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Pulmonary artery sling (PAS) is a rare congenital vascular anomaly in which the left pulmonary artery (LPA) originates from the right pulmonary artery (RPA), forming a ring around the tracheobronchial tree. Due to non-specific respiratory symptoms, it is frequently misdiagnosed, leading to significant delays in diagnosis. This report emphasizes the crucial role of quantitative multimodal imaging in establishing a definitive diagnosis, stratifying risk, and guiding optimal surgical planning. A 4-year-and-7-month-old boy presented with a 4-year history of recurrent cough and wheezing that was refractory to standard medical therapy. Echocardiography revealed a dilated main pulmonary artery (MPA) measuring 1.9 cm ( This case of isolated PAS underscores the indispensable role of a multimodal imaging strategy. While echocardiography can provide initial clues, quantitative CTA is paramount for definitive anatomical classification, precise stenosis quantification, and comprehensive preoperative planning. Early consideration of PAS in children presenting with refractory respiratory symptoms, coupled with advanced imaging, can prevent misdiagnosis and optimize outcomes. Show less

Global life expectancy has consistently increased since 1950, resulting in more people living to an older age. However, maintaining optimal cognitive health is a challenge as ageing is accompanied by natural cognitive decline, which can affect daily functioning and quality of life. Importantly, modifiable lifestyle factors can play a role in promoting healthy ageing. Among these, physical activity (PA), sedentary behaviour (SB) and sleep have gained increasing attention for their potential contributions to cognitive health. This study investigates in greater detail how these 24-hour movement behaviours relate to cognitive function in older adults. Participants were 233 healthy adults aged 55 years and older (51.1% women; mean age 68.3 ± 7.7 years). Daily time spent in light PA (LPA), moderate-to-vigorous PA (MVPA), SB and sleep was derived from 7-day wrist-worn ActiGraphy (wGT3X-BT). Cognitive function, including short-term and long-term memory (STM, LTM), executive function (EF) and processing speed, was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and expressed in z-scores. Compositional multiple linear regression was used to assess the association between time use and cognitive function. Compositional isotemporal substitution examined how hypothetical time reallocations between the different movement behaviours were related to cognitive function. Even after adjusting for age, sex, educational level, social isolation and multiple testing, time use was significantly associated with short-term memory (p = 0.01) and executive function (p = 0.001). Hypothetical time reallocations of 30-min from LPA to MVPA were associated with the largest significant mean differences of 0.19 [95% confidence interval 0.05-0.32] in STM z-scores and 0.21 [0.10-0.33] in EF z-scores. Notably, reallocating time from LPA or sleep to SB was also related to better EF z-scores. Importantly, reallocating even 5 minutes away from MVPA to any other behaviour was significantly associated with poorer z-scores in STM and EF. No significant associations were observed for long-term memory and processing speed. This study underscores the importance of considering 24-hour movement behaviours in cognitive health at older age. Dedicating time to moderate-to-vigorous PA seems to be important for specific cognitive domains. Longitudinal studies are needed to further explore these relationships, with a focus on detailed assessments of the various contexts in which PA and SB occur. Show less

Patients with maintenance hemodialysis (MHD) present endothelial dysfunction (ED), which is characterized by impaired vasodilation and a pro-inflammatory state. Lipoprotein(a) (Lp(a)) has pro-inflammatory and pro-atherogenic properties. No study has investigated the association between serum Lp(a) and ED in patients with MHD. This study was conducted to address this issue. We collected serum specimens from 123 fasting MHD patients. The endothelial function was measured using the vascular reactivity index (VRI) determined by digital thermal monitoring, and VRI values of ≥ 2.0, 1.0 to <2.0, and < 1.0, indicated good, intermediate, and poor vascular reactivity, respectively. Lp(a) levels were measured by enzyme-linked immunosorbent assay. Of the 123 MHD patients, 54 (43.9%) had good VRI, 51 (41.5%) had intermediate VRI, and 18 (14.6%) had poor VRI. Serum Lp(a) levels ( The serum Lp(a) level had a negative correlation with the VRI, and it may serve as a potential biomarker for early detection of ED in MHD patients. Show less

