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Psychological empowerment is a critical factor for employee work well-being, particularly within high-stress professions such as policing. However, experiences of empowerment among individuals are not uniform. This study aims to identify distinct profiles of psychological empowerment among police officers and to examine their associations with perceived coworker support and work well-being. A person-centered approach was adopted. Data were collected from 505 Chinese police officers. Latent Profile Analysis (LPA) was employed to identify subgroups based on their psychological empowerment patterns. The analysis revealed two distinct profiles: a "Globally Disempowered" profile and a "Globally Empowered" profile. Perceived emotional support from coworkers was a significant predictor of profile membership, where higher levels of support increased the likelihood of belonging to the empowered group. Furthermore, officers in the high empowerment profile reported significantly greater work well-being compared to those in the low empowerment profile. The findings underscore the heterogeneity in psychological empowerment experiences within the policing context. They emphasize the pivotal role of fostering emotional peer support as a means to enhance officers' psychological empowerment and, consequently, their work well-being. Practical implications for organizational interventions are discussed. Show less

Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease and cerebrovascular disease, is caused by the accumulation of plaque on artery walls. Elevated levels of low-density lipoprotein (LDL) cholesterol significantly contribute to the development and progression of ASCVD. Multiple studies have provided evidence of a correlation between individual LDL subpopulations and the development of atherosclerosis (AS); among these, small, dense low-density lipoprotein (sdLDL) and lipoprotein(a) [Lp(a)] have been particularly implicated. There are multiple considerations of why sdLDL may cause AS including their low affinity for the LDL receptor, their ability to diffuse into the artery wall and remain there for a long time, and their tendency to become excessively oxidized. Oxidized LDL (oxLDL), generated under oxidative stress, drives AS by impairing endothelial function, promoting foam cell formation, and triggering vascular inflammation. Lp(a) contributes to the development and progression of AS by causing inflammation of the arterial wall. Studies conducted in recent years have found that electronegative LDL [L5/LDL(-)] may also be an important factor in the development and progression of AS. L5/LDL(-) causes atherosclerotic changes in the vascular wall by triggering apoptosis in endothelial cells via the lectin-like oxLDL receptor-1. This article offers an updated overview of ASCVD and briefly examines the classifications of atherogenic LDL subfractions and their roles in atherogenesis. Show less

Certain parents of children with febrile seizures have a high sense of perceived vulnerability, which may lead to overprotective behaviors. This study aimed to measure the latent profile types of perceived vulnerability in parents of children with febrile seizures and investigate the factors affecting these different profiles. A cross-sectional study was conducted from October 2023 to December 2024. Participants were surveyed using a general data questionnaire, the child vulnerability scale (CVS), parents' perception of uncertainty scale (PPUS), and perceived social support scale (PSSS). Latent profile analysis (LPA) was conducted to identify different types of perceived vulnerability among parents of children with febrile seizures. The influencing factors for each profile were identified using univariate and multivariate logistic regression analysis. In total, 400 participants were included in this study. The perceived vulnerability among parents of children with febrile seizures was divided into three latent profiles: "General Low Perceived Vulnerability Group" (37.9%), "Moderate Perceived Vulnerability Group" (32.8%), and "High Perceived Vulnerability Group" (29.3%). Multivariate analysis indicated that relationship with children, parents' age, educational attainment, marital status, body temperature during febrile seizures, PPUS, and PSSS were the factors affecting perceived vulnerability in parents of children with febrile seizures. The perceived vulnerability in parents of children with febrile seizures exhibited significant heterogeneity. To minimize the perceived vulnerability, medical professionals should provide tailored mental health counseling and intervention based on vulnerability characteristics. Show less

Elevated lipoprotein(a) (Lp[a]) is an independent risk factor for the development of atherosclerotic cardiovascular disease. Despite National Lipid Association guidelines recommending one-time Lp(a) screening in adults aged 18 years and older, Lp(a) testing remains underutilized. A novel gamified ambulatory curriculum educating internal medicine residents on Lp(a) was implemented at a single academic internal medicine residency program. A total of 108 residents received a Lp(a) lecture in either a gamified format using KAHOOT! or slide-based traditional format. Learning outcomes including Likert scale ratings of confidence utilizing and interpreting Lp(a) results and a 10-question knowledge assessment were collected prior to the didactic, immediately following, and after 3 months. Screening rates prior to and following intervention were assessed. The Lp(a) curriculum significantly improved resident knowledge following the lecture (8.5 out of 10 questions post-test vs 3.9 pretest, P < .0001) and at 3-month follow up (5.8 3-month vs 3.9 pretest, P = .0001). Learning outcomes in the gamified group were similar to the traditional group (8.5 post-test traditional vs 8.6 post-test gamified, P = .978; 6.3 3-month traditional vs 5.8 3-month gamified, P = .466). In the 3 months following the didactic, there was a significant increase in resident Lp(a) screening among patients who had a lipid panel assessed compared to baseline (3.11% vs 1.21%, P < .0001). Both internal medicine resident Lp(a) knowledge and confidence improved following either a gamified or traditional lecture-based didactic. Addressing gaps in resident knowledge led to a modest increase in Lp(a) screening rates in our resident clinic among patients for whom a lipid panel was assessed. Show less

