation. Moreover, high-SDI regions should strengthen nationwide physical activity promotion, while low- and middle-SDI areas must enhance healthcare infrastructure and manage population growth to reduce LPA-related disease burdens. Show less