To elucidate the accurate roles of dysfunctional sleep beliefs in modulating cancer-related fatigue (CRF), identify distinct sleep hygiene profiles, and assess whether and how these profiles serve as mediators in lung cancer patients undergoing chemotherapy. This study recruited 396 lung cancer patients receiving chemotherapy between May and December 2023. Participants completed the Sleep Hygiene Index, Brief Fatigue Inventory, and Dysfunctional Beliefs and Attitudes about Sleep Scale. Latent profile analysis (LPA) was conducted to identify profiles of sleep hygiene, and mediation analysis was performed to explore the impacts of sleep hygiene profiles and dysfunctional sleep beliefs on CRF. LPA revealed three distinct sleep hygiene profiles: normal (33.3%), excellent (50.3%), and poor (16.4%). Family monthly disposable income, radiotherapy, and performance status were identified as influential factors distinguishing these profiles. Additionally, the dimensions of dysfunctional sleep beliefs and sleep hygiene profiles showed different correlations with CRF. With the normal sleep hygiene group as reference, mediation analysis revealed that poor sleep hygiene serves as a mediator between sleep worry of dysfunctional sleep beliefs and CRF (SE = 0.010, 95% CI [0.006, 0.047]). This study contributes to understanding the heterogeneity in sleep hygiene in lung cancer patients undergoing chemotherapy and elucidates the underlying mechanisms of the relationship between sleep worry of dysfunctional cognitions and CRF. Clinical healthcare providers developing targeted interventions in terms of sleep beliefs and sleep hygiene might be helpful to alleviate CRF in this population. Show less

Despite the critical role of e-Health literacy (eHL) in modern healthcare, current research predominantly concentrates on conditions such as cancer and diabetes, as well as outpatient care settings. However, there remains a significant gap in studies specifically addressing the eHL needs of patients with maintenance hemodialysis (MHD). This study aims to explore the latent categories of eHL among MHD patients and its impact on health-promoting lifestyle (HPL). A survey was conducted using a convenience sampling method involving 500 MHD patients from three tertiary hospitals in Baoding. Data were analyzed using latent profile analysis (LPA) and a mixed regression model. This study showed that MHD patients could be classified into low (23.17%), middle (49.78%), and high (27.05%) eHL groups, with the three-class model showing optimal fit (AIC = 2321.213, BIC = 2271.168, entropy = 0.967). MHD Patients in the high literacy group scored significantly higher in all dimensions of e-HL and overall HPL (119.58 ± 13.86) compared to those in the low literacy group (91.82 ± 11.73) (all The findings suggest a heterogeneous stratification of eHL among MHD patients, closely linked to HPL. Stratified intervention strategies should be developed for different patient groups to potentially improve their health behaviors. The study provides evidence-based support for personalized health management. Show less

Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of death. Although statins are the foundation of lipid-lowering therapy, many high-risk patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets due to intolerance or insufficient response. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as potent agents that address this residual risk. This review summarizes the clinical efficacy, safety, and mechanistic role of PCSK9 inhibitors in cardiovascular risk reduction. Relevant randomized trials, meta-analyses, and observational studies were analyzed, alongside emerging nonstatin therapies including bempedoic acid, inclisiran, and Angiopietin-like 3 inhibitors. PCSK9 inhibitors, such as alirocumab and evolocumab, have shown LDL-C reductions of up to 62% and significant decreases in major adverse cardiovascular events. Trials like Further cardiovascular outcomes research with PCSK9 inhibition in subjects With elevated risk (FOURIER) and Evaluation of cardiovascular outcomes after an acute coronary syndrome during treatment with alirocumab (ODYSSEY OUTCOMES) reported relative risk reductions of 15-24% in select populations. These agents also reduce lipoprotein(a) (Lp(a)) and stabilize atherosclerotic plaques. Additional therapies like inclisiran and bempedoic acid further expand treatment options, particularly for statin-intolerant patients. PCSK9 inhibitors offer a well-tolerated and effective approach to lowering LDL-C and mitigating cardiovascular risk. Their integration, along with emerging therapies, provides a comprehensive strategy to address residual ASCVD risk and improve patient outcomes. This review highlights the pivotal role of PCSK9 inhibitors in achieving significant LDL-C reduction and improving cardiovascular outcomes, especially in high-risk and statin-intolerant populations. By also targeting Lp(a) and promoting plaque stabilization, these agents address multiple contributors to residual ASCVD risk. Incorporating PCSK9 inhibitors and emerging nonstatin therapies into clinical practice offers a powerful strategy to enhance long-term cardiovascular prevention. Show less