Assessing white matter hyperintensity (WMH) is essential for the diagnosis, treatment, and prognosis of multiple sclerosis (MS) and neuromyelitis optical spectrum disorder (NMOSD). MS and NMOSD present dispersed small lesions alongside larger aggregated lesions that are irregularly shaped, posing challenges for the automatic segmentation of WMH on magnetic resonance images. Furthermore, research on NMOSD brain WMH segmentation is limited due to the rare nature of the disease. This study aims to propose a deep learning method for MS and NMOSD brain WMH segmentation. In this study, we propose a 2.5D Fourier Convolutional ResUnet (FrC-ResUnet). It utilizes a spectral encoder to extract global information, enabling accurate segmentation of scattered lesions. Additionally, the model incorporates the selective features module (SFM) and the convolutional block attention module (CBAM) to enhance lesion-background differentiation and outline the lesions distinctly. We evaluated our approach on the MS public and local datasets of MS and NMOSD. Compared to U-Net, ResUNet, FC-DenseNet, AttentionUNet, lesion prediction algorithm (LPA) and Sequence Adaptive Multimodal SEGmentation (SAMSEG), the 2.5D FrC-ResUnet achieved the highest Dice similarity coefficient (DSC) on three different datasets, with values of 0.710, 0.667, and 0.822, respectively. The 2.5D FrC-ResUnet demonstrates accurate and robust segmentation of NMOSD brain WMH. Meanwhile, the model excels in segmenting MS brain WMH, particularly when confronted with irregularly shaped and dispersed lesions. Show less

Lipoprotein(a) (Lp(a)) is an established independent risk factor for atherosclerotic cardiovascular disease, particularly in the development of high-risk coronary plaques (HRPs). Elevated Lp(a) contributes to lipid accumulation, vascular inflammation, and plaque instability, primarily through oxidized phospholipids that promote monocyte adhesion and foam cell formation. Genetic studies have identified variants in the Show less

Many studies have revealed the observational associations between lipoprotein(a) (Lp(a)) concentrations and the incidence of cardiovascular diseases (CVDs). However, the causal associations remain unclear. Public summary data were analyzed using a Mendelian randomization (MR) design to assess the causal associations between Lp(a) levels and risks of nine CVDs and evaluate the potential impact of aspirin on Lp(a) levels. The principal analysis was conducted employing the random-effects inverse-variance weighted (IVW) method. Furthermore, the weighted median and MR-Egger approaches were used as the sensitivity analysis. Additionally, the significantly associated single nucleotide polymorphisms (SNPs) in salicylic acid (INTERVAL and EPIC-Norfolk, n = 14,149) were chosen to assess the potential effects of aspirin on lowering Lp(a) levels. The IVW analysis showed that the per standard deviation (SD) increment in Lp(a) level was causally associated with a higher risk of coronary artery disease (odds ratio (OR), 1.237; 95% confidence interval (CI), 1.173-1.303), atrial fibrillation (OR, 1.030; 95% CI, 1.011-1.050), heart failure (OR, 1.074; 95% CI, 1.053-1.096), hypertension (OR, 1.006; 95% CI, 1.004-1.008), and peripheral artery disease (OR, 1.001; 95% CI, 1.001-1.001) (all A causal nexus was discerned between Lp(a) levels and an increased risk of conditions including coronary artery disease, atrial fibrillation, heart failure, hypertension, and peripheral artery disease. Furthermore, administering aspirin may be a potential therapeutic to reduce these CVD risks among individuals with elevated Lp(a) levels. Show less

Background & objectives Central TB division facilitated development of a line probe assay (LPA) artificial intelligence (AI) tool. The tool was developed, trained, and validated for performance by collecting more than 18,000 LPA strips across culture and drug susceptibility Testing (C&DST) laboratories. The Indian Council of Medical Research (ICMR)-National Institute for Research in Tuberculosis (NIRT) evaluated the LPAAI tool independently. The objective was to establish and verify an AI-driven system for automatically interpreting LPA strips, which are employed in tuberculosis drug resistance screening, to improve accuracy, consistency, and scalability across diverse laboratory settings. Methods The AI system integrates faster regions convolutional neural network (FR-CNN) for strip detection, detection transformer (DETR) for band localisation, and a hierarchical neural network (HNN) for classification of bands, loci, and drug labels. Independent validation was conducted by ICMR-NIRT using 2810 first-line (FL)-LPA and 241 reflex second-line (SL-LPA) across ten intermediate reference laboratories (IRLs). Results AI comparative models demonstrated an accuracy range of 92-100 per cent, with sensitivity between 80-100 per cent and specificity from 86-100 per cent for the tub, rpoB, katG, InhA, gyrA/gyrB,rrs, and eisgenes. The overall F1 score varies from 0.81 to 1.00, indicating perfect precision and recall. Interpretation & conclusions This AI system offers a novel, modular architecture capable of expert-level interpretation of LPA strips. The AI tool performs at par with expert readers and offers a reliable, scalable solution for LPA interpretation.AI tool adoption can reduce interpretation time, enhance result uniformity, and improve treatment delivery across India's TB programme, supporting national goals for TB elimination. Show less

Tuberculosis (TB) is still a major health concern. However, each year more than one-third of all global TB cases remain undetected and unreported. On top of that, emergence of drug-resistant TB poses a major challenge. Therefore, a Reliable, Accessible, Cost-Effective, and Easy (RACE) diagnostic modality is crucial for starting suitable treatment of TB and curtailing its transmission. In the last two decades, several advances have been made for improved diagnosis, which include liquid culture and drug susceptibility testing (DST), line probe assay (LPA) for drug resistance detection at the molecular level, and cartridge-based nucleic acid amplification tests (CBNAAT) for rapid diagnosis of TB and rifampicin resistance detection. Newer drugs and treatment regimens have been introduced and vaccines are in the pipeline. Despite these advances and opportunities, a precise, affordable, and accessible diagnostic model is yet to be evolved, especially in rural and difficult-to-reach areas, where the most desirable test would be a test that is easy to perform, accessible to masses, is cost-effective, besides being reliable. Only a point-of-care triage test can meet these requirements, which can be used by an unskilled or minimally trained healthcare worker or even by the patient (self-testing). This test should be able to detect all forms of tuberculosis and latent TB infection. Currently, no such test is available. In this narrative review, we will discuss how such a diagnostic modality can help eliminate TB. Show less

