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Lipokines are a class of lipid-derived signaling molecules, playing essential roles in regulating metabolic homeostasis and systemic metabolism. In this review, we first comprehensively describe six major lipokines, including palmitoleic acid (C16:1n7), 12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME), fatty acid esters of hydroxy fatty acids (FAHFAs), 12-hydroxyeicosapentaenoic acid (12-HEPE), lysophosphatidic acid (LPA), and 15-hydroxyeicosatetraenoic acid (15-HETE), focusing on their mechanistic roles in energy metabolism and inflammatory modulation as well as their cross-talk within different signaling pathways. These lipokines collectively contribute to metabolic homeostasis by regulating multiple pathways, including insulin signaling, AMPK activation, inflammatory modulation, and G-protein-coupled receptor-mediated pathways. Furthermore, we clarify the associations between lipokines and various diseases such as obesity, type 2 diabetes, cardiovascular diseases, non-alcoholic fatty liver disease, inflammatory disorders, and cancer, and discuss their potential as biomarkers and therapeutic targets. Despite current challenges, including functional complexity, limitations of model systems, and difficulties in clinical translation, lipokines demonstrate promising prospects in the prevention and treatment of metabolic diseases and application in precision medicine. Future research should prioritize the elucidation of the specific action mechanisms of different lipokines, development of highly sensitive detection methodologies, and large-scale clinical trials to facilitate the translation of the research results into practical medical applications. Show less

Lipoprotein(a) [Lp(a)] is a known independent risk factor for cardiovascular disease, yet awareness and management remain limited. The psychosocial implications of elevated Lp(a)-levels have been poorly characterized. To compare cardiovascular outcomes and cardiovascular risk factor (CVRF) modification in individuals with normal vs. elevated Lp(a) levels, and to assess the impact of individualized prevention recommendations. For the first time, the individual psychological stress caused by Lp(a) is being surveyed. The ELITE study is a prospective, interventional cohort study conducted in north-western Germany. Participants were regularly assessed for CVRFs, including Lp(a), hypertension, dyslipidemia, diabetes mellitus, weight, nicotine - as well as lipoprotein (a), physical activity, dietary habits, depression and stress. They received written, personalized prevention recommendations. Follow-up averaged 4.4 years. Two groups were analyzed: Group 1 (Gr1, n=3,241) with normal Lp(a), and Group 2 (Gr2, n=841) with elevated Lp(a ≥75 nmol/l). Gr2 (mean Lp(a) 154.8 nmol/l) and Gr1 (mean Lp(a) 16.4 nmol/l) were comparable in age (~53 years) and sex distribution (~49% female). Most participants with elevated Lp(a) were previously unaware of their levels; 30% were referred to specialists, and ~40% reported concern or anxiety. Combined cardiovascular endpoints (CHD, stroke, heart failure, PAD, carotid stenosis, AF) occurred significantly more often in Gr2 (p<0.001), despite similar CVRF profiles, except for higher baseline LDL-C in Gr2 (p<0.001). Hypertension (61%) and physical inactivity (57%) were the most prevalent CVRFs. Personalized prevention measures led to significant improvements in blood pressure, LDL-C, smoking, physical activity, and weight in both groups. Lipid-lowering therapy improved markedly in Gr2 (12% to 23%). Elevated Lp(a) is associated with a significantly higher rate of cardiovascular events, independent of traditional CVRFs. This confirms a causal role of Lp(a) in CV morbidity. Personalized written prevention recommendations improved CVRFs across both groups, though further optimization is needed. Notably, elevated Lp(a) also imposes a psychosocial burden, underlining the need for enhanced education, counseling, and clinical pathways. Show less

Genetic and numerous epidemiologic studies have identified lipoprotein (a) [Lp(a)] as a risk factor for atherothrombotic diseases. The structure of Lp(a) is similar to plasminogen and tissue plasminogen activator and it competes with plasminogen for its binding site, leading to reduced fibrinolysis. Furthermore, since Lp(a) stimulates the secretion of plasminogen activator inhibitor-1, it may lead to thrombogenesis. In this cross-sectional study, we aimed to investigate Lp(a) levels in patients with mechanical prosthetic valve thrombosis (MPVT). Blood samples for Lp(a) determination were obtained from 80 MPVT patients (median age: 48.5 (39-59.75) years; 47 male) and 75 age and sex matched controls (median age: 52 (39-63) years; 44 male) with normally functioning mechanical prosthetic valves. The Lp(a) levels in the PVT group were significantly higher than in the controls [22(16.2-39.4) vs. 6.9(2.9-24.6) mg/dL, p < 0.001]. Elevated Lp(a) levels, recent history of subtherapeutic anticoagulation, history of cerebrovascular accidents (CVA) and a low value of international normalized ratio on admission were found to be the independent predictors of PVT. Lp(a) levels above 19.6 mg/dL predicted PVT with a sensitivity of 65% and a specificity of 71% (AUC:0.767; 95%CI: 0.687 to 0.847; p < 0.001). Lp(a) levels were significantly higher in PVT patients with a history of CVA [42.0 (23.6-53.6) vs. 21.1 (16.1- 36.2) mg/dL, p = 0.012]. Elevated Lp(a) levels may be associated with MPVT. The assessment of plasma Lp(a) levels in patients with prosthetic heart valves may provide additive information regarding the risk of PVT and CVA. Show less