Transcutaneous closure of patent ductus arteriosus (PDA) in childhood is a common procedure. Long-term follow-up by paediatric cardiologists is variable. Identification and classification of postoperative complications may enable targeted follow-up and timelier discharges. This study aimed to characterize complication rates and assess discharge timing. This is a single-centre retrospective study of paediatric patients (aged 0-15 years) who underwent a transcutaneous closure of a PDA between January 2006 and December 2015. A total of 156 patients who underwent interventional occlusion of a PDA were included. Complications were seen in 18 of 156 (12%) patients. High-grade complications occurred in 8 of 156 (5.1%) patients; these included device embolization, failure requiring surgical closure, or repeated interventional closure. Moderate to low-grade complications including flow acceleration in the aorta and left pulmonary artery (LPA) occurred in 10 of 156 (6.4%) patients. Fourteen of 18 (77%) complications were immediately apparent. Late mild to moderate obstruction of the descending aorta or LPA occurred in 3 of 156 (2%) patients. Later obstruction occurred in the Amplatzer ductal occluder 1 (ADO1) group only with large (4.5-5 mm) ducts. The average follow-up time for all patients was 81 (±47) months. Younger age at insertion and larger size of ADO1 devices were associated with later obstruction. In our cohort, PDA occlusion was associated with a 5.1% major complication rate, which is evident within 24 hours; a further 2% (all treated with ADO1 devices) developed between mild and moderate aortic or LPA obstruction at least 1 year after the procedure. To date, this has not required intervention. It may therefore be prudent to continue longer-term surveillance of patients who have undergone PDA occlusion with the ADO1 device. Show less

Elevated plasma lipoprotein(a) [Lp(a)] is a causal risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). However, commonly used ASCVD clinical risk-assessment tools in primary care do not include the measurement of Lp(a) levels, potentially under-estimating individual risk. Here we describe the case of a late-40s, asymptomatic, normotensive, non-smoking veteran athlete with a moderately raised low density lipoprotein cholesterol (LDL-C) level and a calculated 10-year QRISK3 score of 4.1%. Despite his low calculated QRISK3 score, significantly elevated Lp(a) levels led to advanced cardiovascular imaging, which revealed severe stenosis (75%, CAD-RADS 4A) of the left anterior descending coronary artery. This case demonstrates the limitations of conventional cardiovascular risk tools and highlights the importance of Lp(a) measurement for identifying and managing high-risk patients. Show less