This study employs latent profile analysis (LPA) to identify distinct profiles of positive youth development (PYD) based on the 5C model (connection, competence, confidence, character, and caring). While extensive research has established associations between PYD indicators and adolescent mental health, well-being, and behavioral outcomes, a person-centered approach allows for a deeper exploration of how different patterns of PYD characteristics are related to these distal outcomes. Unlike previous studies, this research uses 15 PYD indicators, capturing all subdimensions of each of the four Cs, with caring treated as a unidimensional construct. The study was conducted on a national cross-sectional sample of 3,559 first-year high school students (aged 15.1 years). Latent profiles were identified via maximum likelihood estimation, and model fit was evaluated through multiple fit indices. The BCH method was used to assess profile associations with distal outcomes. Six distinct profiles were identified along with their relationships with distal outcomes (Vulnerable Youth: Distressed and Risk Behaving, Caring but Struggling: Distressed but Reserved, Balanced Achievers: Resilient Contributors, Self-Centred Underachievers: Risk Behaving, Confident but Detached: High-Performing Rebels, and Thriving Stars: Thriving and Contributing). The results highlight how strengths in one area (e.g., confidence, competence, and caring) can coexist with significant risks (e.g., binge drinking, antisocial behaviour, and mental health), whereas adolescents with poor mental health or risk behaviour may possess very different internal and external resources. Among the below-average PYD groups, students with very low levels of character and caring but preserved confidence are prone to risk behaviors while being somewhat protected from mental health issues. Others, characterized by high diversity and caring but very low confidence, show vulnerability to mental health challenges without risk behaviors. Additionally, high-risk behaviors can either cooccur with mental health issues in extremely low-PYD students or emerge independently in confident, competent adolescents lacking character, caring, and school connections. By revealing unique developmental pathways, this study enhances the understanding of youth development diversity, emphasizing the necessity of examining both observable behaviors and underlying developmental traits for developing targeted interventions that support strengths and address challenges within distinct adolescent subgroups. Show less

This study aims to identify and characterize daily activity accumulation patterns (bouts of physical activity and sedentary behavior) among adolescents and then to explore the associations between these groups and depressive symptoms. A total of 521 adolescents aged 13-18 years from Wuhan and Changsha, China, were included. Bouts of physical activity (PA) and sedentary behavior (SED) were measured using accelerometers. The Center for Epidemiologic Studies Depression Scale was used to assess participants' depressive symptoms. Latent profile analysis was employed to identify distinct groups based on their activity patterns. Three distinct groups were identified: "Prolonged sitters" ( The synergistic effect of strategies to reduce total SED duration by limiting SED bouts to 30 min or less and increasing light physical activity (LPA) may also be effective in alleviating depressive symptoms in adolescents. Show less

Although light-intensity physical activity (LPA) has been suggested to be associated with a lower risk of mortality, the minimal and optimal volumes of LPA remain unclear. We aimed to examine the minimal and optimal volumes of LPA associated with the risks of mortality and disease incidence (i.e., cardiovascular diseases and cancer). Data were derived from the population-based UK Biobank cohort study, including 69,492 adults aged 43-78 years. Accelerometer-measured LPA was defined using a validated, published machine learning-based Random Forest activity method, which was categorized into 4 quartile groups. All-cause and cause-specific mortality (cardiovascular disease- and cancer-specific) were determined according to the International Classification of Diseases, 10th version codes. Disease incidence was defined based on primary care, hospitalization, or death records. During a median follow-up period of 8.04 years, 2024 adults died from all causes, 539 from cardiovascular disease, and 1175 from cancer. For all-cause mortality, compared with participants in the lowest quartile of LPA (<3.9 h/day), the hazard ratios (HRs) and 95% confidence intervals (95%CIs) were 0.82 (95%CI: 0.73‒0.93) for those with 3.9 to <5.0 h/day, 0.75 (95%CI: 0.66‒0.85) for those with 5.0 to <6.1 h/day, and 0.77 (95%CI: 0.68‒0.88) for those with ≥6.1 h/day, respectively. There was an inverse non-linear dose-response association between LPA and all-cause mortality, with an optimal dose of 5.72 h/day (95%CI: 5.45‒6.41; HR = 0.63, 95%CI: 0.56‒0.71) and a minimal dose of 3.59 h/day (95%CI: 3.53-8.56; HR = 0.81, 95%CI: 0.78‒0.86), with the 5th percentile as the reference. Similar patterns were observed for cause-specific mortality and disease incidence (cardiovascular disease and cancer). Engaging in LPA for ∼3.5 h/day was conservatively associated with lower risk of mortality and disease incidence, with further risk reductions observed up to an optimal dose of ∼6.0 h/day. These findings suggest that sufficient LPA offers important health benefits, which can inform the development of future PA guidelines. Show less