Acquired renal cysts (ARC) are associated with kidney function decline, necessitating novel dietary pattern (DP) analyses in large cohorts. This UK Biobank prospective cohort study (2006-2010) included participants with ≥2 dietary records, excluding those with severe kidney damage. The constructed comprehensive dietary pattern integration (CDPI) utilized reduced rank regression (RRR) and latent profile analysis (LPA). ARC cases (ICD-10: N28.1) were assessed via Cox regression for risk and dose-response, with NMR metabolites examined as mediators. Among 119,709 participants (median follow-up: 10.57 years), 850 ARC cases were identified. Lipid-rich and hyperglycemic diets increased ARC risk [e.g., HRs for G1.DP1: 1.080 (1.024, 1.139); G1.DP2: 1.144 (1.048, 1.249)], while micronutrient-rich diets showed weak protective effects [G4.DP1: 0.943 (0.892, 0.998)]. LPA confirmed RRR findings, and 7/251 NMR metabolites had significant mediating effects. Diets high in fat (cheese, butter, pizza) and sugar (chocolate, sugary drinks) elevated ARC risk, whereas micronutrient- and fiber-rich diets (vegetables, fruit, lean poultry, nuts, eggs) were protective. Key mediators included branched-chain amino acids, IGF-1, and RBC distribution width. Show less

The purpose of this study was to investigate the longitudinal association of replacing stationary time (ST) with either light (LPA) or moderate-to-vigorous (MVPA) physical activity and replacing LPA with MVPA on 2-year clinical outcomes in individuals with varying severities of knee osteoarthritis. This retrospective cohort study used isotemporal substitution models to investigate the association of replacing 10-60 min of ST with LPA or MVPA and of LPA with MVPA on Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, function, and gait speed at 2 years. Device-based stationary and physical activities were monitored using accelerometry within the Osteoarthritis Initiative cohort (n = 848). All analyses were completed separately for mild-to-moderate (Kellgren-Lawrence grade = 1-2) and severe (Kellgren-Lawrence grade = 3-4) knee osteoarthritis groups. In individuals with mild-to-moderate osteoarthritis, substituting 30-60 min of ST or LPA with MVPA improved pain and gait speed at 2 years but worsened stiffness. Replacing 60 min of ST with LPA improved Western Ontario and McMaster Universities Osteoarthritis Index function. For severe osteoarthritis, substituting 30-60 min of ST or LPA with MVPA led to worsened Western Ontario and McMaster Universities Osteoarthritis Index pain and function at 2 years, whereas substituting ST or LPA with MVPA minimally impacted stiffness. Improvements in gait speed were observed with 10-to-60-min ST or LPA substitutions with MVPA. Stationary and physical activity substitutions had varying longitudinal effects in individuals with mild-to-moderate versus severe knee osteoarthritis. Individuals with mild-to-moderate and severe knee osteoarthritis may require differing physical activity prescription to improve functional and overall health outcomes. Significance/Implications: These findings underscore the importance of severity-specific physical activity recommendations to support clinical outcomes in knee osteoarthritis management. Show less

Household contact (HHC) investigation helps in early identification of people with tuberculosis (TB) and initiation of TB preventive treatment (TPT) among those at high risk of developing TB. This cross-sectional study uses National TB Elimination Program data of all people notified with bacteriologically confirmed pulmonary TB and their HHCs from October to December 2023, from Chhattisgarh, a central Indian state, to assess coverage of HHC investigation, proportions identified with TB and put on TPT (all age groups and age < 5 years). Sociodemographic, clinical, and health system-related factors were used to identify predictors of HHC investigation not done, as determined through modified Poisson regression. Of the 4,221 people notified with TB, an HHC investigation was conducted for 3,177 (75%) cases. Among a total of 11670 contacts screened, TB was diagnosed in 0.9%(n = 109) for all age groups and 0.7%(n = 9) for children<5 years. TPT was initiated in 66% (n = 7740) for all age groups and 73% (n = 903) for children<5 years. Women (adjusted prevalence risk aPR 1.10; 95%CI:1.01-1.19), those notified from non-tribal districts (aPR 1.14; 95%CI:1.01-1.29), current facility being tertiary care (aPR 1.50; 95%CI:1.12-2.00) and private (aPR 1.42; 95%CI:1.08-1.86) facility, diagnosed with test other than sputum microscopy (aPR NAAT 3.19; 95%CI:2.39-4.28; LPA 8.88 95%CI:6.15-12.82; culture 9.69; 95%CI:5.99-15.68) and for whom diabetes (aPR 1.40; 95%CI:1.16-1.70) and HIV screening (aPR 1.55, 95% CI:1.17-2.05) was missing predicted higher risk of HHC investigation not done. The study highlights the need to improve HHC investigation, as well as the low yield of TB and TPT initiation. Predictors of HHC investigation not done suggest a need to decentralize it to the primary level and improve data-based program monitoring. A statewide capacity-building initiative for improving the investigation of HHC is the way forward. Show less