The COPD guidelines recommend engaging in regular physical activity and reducing sedentary time (ST), but little is known about the optimal or minimal dose of physical activity and ST. This study aimed to quantify the prospective dose-response relationships between daily time spent in moderate to vigorous physical activity (MVPA), light physical activity (LPA), ST and mortality, and examine the theoretical consequences of replacing ST with equal time of MVPA or LPA. A population-based cohort study of 1,551 individuals with COPD enrolled in the UK Biobank. MVPA, LPA, ST were measured with the wrist-worn Axivity AX3 accelerometer. All-cause mortality was obtained through the linkage to death registries. Restricted cubic splines were used to assess the dose response associations of MVPA, LPA, ST and all-cause mortality. Isotemporal substitution models were used to estimate the theoretical effect of replacing ST with MVPA or LPA. 54% were male, and the mean (SD) age was 66.31 (6.52) years. Over a mean (SD) follow-up of 7.44 (1.67) years, 244 (15.7%) died. We observed a significant L-shaped association between MVPA and all-cause mortality, with an optimal amount at 60 min/day (HR = 0.27, 95% CI: 0.18-0.41). For LPA, we observed a significant U-shaped association, with an optimal amount at 5.2 h/day (HR = 0.15, 95% CI: 0.10-0.25). The threshold for ST was 12.43 h/day, above which a significant increase in mortality was observed. Replacing 30 min/day of ST was associated with 34% decreased risk in mortality for MVPA (HR = 0.66, 95%CI: 0.55-0.81, P < .001) and 10% lower mortality for LPA (HR = 0.90, 95% CI: 0.86-0.94, P < .001). The findings of this study suggest non-linear associations of MVPA, LPA, ST and all-cause mortality. Replacing ST with either MVPA or LPA is associated with decreased risk of mortality. Show less

Nurses frequently engage in high levels of emotional labor, which, when sustained, may be detrimental to their psychological well-being. However, the way nurses regulate emotions is heterogeneous. Identifying distinct emotional labor profiles and examining their psychological associations is crucial for developing tailored interventions. This study aimed to identify latent profiles of emotional labor among nurses in tertiary hospitals and investigate their associations with psychological resilience. A cross-sectional survey was conducted from March to May 2025 among 458 registered nurses across eight tertiary hospitals in Sichuan Province, China. Data were collected using a general demographic questionnaire, the Emotional Labor Scale, and the Psychological Resilience Scale. Latent Profile Analysis (LPA) was employed to identify distinct emotional labor profiles. One-way ANOVA was used to compare psychological resilience across profiles, and a multivariate logistic regression model was constructed to explore independent predictors of emotional labor categories. A total of 458 valid responses were analyzed. Three distinct emotional labor profiles were identified: Surface Acting-Suppression Type (C1, 30.3%), Deep Acting Type (C2, 45.4%), and Natural Engagement Type (C3, 24.2%). Multivariate logistic regression revealed that gender, age, employment type, monthly night shifts, salary satisfaction, and psychological resilience were significant predictors of emotional labor classification. Psychological resilience significantly differed across all profile comparisons: C1 vs. C2, C1 vs. C3, and C2 vs. C3 ( Emotional labor among nurses exhibits notable latent heterogeneity, with psychological resilience varying significantly across profile types. Tailored interventions are recommended based on emotional labor typologies to enhance psychological resilience and organizational support, thereby improving emotional labor management and promoting sustainable occupational health among nurses. Show less

To investigate the associations of monocyte count, lipoprotein(a) [Lp(a)], and monocyte-to-HDL ratio (MHR) with in-stent restenosis (ISR) in coronary heart disease (CHD) patients after drug-eluting stent (DES) implantation, and to develop a predictive risk model. This study enrolled 190 CHD patients who underwent DES implantation from 2019 to 2024. Based on 1-year coronary angiography, patients were divided into an ISR group ( Compared to the Non-ISR group, ISR patients had higher monocyte count, MHR, and Lp(a) levels (all Monocyte count, Lp(a), and MHR are closely linked to ISR in CHD patients post-DES. Combined assessment enhances risk prediction, offering a basis for early identification and personalized management to reduce restenosis and improve outcomes. Show less