Transitional-age youth (TAY; 15 to 25 years old) are more likely to experience psychological problems compared to other age groups. This study aimed to identify the most relevant transdiagnostic factors underlying internalizing and externalizing symptoms in TAY, including perfectionism, perceived stress, self-compassion, psychological flexibility, adaptive and maladaptive emotion regulation, self-esteem, and autonomy. The sample consisted of 87 TAY from a clinical and 649 from a community sample (M = 20.71, 64.1% female). Confidence Interval Based Estimation of Relevance (CIBER) was used to detect the most relevant transdiagnostic factors, and Latent Profile Analyses (LPA) were used to identify groups of TAY sharing similar patterns of transdiagnostic factors. CIBER showed that all transdiagnostic factors were associated with both internalizing and externalizing symptoms, with most factors being more strongly associated with internalizing symptoms. LPA identified six groups of TAY: low resilience (6.5%), moderate low resilience (20.5%), average resilience (29.3%), moderate high resilience (26.8%), moderate high resilience - high perfectionism and autonomy (1.8%) and high resilience (15.1%). Generally, TAY in the lower resilience groups were more likely to be in the clinical sample than in the community sample and showed more symptoms compared to TAY in the higher resilience groups. Conversely, TAY in the moderate high resilience - high perfectionism and autonomy group were most likely to be in the community sample. The study highlights the importance of focusing on transdiagnostic factors in research and clinical practice for TAY. Show less

Incontinence-associated dermatitis (IAD) is a common nursing challenge in clinical practice, imposing a significant burden on both patients and healthcare providers. Studies have reported that nurses' preventive attitudes toward IAD significantly influence its prevalence, and there may be a potential association between achievement motivation and these attitudes. Previous research on nurses' preventive attitudes toward IAD has primarily focused on overall levels, overlooking potential heterogeneity within the population. This study aimed to investigate the heterogeneity in clinical nurses' preventive attitudes toward IAD using a person-centered approach and to identify the influencing factors for different subgroups. A secondary aim was to utilize Self-Determination Theory (SDT) to elucidate the relationship between the identified attitude profiles and nurses' achievement motivation, thereby providing targeted strategies to enhance their preventive attitudes. This study selected 1058 clinical nurses from a tertiary hospital in Fujian, China, as research participants from September to October 2024. The study utilized the following instruments: a general information questionnaire, the Attitude Toward the Prevention of Incontinence-Associated Dermatitis Instrument, and the Achievement Motivation Scale. Latent profile analysis (LPA) was employed to identify the latent profiles of nurses' attitudes toward IAD prevention. At the same time, Two subgroups of nurses' attitudes toward IAD prevention were identified: the low-level group (63.42%) and the high-level, low-personal-responsibility group (36.57%). A significant correlation was found between nurses' attitudes toward IAD prevention and achievement motivation. Nurses with a more positive preventive attitude scored higher on the motivation for success dimension, while those with a less positive attitude scored higher on the motivation to avoid failure dimension. Factors influencing nurses' attitudes toward IAD prevention included position, department, number of participants in wound/ostomy/incontinence care training, satisfaction with the work atmosphere, and achievement motivation scores. This study revealed heterogeneity in nurses' attitudes toward IAD prevention. Nurses with positive attitudes tended to adopt a success-driven approach, while those with relatively negative attitudes leaned toward a failure-avoidance strategy, reflecting two fundamentally distinct coping mechanisms. Nursing managers should address these individual differences by targeting achievement motivation as an intervention point. Management strategies should be tailored to the distinct profiles; for instance, interventions for the "low-level group" should prioritize building competence through structured training, while strategies for the "high-level, low-personal-responsibility group" should focus on enhancing autonomy and personal accountability. By adopting such targeted approaches, managers can more effectively enhance nurses' preventive attitudes, thereby improving care quality and reducing IAD incidence. Show less

Impaired decidualization is associated with recurrent implantation failure (RIF) and lysophosphatidic acid (LPA) is known to play an important role in decidua formation. However, the specific impact of LPA in endometrial decidualization during RIF remains unclear. Metabolomics analysis was performed to identify differentially expressed metabolites (DEMs) in RIF patients Expression of the LPA receptor subtypes, LPAR1-6, was detected in both GEO datasets and clinical endometrial samples. An LPA was identified as a pivotal metabolite in RIF. Among the LPA receptors, LPAR1 and LPAR6 were highly expressed during LPA plays a significant role in the decidualization process of hESCs by regulating LPAR6, rather than LPAR1, providing insights into potential therapeutic target for RIF. Show less

Given that limited research has examined the relationships between lifestyle activities of varying intensities, including moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior (SB), and dynapenia, which refers to an age-related decline in muscle function, this study aimed to investigate the longitudinal associations between MVPA, LPA, and SB and the risk of dynapenia among older adults in Taiwan. This longitudinal study included older adults aged ≥ 65 years with independent mobility, recruited from the National Taiwan University Hospital. Baseline data were collected from September 2020 to December 2021 and follow-up data were collected until December 2022. Participants wore a tri-axial accelerometer (GT3X + ActiGraph) on the hip for seven consecutive days to evaluate baseline time spent of MVPA (≥ 2020 counts/min), LPA (100-2019 counts/min), and SB (< 100 counts/min). To confirm the dynapenia classification at baseline and follow-up, participants underwent standard assessments, including handgrip dynamometry for muscle strength, bioelectrical impedance analysis for muscle mass, and a 6-m walk test for physical performance. Adjusted binary logistic regression analyses were conducted to examine the association between lifestyle activities and dynapenia risks. Among 154 participants (mean age 80.3 ± 7.2 years; 53.9% women), 53.9% were classified as having dynapenia at baseline, compared to 55.2% at follow-up. Participants spent an average of 16.9 (± 26.6) min in MVPA, 249.5 (± 85.7) min in LPA, and 604.5 (± 76.4) min in SB daily. The longitudinal analysis results indicated that higher MVPA time was significantly associated with lower odds of dynapenia in both the unadjusted (odds ratio [OR] = 0.625, 95% confidence interval [CI]: 0.466-0.837) and fully adjusted models (OR = 0.578, 95% CI: 0.406-0.823). Each additional 10 min/day of MVPA was associated with 42.2% lower odds of dynapenia in the adjusted model. No significant prospective associations were observed between the LPA or SB time and dynapenia. This study provides longitudinal evidence that higher MVPA levels are significantly associated with a reduced dynapenia risks among community-dwelling older adults in Taiwan. These findings underscore the importance of promoting MVPA as a part of lifestyle interventions aimed at preserving muscle function and preventing dynapenia in older populations. Show less