Lipoprotein(a) (Lp[a]) is an established predictor of cardiovascular risk but associations with secondary events are less certain, and data on understudied ethnic groups are scarce. This study aimed to assess the association between Lp(a) and secondary events and explore variation in Lp(a) levels by ethnicity in first-time acute coronary syndrome (ACS) patients, to inform future risk prediction models. The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a longitudinal multi-centre cohort study of 1900 patients enrolled during their ACS admission. Baseline plasma Lp(a) concentrations were measured using an isoform-insensitive assay measured in nmol/L. The primary outcome was a composite of all-cause mortality or cardiovascular readmission, ascertained through national health datasets. Cox regression models were used to assess the association between Lp(a) levels and outcomes, adjusted for clinical risk factors. The mean age was 61 years, 20 % were female, and 73 % were European, 14 % Māori, 5 % Pacific peoples, 4 % Indian and 3 % other ethnicities. Of 1890 alive at discharge, 493 (26 %) experienced the primary outcome over a median follow-up of 4.9 years. Higher Lp(a) levels were associated with increased risk of secondary events. Compared to the lowest quartile (≤7 nmol/L), the adjusted hazard ratio for the highest quartile (>92 nmol/L) was 1.46 (95 %CI 1.12-1.89, p = 0.004). In this ACS cohort, Lp(a) concentrations varied by ethnicity, being highest amongst Indian participants (median 27 nmol/L) and lowest amongst Māori participants (median 12 nmol/L). Elevated Lp(a) concentrations are associated with secondary events following ACS. Further research is needed to define optimal thresholds for increased risk and explore ethnic-specific implications for secondary prevention. Show less

Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). Data on long-term outcomes following invasive coronary angiography (ICA) in those with elevated Lp(a) are limited. This study examined the association of Lp(a) levels with clinical outcomes after index ICA, accounting for baseline atherosclerotic plaque burden. Data were from participants with Lp(a) measurement who underwent index ICA between 2000 and 2023. Lp(a) levels were categorized as normal (<75 nmol/L), intermediate (75- < 125 nmol/L), high (125- < 175 nmol/L), and very high (≥175 nmol/L). Angiographic characteristics (severity, burden), CAD presentation (stable, acute), and subsequent clinical outcomes [acute myocardial infarction (AMI), revascularization, in-stent restenosis (ISR), and all-cause mortality] were assessed. Among 5118 participants, 973 (19.0%) had very high Lp(a). Compared with normal Lp(a), very high Lp(a) was associated with severe obstructive CAD {adjusted odds ratio (aOR), 1.51 [95% confidence interval (CI), 1.17-1.96]}, left main disease [aOR, 1.67 (95% CI, 1.22-2.29)], and a 14.04-point higher Gensini score (95% CI, 9.57-18.52). During a median (interquartile range) follow-up of 16.87 (6.38-18.99) years, participants with very high vs. normal Lp(a) had higher risk of AMI [adjusted hazard ratio (aHR), 1.20 (95% CI, 1.05-1.37)], revascularization [aHR, 1.32 (95% CI, 1.13-1.56)], ISR [aHR, 1.28 (95% CI, 1.04-1.56)], and mortality [aHR, 1.19 (95% CI, 1.05-1.34)]. Among 798 individuals undergoing coronary artery bypass grafting surgery after index ICA, those with very high vs. other Lp(a) were more likely to require subsequent percutaneous coronary intervention [aHR, 2.20 (95% CI, 1.06-4.58)]. Elevated Lp(a) levels are associated with increased burden of coronary atherosclerosis and significant residual risk for adverse outcomes following ICA, highlighting a need for targeted risk-reduction strategies. Show less

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in Poland. Lipoprotein(a) [Lp(a)] constitutes an independent, causal risk factor for ASCVD and aortic valve stenosis. Elevated Lp(a) is found in approximately 20% of the Polish population. Lp(a) measurements have been recommended in all adult patients to improve cardiovascular risk stratification. As the testing rate remains insufficient, there is a need to facilitate the incorporation of Lp(a) into routine patient care. This clinically oriented review outlines (i) up-to-date evidence on the role of Lp(a) in cardiovascular diseases, (ii) recent real-world data on the characteristics of Polish patients with elevated Lp(a), and (iii) strategies for Lp(a) testing and management in light of the current national recommendations and the latest 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidemias. Show less