Lipoprotein(a) (Lp[a]) is a promising biomarker with potential to improve atherosclerotic cardiovascular disease risk assessment tools. We assessed knowledge, awareness, and frequency of encounters with elevated levels of Lp(a) and related management strategies among physicians in the Arabian Gulf region. In this cross-sectional study, a self-administered online survey was distributed from December 2024 to February 2025 to clinicians in Saudi Arabia, Oman, United Arab Emirates, Qatar, Kuwait, and Bahrain. The questionnaire assessed demographics, knowledge, awareness, and clinical practice. Among the 1069 included respondents, the mean knowledge score was modest (M = 9.0 ± 3.5/17.0), and 75% self-reported as being unaware of Lp(a) or "neutral." Those in cardiology had slightly higher knowledge scores compared to those in other subspecialties (P < .001), and tertiary care practitioners had marginally better knowledge scores than non-tertiary practitioners (9.34 vs 8.78; P < .001). Only 252 (23.6%) participants reported having requested Lp(a) measurements, and lack of information (31.2%) and unavailability in hospitals (23.9%) were cited as the main reasons for not ordering Lp(a). Statins were viewed as the best initial approach to lowering Lp(a) (55.6%), and the Lp(a)-lowering medication pelacarsen was not commonly selected as first-line (31.7%). Physicians in the Arabian Gulf region report limited basic and clinical knowledge of Lp(a), which could result in underestimation of cardiovascular risk. These findings, in the largest such study to date, are a call to action to increase awareness about Lp(a) and accessibility to testing. Show less

In this study, we aimed to describe the mutations associated with first-line drug resistance in Mycobacterium tuberculosis complex (MTBC) isolates from São Paulo, Brazil, between 2019 and 2021. Mutations in the coding regions of rpoB and katG genes and in the promoter region of the inhA gene in MTBC clinical isolates were detected using the GenoType MTBDRplus assay (LPA). All mutations inferred by LPA were sequenced. Of the 13,489 MTBC isolates with valid LPA results, 657 (4.9%) harbored mutations. The overall prevalence rates of rifampicin-resistant (RIF-R) tuberculosis (TB), isoniazid-resistant (INH-R) TB, and multidrug-resistant (MDR) TB were 1.5, 2.0, and 1.2%, respectively. A significant proportion of RIF-R isolates presented inferred rpoB mutations (89.1%), most of which were the borderline H445N mutation. The inhA promoter C-15T mutation was predominant among the INH-R isolates (52.8%). Most MDR isolates presented rpoB S450L + katG S315T1 mutations. Gene sequencing identified mutations not included in the catalogue of mutations published by the World Health Organization. Phenotypic drug susceptibility testing on isolates with inferred rpoB mutations revealed that the 0.5 µg/mL critical concentration of RIF failed to detect most borderline mutations when using the BACTEC MGIT 960 system. These findings emphasize the need for continuous surveillance and the integration of molecular and phenotypic methods to ensure an accurate detection and management of drug-resistant TB in high-burden settings. Show less

Lp(a) (lipoprotein [a]) and coronary artery calcium score (CACS) are independently associated with atherosclerotic cardiovascular disease (ASCVD) risk. This study aimed to investigate sex-specific prognostic differences between Lp(a) and CACS in ASCVD risk. We analyzed 4651 participants from the Multi-Ethnic Study of Atherosclerosis, grouped by sex. Multivariable Cox regression analysis was performed to evaluate the prognostic value of Lp(a) and CACS for ASCVD risk in both sexes. The predictive performance of these factors was compared in men and women. During a median follow-up of 13.84 years, 465 ASCVD events were recorded (272 in men and 193 in women). Multivariable Cox regression analysis revealed that both elevated Lp(a) and CACS were independent predictors of ASCVD risk in both sexes. The C-index analysis demonstrated that CACS provided incremental prognostic value over Lp(a) in men (C-index: 0.732 versus 0.714; Although both Lp(a) and CACS independently predict ASCVD risk in both sexes, the predictive value of Lp(a) varies significantly between men and women across different CACS categories. These findings may inform sex-specific strategies for primary prevention of ASCVD. Show less

This study aimed to explore the potential classification and influencing factors of post-traumatic stress disorder (PTSD) in intensive care unit (ICU) patients receiving mechanical ventilation to provide a theoretical basis for formulating targeted intervention measures. A total of 229 patients on mechanical ventilation who were hospitalized in the intensive care unit of a Class III Grade A hospital in Zunyi from August 2023 to July 2024 were selected as research participants using a purposive sampling method. The General information questionnaire, Eysenck Personality Questionnaire Revised, Short Scale for Chinese (EPQ-RSC), Simplified Coping Style Questionnaire (SCSQ), Perceived Social Support Scale (PSSS), and Hospital Anxiety and Depression Scale (HADS) were used to assess the patients within 7 days after discharge from the ICU. One month after extubation, a cross-sectional survey was conducted using the Impact of Event Scale-Revised (IES-R). Latent profile analysis (LPA) was used to analyze the latent subtypes of PTSD, and univariate analysis and a disordered multivariate logistic regression model were used to evaluate the influencing factors associated with different types of PTSD. A total of 215 valid questionnaires were collected, and the effective recovery rate was 93.89%. The incidence of PTSD was 14.9% (95% CI: 10.12%-19.64%). There were three latent categories of PTSD among the ICU patients on mechanical ventilation: the "low-stress group" (56.8%, PTSD symptoms among mechanically ventilated ICU survivors manifest in three distinct profiles. Our findings strongly recommend early psychological screening, particularly focusing on anxiety and depression levels and patients' educational background. Medical staff should formulate targeted intervention plans based on the characteristics of different patient categories to lower the level of PTSD in patients. Show less

Background Prism adaptation (PA) is a classical paradigm known to induce sensorimotor plasticity, and accumulating evidence suggests that it may also influence language networks. In particular, leftward prism adaptation (L-PA) has been proposed to modulate language-related functions through alterations in motor cortical excitability and interhemispheric inhibition. However, its effects on native Japanese speakers remain unclear. Objective This study aimed to investigate the effects of L-PA on performance in phonemic fluency tasks (PFT) and category fluency tasks (CFT) in healthy adults whose native language is Japanese. Methods A randomized controlled trial was conducted on 57 right-handed healthy adults, who were undergraduate or graduate students at Kumamoto Health Science University (Kumamoto, Japan) and volunteered without financial compensation. Participants were assigned to one of three groups using a virtual reality-based prism adaptation system (VRPA): the L-PA group, in which visual space was shifted leftward; the R-PA group, in which visual space was shifted rightward; or the control group, with no visual displacement. Both PFT and CFT were administered before and after the intervention. The dependent variable was the number of correct words generated within one minute. The primary analysis tested the interaction between group (L-PA/R-PA/control) and time (pre-/post-intervention) using split-plot ANOVA. Results In total, nine participants who failed to exhibit an aftereffect were excluded, leaving 48 for analysis. No significant differences were observed among groups at baseline. In the L-PA group, performance significantly improved after the intervention in both PFT (p = 0.0065) and CFT (p = 0.0404). No significant changes were found in the R-PA or control group. Conclusion These findings suggest that L-PA may transiently enhance both phonemic and semantic verbal fluency in Japanese speakers. This study provides preliminary evidence that L-PA can modulate language functions through plasticity of language networks. Future research should address the underlying neural mechanisms, the durability of the effects, and validation in larger clinical trials. Show less

As university libraries transform into "Learning Commons," peer collaborative learning has become increasingly common. However, the complexity of its effectiveness and its underlying mechanisms remain underexplored. This study systematically investigates the relationship between peer collaborative learning and academic engagement. Integrating both person-centered and variable-centered approaches, the study employs Latent Profile Analysis (LPA) to identify heterogeneous groups of students based on their collaboration patterns and engagement levels, challenging the conventional wisdom that "collaboration is always beneficial." Concurrently, based on Self-Determination Theory (SDT), a mediation model is constructed to test the bridging role of basic psychological needs (competence and relatedness). Using a questionnaire survey, data were collected from 820 university students to measure their quality of peer collaborative learning, basic psychological need satisfaction, and academic engagement. The SPSS PROCESS macro was used for mediation analysis, and Mplus was used for Latent Profile Analysis. (1) LPA identified four heterogeneous profiles: "High-Achieving All-Rounders" (26.1%), "Balanced Developers" (25.5%), "Inefficient Socializers" (27.6%), and "Indifferent and Unengaged" (20.9%). Notably, the largest group, "Inefficient Socializers," exhibited a distinct pattern of "high emotional support, low academic engagement." (2) Basic psychological needs played a significant partial mediating role in the relationship between the quality of peer collaborative learning and academic engagement, with the mediating effect accounting for 52.3% of the total effect. (3) The moderating effect of academic discipline was not significant. The study confirms that while high-quality peer collaboration can promote academic engagement by satisfying students' psychological needs, not all forms of collaboration are beneficial. The discovery of the "Inefficient Socializers"-the largest profile-is the core contribution of this research. It exposes the existence of a "pseudo-collaboration" trap, where social interaction detached from task-oriented goals may actually inhibit academic engagement. This finding offers crucial practical implications for the design of university learning spaces (shifting from "promoting co-presence" to "fostering effective interaction") and for academic advising (enabling the precise identification and intervention for different student types). Show less