The purpose of this population-based study was to examine whether sedentary behavior (SB) and light physical activity intensity (LPA) are associated with pain in older adults. A further aim is to investigate the psychosomatic complaints as mediators between SB and pain. Individuals aged ≥50 from the 2018 Study on Aging, Health, and Health-seeking Behavior reported on SB and LPA using the International Physical Activity Questionnaire and pain severity using a cross-culturally validated item from the bodily pain subscale of the MOS SF-36. Multivariable logistic regression models evaluated the associations of SB and LPA with pain. Bootstrapping analyses assessed whether psychosomatic complaints mediate the association between SB and pain. Among 1201 participants (mean ± SD age = 66.1 ± 11.9 years; women = 63.3%), the prevalence of SB and pain was 21.4% and 43.0%, respectively. Compared with <8 h/d, ≥8 h/d of SB was positively associated with pain (OR = 2.42, 95% CI = 1.71-3.42). However, LPA was associated with 11% lower odds of reporting pain (OR = 0.89, 95% CI = 0.81-0.98). Self-rated health (41.2%), anxiety (23.5%), comorbidity (20.6%), functional limitations (17.6%), depression (13.2%), and sleep problems (11.8%) were associated with pain and mediated the SB-pain link. The present study observed that SB and LPA were associated with pain in older adults residing in Ghana, and psychosomatic complaints were identified as potential mechanisms in the pathway between SB and pain. Managing the pain burden in old age may require shifting the 24-hour behavior from SB to LPA and addressing the inherent psychosomatic complaints. Show less

The PRO-CTCAE provides patient-reported data on symptomatic AEs. A summary metric-the ACS-reflecting total AE burden can be calculated by averaging AE-level composite scores at a given timepoint for each participant. This study investigated the psychometric properties and interpretability of this PRO-CTCAE ACS in patients with breast, lung, or head/neck cancers. We conducted a secondary analysis of a PRO-CTCAE validation dataset comprising 940 adults undergoing chemotherapy or radiation therapy (clinicaltrials.gov: NCT02158637). We focused on empirically recommended symptom terms for three cancer sites. Analyses included Spearman's correlations, coefficient alpha, and eigenvalues from the correlation matrices, confirmatory factor analysis (CFA), and principal component analysis (PCA). Latent profile analysis (LPA) was used to assess ACS interpretability in the lung cohort. Mean composite score inter-correlations were moderate (0.30-0.35), and coefficient alphas were high (0.81-0.91). Eigenvalue ratios and CFA supported retention of a single factor/component, with suitable model fit indices. ACS correlated highly with factor scores and the first principal component from the PCA. Reduced sets of terms produced reliable scores that closely approximated the full set scores and aligned with external criteria. LPA in the lung subgroup identified four latent classes; ACS differentiated high vs. low symptom burden groups but did not distinguish the two groups expressing distinct symptom profiles. The ACS demonstrated structural validity through adequately fitting linear factor models and effectively summarized symptomatic AE burden. However, similar ACS values may mask clinically distinct symptomatic AE profiles, underscoring the value of both summary metrics and profile-based approaches. Show less

Aortic valve stenosis (AVS) is the most common valvular disease in developed countries, and no pharmacological therapy is currently available. Increasing evidence identifies lipoprotein(a) [Lp(a)] as a causal factor linking lipid metabolism, inflammation, and valve calcification. Lp(a) levels are largely genetically determined and remain stable throughout life, making them a potential therapeutic target. This review summarizes the current evidence on Lp(a) and AVS pathophysiology, the diagnostic and prognostic role of Lp(a), and the therapeutic potential of Lp(a)-lowering agents. Emerging Lp(a)-targeted therapies, including antisense oligonucleotides and siRNA-based agents, could reshape AVS management by providing the first pharmacological option to slow disease progression in selected high-risk patients. Show less

Heterozygous familial hypercholesterolemia (HeFH) is a common autosomal dominant genetic disease (1:250) characterized by elevated LDL-C. Patients with HeFH are at increased risk of premature atherosclerosis and have at least a 10-fold greater chance of cardiovascular disease (CVD). The present study examines the effect of PCSK9 inhibitor treatment (iPCSK9: arilocumab or evolocumab) on DNA damage in HeFH patients. Fifty-six patients were studied, with a normolipidemic group (control; Show less