Premature coronary artery disease (PCAD) is characterized by early onset, rapid progression, and poor prognosis, which seriously affects patients' health and quality of life. In this study, we analyzed the proteomic network and biological pathways of PCAD patients by bioinformatics methods, and mined out the key differential proteins, which provided a theoretical basis for clinical intervention. Patients who attended the heart center of the First Affiliated Hospital of Xinjiang Medical University from January 2023 to December 2024 and completed coronary angiography were selected. According to the relevant inclusion and exclusion criteria, a total of 129 patients were included, including 69 in the PCAD group and 60 in the control group. The clinical baseline data of the patients were systematically analyzed. Plasma protein extraction, trypsin digestion and mass spectrometry were completed. The mass spectrometry data were initially separated with the help of proteomics software, and the differential proteins were functionally enriched by RStudio software. Protein interaction networks were constructed by STRING platform and core differential proteins screened were visualized using Cytoscape software (MCODE plug-in). Differences in gender, smoking, alcohol consumption, hypertension, diabetes, HDL-C, Glu, FIB, LPa, NT-pro-BNP, PCT, and IL-6 were statistically significant (P < 0.05). Sex (P = 0.009, OR = 6.782,95% CI: 1.600-28.746), FIB (P = 0.001, OR = 2.662,95% CI: 1.471-4.818), and LPa (P = 0.041, OR = 1.002,95% CI: 1.000-1.004) were independent risk factors for PCAD. A total of 348 up-regulated proteins and 92 down-regulated proteins were screened by bioinformatics analysis. The occurrence of PCAD is associated with protein synthesis, intercellular communication, molecular interactions, ribosomal metabolism, glyoxylate and dicarboxylic acid metabolic pathways. Ribosomal and translational proteins influence the development of PCAD. In this study, we found that gender, FIB, and LPa are risk factors for PCAD. The analysis identified 348 up-regulated and 92 down-regulated proteins. Among them, the differentially expressed proteins DHX9, F7, APCS, and PROC were closely related to the biological process of PCAD. The screened ribosomal and translational proteins showed high-frequency associations in protein-protein interaction networks, providing potential differentially expressed proteins for a deeper understanding of the disease. Show less

Family caregivers ('carers') bear the highest care burden during the postoperative survivorship period of pancreatic cancer, given its poor prognosis. Most carers report unmet needs when taking on caregiving responsibilities during this period. Thoroughly investigating carers' needs is essential for helping families address practical care challenges. However, this important topic remains underexplored. To assess the need levels and identify need subgroups among carers of patients with pancreatic cancer 6 months after surgery and demographic predictors contributing to heterogeneity. Cross-sectional study. Participants were recruited from the pancreas centres of four tertiary A-level comprehensive hospitals in Jiangsu Province, China. 240 patients with pancreatic cancer and their carers ('dyads') participated in the survey. Carers completed the Comprehensive Needs Assessment Tool in Cancer for Carers, the Activities of Daily Living Scale for patients, and the General Demographic Information Questionnaire for dyads. Latent profile analysis (LPA) was used to categorise carers' needs. Non-parametric and chi-square tests were used to examine differences in need scores and sociodemographic characteristics among subgroups. Multiple logistic regression (MLR) was used to analyse sociodemographic impacts. Six months post-surgery, the total carers' need score was 41.83 ± 22.65 points, indicating a moderate level, with the highest needs reported for healthcare personnel, information and knowledge, and facilities and services. The LPA results revealed that carers were divided into five distinct subgroups based on differing levels of need across the domains assessed by the Comprehensive Needs Assessment Tool in Cancer for Carers, with proportions of 8.8 %, 22.5 %, 8.3 %, 55 %, and 5.4 %. Subgroup membership was predicted by four factors: carers' sex (odds ratio [OR]: 11.08, 95 % confidence interval [CI]: 1.64, 74.99, We have highlighted the complex individualised needs of carers of patients with pancreatic cancer. Through LPA and MLR, we identified distinct need subgroups and their predictors. Healthcare professionals may be able to improve dyads' health by tailoring support to each subgroup's specific needs and issues. Registration number: ChiCTR2400079415, registered 03/01/2024, first recruitment 04/02/2024. Show less

Chronic liver disease (CLD) influences the levels of diverse metabolites that may be related to its pathogenesis. The study aimed to indicate the relation between CLD and the levels of phospholipids. In this systematic review, PRISMA guidelines were considered for reporting the results. Up to November 2024, the databases of MEDLINE (through PubMed), Scopus, Web of Science, and Google Scholar were searched. Case-control (CC) and cross-sectional (CS) studies explored the link between CLD and serum phospholipids. The Newcastle-Ottawa scale (NOS) for CC studies and the modified NOS scale for CS studies were applied to evaluate the quality of the included articles. A total of 11304 articles were included. Eleven thousand duplicates were removed, 9304 studies were excluded, and 343 full-text articles were reviewed. Fifteen CC studies and four CS studies were included in this study. Quality assessment using NOS revealed most studies had low to moderate risk of bias, with scores ranging from 4 to 8 out of 9.The included studies verified a significant association between the levels of total PL (TPL), phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylserine (PS), phosphatidylinositol (PI), phosphatidic acid (PA), lysophosphatidylcholine (LPC), lysophosphatidylinositol (LPI) and lysophosphatidic acid (LPA) and liver diseases., with reported odds ratios ranging from 1.44 to 2.51 and correlation coefficients from -0.58 to 0.62. Phospholipid levels are associated with liver diseases. It is important to identify noninvasive ways to diagnose biological risk factors in patients with liver damage so they can be targeted for early treatment. Most of the included studies revealed significant alteration of phospholipid levels in CLD. Thus, the lipidome can predict liver dysfunction and prevent its attributed complications. Show less

Elevated plasma lipoprotein(a) [Lp(a)] is a causal and independent risk factor for atherosclerotic cardiovascular disease and an emerging therapeutic target. Over the past 15 years, many medical bodies from around the world have released scientific statements and clinical guidelines regarding Lp(a). This review tracks how recommendations on Lp(a) have evolved over this timeframe. Powerful studies demonstrating the independent association of elevated Lp(a) in large numbers of patients have been published. The data allowed a more precise formulation of risk categories for Lp(a) levels and of models for how a given level of Lp(a) in a moderate-risk to high-risk primary prevention patient might inform management of modifiable risk factors such as LDL cholesterol. Guidelines and statements have increasingly recommended universal screening for elevated Lp(a) and have identified elevated Lp(a) as a risk-enhancing or amplifying factor. However, some gaps and inconsistencies remain. Ongoing cardiovascular outcomes trials of potent Lp(a)-lowering therapies will inform clinical use of Lp(a) in the future. Presently, consensus is building for measurement of Lp(a) in all adults and for incorporation of Lp(a) levels into clinical decision-making for prevention of cardiovascular disease. However, caution is warranted as the evidence base underlying this consensus has several important missing pieces. Show less