Leukocyte-platelet aggregates (LPAs) play a crucial role in the pathogenesis of inflammatory diseases, linking pathological immune responses with thrombosis.The levels of LPAs, their composition, and cellular reactivity were determined in patients with distinct inflammatory conditions, namely coronavirus disease 2019 (COVID-19), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE), compared with healthy controls. Flow cytometry was used to identify cell types and measure LPA levels in the blood. The ability of platelets, neutrophils, and monocytes to form additional LPAs in response to hyperstimulation with phorbol-12-myristate-13-acetate (PMA) was assessed. Coaggregation of isolated neutrophils and platelets in vitro was visualized using scanning electron microscopy. Blood tests included coagulation, hematology, biochemistry, and immunology.LPA levels were significantly higher in all patient groups compared with controls, with variations in the composition: neutrophil-platelet aggregates predominated in the COVID-19 patients, whereas monocyte-platelet aggregates prevailed in the blood of RA and SLE patients. Platelet-to-leukocyte ratios within aggregates varied in a broad range with a substantial prevalence of platelets over leukocytes. Morphological analysis revealed coaggregation of platelets with neutrophils, including relatively large homotypic platelet aggregates associated with one or two neutrophils. In PMA-treated pathological blood samples from COVID-19, RA, and SLE patients, the ability to form additional LPAs over the patients' baseline level was reduced compared with normal blood samples, indicating impaired reactivity (exhaustion) of neutrophils and monocytes in all patient groups.This study highlights distinct changes in the number and composition of LPAs in inflammatory diseases of various etiologies associated with altered functionality of the innate immune cells. Show less

Human papillomavirus (HPV) infection is a global public health issue, and HPV-related stigma can affect cervical cancer prevention. But no validated tools exist to assess HPV stigma in Chinese adult women infected with HPV. This study aimed to adapt and validate the HPVsStigma scale (HPV-SS) in the Chinese context. A cross-sectional study was conducted from December 2024 to February 2025 among 501 HPV-infected women in Shenzhen, China. The HPV-SS was adapted from a 12-item HIV stigma scale. Demographic characteristics, HPV-related variables, and data on mental health were collected. Factor analyses (FA) were used to assess the scale's factorial structure, reliability, and validity. The bi-factor model was used to determine the score-reporting method of the scale. Item response theory (IRT) was employed to assess the relationship between participants' stigma levels and scale scores. Latent profile analysis (LPA) was conducted to classify the participants with different HPV stigma characteristics and determine the optimal cut-off value for HPV-SS. FA showed that the 3-factor model (personalized stigma, public-disclosure concerns, and negative self-image) had the best fit among the nested models, with good reliability and validity. The bi-factor model analysis indicated that the total scale score was more meaningful than dimension scores. IRT analysis confirmed that higher HPV-SS scores represented higher stigma levels. LPA identified a 2-class model as optimal, and the optimal cut-off value of the scale for high HPV stigma was 35. This study validated the 12-item HPV-SS for Chinese women infected with HPV, with good reliability and validity. The scale can be used to evaluate HPV stigma levels, facilitating targeted interventions to improve cervical cancer prevention and the psychological well-being of affected women. Show less

Cervical cancer incidence in China has risen to 13.83/100,000, particularly affecting younger women. Following recent family policy changes, reproductive concerns among cervical cancer patients have intensified. While fertility-sparing treatments show good survival rates, many patients still experience significant anxiety about future fertility. This study aims to examine distinct reproductive concern profiles and their influencing factors in cervical cancer patients of childbearing age. We studied 247 patients from a Nanjing tertiary hospital between October 2023 and October 2024. Participants completed surveys including a demographic questionnaire, Reproductive Concerns After Cancer Scale, Patient Health Questionnaire-9, Benefit Finding Scale, and Fear of Cancer Recurrence Scale. Latent profile analysis (LPA) was conducted to identify reproductive concerns. Latent profile analysis revealed three distinct reproductive concern profiles: (1) a low-concern group with reproductive expectations (27.94%), (2) a moderate-concern group with self and child health preoccupations (49.39%), and (3) a high-concern group with impaired reproductive adaptation (22.67%). Significant influencing factors included age, number of children, residential location, depressive symptoms, and fear of cancer recurrence. These cross-sectional findings emphasize the need for careful consideration of individualized, multiple-disciplinary care for young women with cervical cancer. Benefit finding was associated with lower reproductive concerns. Show less

Elevated lipoprotein(a) [Lp(a)] is associated with atherosclerotic cardiovascular disease (ASCVD) risk, and vascular inflammation is one mechanism through which Lp(a) causes ASCVD. The authors aimed to evaluate whether interleukin-6 (IL-6), a biomarker associated with inflammation and cardiovascular disease, helps risk-stratify individuals with elevated Lp(a). Data from participants in the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 6,514) and the UK Biobank (UKB) (n = 26,574) were used for this analysis. The associations between Lp(a) and IL-6 with coronary heart disease (CHD) (defined as myocardial infarction or resuscitated cardiac arrest), ASCVD (CHD and ischemic stroke), and peripheral vascular disease (PVD) were evaluated separately and with mutual adjustment in Cox proportional hazard models adjusted for traditional cardiovascular risk factors and high-sensitivity C-reactive protein (hsCRP). HRs were presented per standard deviation. Participants were also grouped by Lp(a) level (≤50 or >50 mg/dL [125 nmol/L]) and IL-6 level (≤ median or > median) in similar models. Participants with higher IL-6 levels were more likely to have higher body mass index, systolic blood pressure, triglycerides, and hsCRP with lower high-density lipoprotein cholesterol. Lp(a) (HR: 1.13; 95% CI: 1.04-1.23 in MESA; HR: 1.11; 95% CI: 1.09-1.13 in UKB) and IL-6 (HR: 1.22; 95% CI: 1.10-1.35 in MESA; HR: 1.19; 95% CI: 1.15-1.24 in UKB) were both independently associated with CHD events when evaluated separately. When evaluated together, no significant change was noted, and interaction testing was not significant. Similar results were seen for ASCVD and PVD. When participants were categorized by both Lp(a) and IL-6 levels, the strongest association for each outcome was noted when both levels were high (for CHD: HR: 1.72; 95% CI: 1.25-2.36 in MESA; HR: 1.39; 95% CI: 1.12-1.72 in UKB). In 2 independent primary prevention cohorts, Lp(a) and IL-6 were independent predictors of ASCVD risk, and their combination identified individuals at highest risk. Show less

The World Health Organization (WHO) has endorsed a range of diagnostic tuberculosis (TB) over the years. A little is documented about the uptake in the WHO African Region (WHO/FR). We assessed the uptake of the endorsed diagnostic technologies for tuberculosis through a literature review. We reviewed literature in French and English from PubMed, Google Scholar, and Embase for TB diagnostics endorsed by WHO between January 2007 and December 2017, extending to December 2021 for recent technologies. We included publications from the 47 countries in the WHO/AFR. Data were analyzed using PRISMA diagrams and STATA 14.0. Out of 3,399 articles, 1,716 articles were screened, and 92 qualified for analysis. The majority of articles were on Xpert MTB/RIF (XPERT) 22 (47%), Line Probe Assay (LPA), 10 (21%), and Mycobacteria Growth Indicator Tube (MGIT) 9 (19%). For rollout, 11 (24%) of countries had publications on Lipoarabinomannan (LAM) and 16 (36%) on XPERT. The median years for uptake were 6 for MGIT, 5 for XPERT, and 2.5 for LPA. For the rollout, the median years for MGIT, LPA, and XPERT were 7, 6, and 5 respectively. Our study shows that the uptake and rollout are slow. Future studies should identify factors affecting rapid uptake and rollout. Show less

Health literacy plays an important role in disease prevention and control. The aim of this study is to explore the health literacy patterns and associated factors among residents in Zhejiang Province. This study included 56,863 residents aged 15-69 years from the 2024 Zhejiang Province Health Literacy Survey. Latent Profile Analysis (LPA) was used to investigate health literacy patterns, and multinomial logistic regression analysis was employed to identify associated factors. Dominance analysis was performed to compare the relative contribution of the main variables associated with health literacy. The analysis identified three distinct health literacy profiles: low literacy (15.13%), moderate literacy (32.24%), and relatively high literacy (52.63%). The low literacy group was characterized by an older demographic (with an average age of 58.71 years), lower educational attainment (20.72% had no formal education), a higher proportion of farmers (52.93%), and a significant share of low-income individuals (40.98%). Multinomial logistic regression and dominance analysis revealed that education level, age, and occupation were the most important associated factors of health literacy. The study findings highlighted the heterogeneity in health literacy among various population groups and emphasized the need for targeted interventions. This study provides empirical evidence to inform precision health promotion strategies in developed regions of China. Show less

The immunoregulatory effects of probiotics have been widely studied, particularly in maintaining immune balance. Conventional in vitro functional screening of probiotics relies on fresh donor-derived primary immune cells, which often exhibit significant inter-individual and temporal variability, limiting reproducibility and interpretation. As an alternative, human-induced pluripotent stem cell (iPSC)-derived dendritic cells were co-cultured with five probiotic strains in the current study to evaluate their immunomodulatory interactions. To assess whether cytokines produced by probiotic-stimulated dendritic cells can influence T cell differentiation, human CD4 Show less