Autism spectrum disorder (ASD) is characterized by core and associated symptoms that adversely affect the quality of life (QOL) of both children with ASD and their parents. Although physical activity (PA) has been shown to promote QOL and well-being, limited research has examined these associations within parent-child dyads in families affected by ASD. This cross-sectional study recruited 85 parent-child dyads from two autism rehabilitation centers in Central China. Children had a mean age of 5.25 years, and 75.3% of parents were aged between 31 and 40 years. Partial Pearson correlation analyses were conducted to examine associations between children's and parents' PA levels and multiple domains of QOL, controlling for child age, sex, and symptom severity. Significant reciprocal associations were observed between the PA levels of children with ASD and their parents. Specifically, children's light-intensity physical activity (LPA) was positively associated with parents' LPA ( These findings underscore the potential of LPA as a feasible and accessible form of joint activity that may support QOL within families of children with ASD. Framed through reciprocal determinism, the results highlight the interconnected roles of children's PA (behavior), parents' psychological well-being (personal factor), and the family context (environment). Further longitudinal and intervention studies are warranted to confirm these relationships and inform family-centered PA interventions. Show less

Symptoms of social anxiety and depression often co-occur, but many questions remain about symptom-level co-occurrence and the heterogeneity of symptom presentations across individuals, as well as their emotional functioning. This study aimed to investigate the co-occurrence of social anxiety and depressive symptoms in adults and variations in emotional functioning linking symptom heterogeneity. This study used a person-oriented approach, Latent Profile Analysis (LPA), to identify distinct profiles (i.e., subgroups) in a UK adult sample ( Four profiles were identified: Comorbid (12.61%), Dysphoric (10.36%), Socially Anxious (36.94%), and Low Distress (40.09%), replicating the four-profile solution revealed in prior research on adolescents. The Comorbid subgroup reported the most pronounced emotional dysfunction, with higher daily negative affect, lower positive affect, and greater emotion dysregulation than the other three subgroups. The Low Distress subgroup reported the best emotional functioning. The cross-sectional study design restricts our ability to evaluate the long-term stability of the identified profiles. Nevertheless, this study illuminates the diverse ways social anxiety and depression intertwine, underscoring the necessity of transdiagnostic interventions that cater to a wide range of symptom patterns and emotional functioning. Show less

Elevated lipoprotein(a) [Lp(a)] and low high-density lipoprotein-cholesterol (HDL-C) are established cardiovascular (CV) risk factors, but their combined impact on mortality and sex differences remains unclear. This retrospective study analyzed 97 396 patients with measured Lp(a) and HDL-C. Groups were stratified by Lp(a) (≥50 vs. <50 mg/dl) and HDL-C [low (<40), optimal (40-60), high (>60 mg/dl)]. Mortality was assessed using the Kaplan-Meier curve and Cox models. Over a median of 5.9 years, 7794 deaths occurred. Compared to optimal HDL-C/low Lp(a) (reference), high HDL-C/low Lp(a) had the lowest mortality [adjusted hazard ratio (aHR): 0.85; 95% confidence interval (CI): 0.80-0.91], while low HDL-C/high Lp(a) had the highest risk (aHR: 1.55; 1.41-1.71). High HDL-C protective effect was insignificant with elevated Lp(a) (aHR: 0.98; 0.89-1.08). Sex-stratified analyses revealed divergent effects: women with high HDL-C/high Lp(a) retained the HDL-C protective effect (aHR: 0.82; 0.72-0.93), whereas men faced increased risk (aHR: 1.22; 1.05-1.42). Elevated Lp(a) enhances mortality risk despite elevated HDL-C levels, with sex-specific differences: women retain mortality benefits from high HDL-C despite elevated Lp(a), whereas men with concurrent elevations in HDL-C and Lp(a) experienced mortality risks comparable to those with low HDL-C. Findings underscore sex-specific CV risk stratification incorporating HDL-C and Lp(a), challenging the HDL-C universal protective role. Show less

As global population aging intensifies, mental health issues in older adults are increasingly prominent, with depression being particularly prevalent and detrimental. The study investigated how substituting sedentary behavior (SB) and sleep (SLP) with physical activity (PA) affects depression risk in this population. Meta-analysis was conducted by searching four databases: PubMed, Scopus, SPORTdiscus, and PsycINFO (via EBSCOhost platform) for relevant studies published until January 2025. Regression coefficients (β) with 95% confidence intervals (CIs) for depressive symptoms were estimated. Publication bias was assessed using funnel plots and Egger's tests, and heterogeneity was evaluated using Q tests and the I Among 18,912 participants (53.45% female, ≥60 years) across nine studies, replacing SB with MVPA significantly reduced depression (β = -0.12, 95% CI: -0.20, -0.04), subgroup analyses indicated that reallocating 10, 30 and 60 min/day of SB to MVPA ( Substituting SB and SLP with MVPA is significantly associated with a reduction in depression, whereas no significant association is observed when replaced by LPA. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=546666, identifier CRD42024546666. Show less