The study aimed to characterise presenteeism among nurses and identify nurses' presenteeism associated with distinct latent profiles. This study employed a cross-sectional descriptive approach. From July to December 2024, data were collected from 404 Chinese clinical nurses across four tertiary hospitals in Sichuan Province, Southwest China, using demographic questionnaires, the Stanford Presenteeism Scale (SPS-6), and the Challenge- and Hindrance-Related Self-Reported Stress Scale (C-HSS). A latent profile analysis was conducted on SPS-6 scores using Mplus 8.3, followed by univariate analyses to compare characteristics across subgroups. The total mean score of nurses' presenteeism is (16.13 ± 4.46), with approximately 59.4% classified as having a high level of presenteeism. Four latent profiles of nurses' presenteeism were identified through LPA: low fatigue-low work constraint (19.8%), low fatigue-high work constraint (33.9%), high fatigue-low work constraint (18.8%), and high fatigue-high work constraint (27.5%). Nurses demonstrated moderately severe presenteeism, with LPA revealing four distinct phenotypes characterised by divergent fatigue- work constraint configurations. This heterogeneity underscores the need for stratified interventions addressing unique risk profiles across subgroups. Administrators should adopt targeted interventions according to the characteristics of nurses in different profiles to minimise nurses' loss of productivity. This study addresses the evidence gap regarding the significant heterogeneity of presenteeism among nurses and the lack of precise identification, and identifies four distinct latent profiles of presenteeism. The findings provide critical evidence for nursing managers to design and implement differentiated intervention strategies tailored to groups with different risk characteristics. The study followed the STROBE guideline. This study did not include patient or public involvement in its design, conduct or reporting. Show less

To identify distinct sleep quality profiles among patients undergoing maintenance hemodialysis (MHD) using latent profile analysis (LPA), and examine differences in perceived stigma across these sleep quality subtypes. From December 2024 to March 2025, a total of 334 MHD patients were recruited via convenience sampling from the nephrology departments of two tertiary hospitals in Xinjiang, China. Data were collected using structured questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Depression Scale (SDS), and the Social Impact Scale (SIS), along with sociodemographic and clinical information. LPA was employed to identify latent subgroups of sleep quality based on PSQI components. Multinomial logistic regression was used to determine predictors of sleep profile membership. Differences in stigma scores across sleep profiles were analyzed using non-parametric equivalents. Three distinct sleep profiles were identified: Class 1 - "overall better sleep", Class 2 - "short sleep duration and low efficiency", and Class 3 - "poor sleep quality with high medication use". Multinomial logistic regression identified comorbid heart failure (OR=2.867, Patients with MHD exhibit heterogeneous patterns of sleep disturbance, which are associated with varying levels of perceived stigma. Those with the poorest sleep quality and highest reliance on medication experience the most pronounced stigma. Tailored interventions addressing sleep-related issues and psychosocial factors may help reduce stigma and improve patient well-being. Show less

Inflammation and hyperlipidaemia contribute with similar magnitude to the risk of future atherothrombotic events. However, the relative importance of high-sensitivity CRP (hsCRP) and lipoprotein(a) (Lp[a]) as determinants of risk of major adverse cardiovascular events (MACE) are not well defined among patients aged 75 years or older with established atherosclerotic cardiovascular disease (ASCVD). The present study prospectively enrolled 2,333 patients aged 75 years or older diagnosed with ASCVD with measurement of hsCRP and Lp(a) at Fuwai Hospital. The primary endpoint was MACE, defined as a composite of all-cause death, myocardial infarction (MI), stroke or ischaemia-driven coronary revascularisation. The median follow-up time was 3.0 years (interquartile range [IQR]: 2.5-3.2 years). hsCRP was significantly associated with an increased risk of MACE (adjusted hazard ratio [aHR]: 1.05, 95% confidence interval [CI]: 1.03-1.08 per 1 mg/l increment, P < 0.001; highest versus lowest quartile: aHR: 1.70 [1.22-2.38]), whereas there was no significant association between Lp(a) and MACE risk (aHR: 1.02 [0.98-1.06] per 10 mg/dl increment, P = 0.341; highest versus lowest quartile: aHR: 1.06 [0.77-1.47]). Risks of MACE were significantly higher in participants with hsCRP ≥2 mg/l than in those with hsCRP <2 mg/l, irrespective of Lp(a) strata (aHR: 1.41 [1.12-1.79]; P = 0.004). Concomitant elevation of hsCRP (≥2 mg/l) and Lp(a) (≥30 mg/dl) was associated with the greatest risk of MACE (aHR, 1.54 [1.13-2.12]; P = 0.007). Inflammation assessed by hsCRP predicted risk of future cardiovascular events more strongly than Lp(a) in patients aged 75 years or older with established ASCVD. These results provided real-world evidence on older patients potentially benefit by targeted anti-inflammatory strategies for secondary ASCVD prevention. Show less

The direct current (DC) in optical orthogonal frequency division multiplexing (DCO-OFDM) scheme is commonly adopted in light fidelity (Li-Fi) technology as it offers a spectrally efficient solution. A prior study adopted a machine learning (ML)-based solution to predict the optimum DC bias using key parameters, including the statistical properties of the OFDM transmitted signal and a polynomial regression model. However, the model's robustness decreased when the data structure was shuffled, indicating limited generalization to unseen data. This study builds upon that work by utilizing the same dataset and improving the prediction model with advanced ML tools, such as the LazyPredict algorithm (LPA), to systematically evaluate and select a regression model. A robust ML regressor selection process is proposed to ensure the reliability of predictions. Additionally, a comprehensive data analysis is conducted to assess the importance of features affecting the optimum DC bias. The results demonstrate that the ensemble learning algorithm, Random Forest (RF), outperforms other models with an R-squared of 0.953 and an RMSE of 0.233. A Friedman statistical test was applied to validate the results over five iterations of model training. Furthermore, hyperparameter tuning and bootstrap sampling were employed to conduct a deeper investigation into the model's performance and stability. The proposed model significantly enhances the accuracy and robustness of DC bias prediction compared to previous approaches, ensuring consistent performance across different data distributions. Show less

Chronic kidney disease (CKD) is associated with generalized inflammation. The presence of CKD-related (non-traditional) cardiovascular disease (CVD) risk factors such as inflammation, oxidative stress and uraemic toxins worsen the CVD. A distinct form of lipoprotein alteration known as uraemic dyslipidaemia, characterized by normal low-density lipoprotein (LDL), reduced high density lipoprotein (HDL) and elevated triglyceride and lipoprotein (a) has been described in CKD. The combination of all these factors increase the cardiovascular risk in CKD patients. We evaluated the relationship of lipoprotein and inflammatory biomarkers to atherosclerotic vascular disease (AsVD) among stage 3 CKD, end stage kidney disease (ESKD) patients on continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis (HD) and kidney transplant recipients (KTRs). This was a cross-sectional study of 40 adult (18-65 years) non-diabetic stage 3 CKD patients, 40 CAPD and 40 HD patients, 41 KTRs and 41 age- and sex-matched healthy controls. Socio-demographic and cardiovascular risk factors were documented and serum samples were analysed for inflammatory and lipoprotein markers. Echocardiography was performed and carotid intima media thickness (CIMT) was measured in all participants. The overall prevalence of AsVD was 52.8% in the study population, with the highest burden of inflammation present in CAPD patients. Significantly increased levels of hsCRP, pentraxin-3, Lp(a) and Lp-PLA2 were seen in CAPD, compared to controls. Older age, male gender, reduced high-density lipoprotein (HDL-C) and elevated Lp(a) levels were independently associated with AsVD. The burden of inflammation and lipoprotein abnormalities was greatest among end stage kidney disease (ESKD) patients and was the highest in CAPD patients. Lipoprotein(a) independently predicted AsVD. Show less

Lipoprotein(a) (Lp[a]) is an independent cardiovascular risk factor. Although current guidelines recommend Lp(a) testing, physicians are seldom screened, even though they remain at risk and often overlook their own health. In Vietnam, data on Lp(a) remain unclear. To address this, the Vietnam Atherosclerosis Society launched a pilot study to assess elevated Lp(a) among Vietnamese cardiologists, aiming to generate initial data, encourage physician screening, and raise medical and public awareness. A cross-sectional study was conducted at the 2024 Vietnam Atherosclerosis Society Congress, inviting 800 cardiologists. After exclusions, 165 without cardiovascular disease were analyzed. Demographic, biochemical, and lipid profiles were collected, and Lp(a) was measured using the Tina-quant Lp(a) Gen 2 assay. Elevated Lp(a) levels (≥ 125 nmol/L) were observed in 12.12% of the participants. There were no significant differences in median age ( At the Vietnam Atherosclerosis Society Congress, elevated Lp(a) levels were detected in several cardiologists without prior cardiovascular disease, including those with well-controlled lipid profiles according to current guideline targets. Show less

The treatment of multidrug-resistant tuberculosis (MDR-TB) is characterized by a prolonged duration and complex medication regimens, often resulting in a substantial medication-related burden that negatively impacts patients' adherence and quality of life. However, research on the heterogeneity of medication-related burden among MDR-TB patients and its influencing factors remains limited. This study aimed to identify latent profiles of medication-related burden among MDR-TB patients and examine differences in burden characteristics across these profiles, thereby providing evidence for tailored intervention strategies. A convenience sampling method was employed to recruit MDR-TB patients diagnosed at a tertiary infectious disease hospital in Chengdu between December 2024 and May 2025. Data were collected using a general information questionnaire, the Living with Medicines Questionnaire (LMQ), and the Health Literacy Management Scale (HeLMS). Latent profile analysis (LPA) was conducted to identify distinct profiles of medication-related burden, and multivariate logistic regression was used to explore associated factors for each profile. A total of 214 valid responses were analyzed. The LPA identified two distinct profiles of medication-related burden: C1 - "Low-Burden (Attitude & Practice-Dominated)" (44%) and C2 - "High-Burden (Daily Interference-Dominated)" (56%). Absence of side effects, not employing a caregiver, and higher levels of health literacy were positively associated with membership in the C1 group ( Medication-related burden among MDR-TB patients exhibits clear heterogeneity. Healthcare professionals should adopt stratified management and personalized interventions based on the identified influencing factors to alleviate the burden of medication in this population. Show less