With the aging population in China, research on preventing frailty is crucial. This study aims to investigate the independent and combined associations of the Dietary inflammatory index (DII) and physical activity (PA) with frailty among Chinese older adults. A total of 285 participants aged ≥60 years with 87 males and 186 females were recruited from Hunan Province. Daily moderate physical activity (MPA), vigorous physical activity (VPA) and light physical activity (LPA) were objectively measured using a triaxial accelerometer. A Food Frequency Questionnaire 25 (FFQ25) was used to assess the participants' dietary patterns, and DII was calculated. Six combined exposure groups were formed based on PA and DII: pro-inflammatory diet and insufficient PA group, neutral diet and insufficient PA group, anti-inflammatory diet and insufficient PA group, pro-inflammatory diet and sufficient PA group, neutral diet and sufficient PA group, and anti-inflammatory diet and sufficient PA group. Frailty was assessed using the Frailty Phenotype (FP), logistic regression analyzed the associations between dietary patterns, PA, and frailty. A total of 285 older adults participants were initially recruited, but 12 were excluded due to missing data. Consequently, 273 participants were included in the final analysis. Compared to individuals with insufficient PA, those with sufficient PA were associated with significantly lower odds of frailty (OR = 0.468, 95%CI = 0.242-0.907). Participants following an anti-inflammatory diet had significantly lower odds of frailty compared with those following a pro-inflammatory diet (OR = 0.467, 95%CI = 0.221-0.988). In the combined groups, frailty prevalence was significantly lower the group with anti-inflammatory diet and sufficient PA group (OR = 0.204, 95%CI = 0.072-0.583), compared with pro-inflammatory diet and insufficient PA group. The sensitivity analysis showed that the associations between anti-inflammatory diet and sufficient PA with frailty remained statistically significant, with the direction of the associations unchanged. These findings suggest that the results are robust. Our study indicates that adhering to an anti-inflammatory diet and maintaining sufficient PA may be associated with a lower likelihood of frailty. Achieving an adequate amount of PA and following a healthy dietary pattern may serve as potential preventive measures against frailty. Show less

This study aimed to explore the potential categories of resourcefulness in patients with type 2 diabetes mellitus (T2DM) and their relationship with self-management. A total of 513 hospitalized T2DM patients in Xi'an were surveyed using a general information questionnaire, the Resourcefulness Scale, and the Diabetes Self-management Activities Scale for Type 2 Diabetes. Latent profile analysis (LPA) was conducted to identify resourcefulness subgroups, and their relationship with self-management was examined. Patients with type 2 diabetes could be classified into three potential categories based on their resourcefulness status: a low resourcefulness level group (17.54%), a moderate resourcefulness level-social alienation group (66.66%), and a high resourcefulness level group (15.78%). Educational level, monthly per capita family income, and the presence or absence of complications were identified as factors influencing the potential categories of resourcefulness. Significant differences were observed in the total self-management scores among patients belonging to different potential categories of resourcefulness ( Type 2 diabetes patients can be classified into three potential categories of resourcefulness, with those in the high resourcefulness level group demonstrating higher self-management ability. Improving the level of resourcefulness can contribute to enhancing patients' self-management capabilities. Show less

People with HIV and chronic hepatitis C may develop metabolic complications after sustained virologic response (SVR), possibly due to persistent molecular alterations induced by HCV. This study aimed to identify baseline (pre-treatment) lipid and immune biomarkers associated with post-SVR metabolic events in HIV/HCV-coinfected participants with compensated advanced chronic liver disease (cACLD) receiving long-term suppressive antiretroviral therapy. We conducted a retrospective study of 56 HIV/HCV-coinfected participants with cACLD. Untargeted lipidomic profiling was performed on baseline plasma samples using a liquid-chromatography-mass spectrometer. The outcome was the development of metabolic events (diabetes mellitus and/or hyperlipidemia) during follow-up, up to seven years post-HCV treatment. Statistical analyses included orthogonal partial least squares discriminant analysis (OPLS-DA), Cox regressions models, and Spearman correlations with inflammation-related biomarkers and immune checkpoint proteins, with multiple comparison corrections using the false discovery rate. 25% participants developed metabolic events after SVR. OPLS-DA identified 163 lipid species (VIP scores≥1) associated with these events, and adjusted Cox regression confirmed significant associations for 24 of them. Lysophosphatidylcholines (LPCs) were the most prevalent, with higher baseline levels linked to increased metabolic risk. Participants who developed events also had higher levels of plasmalogens LPC (O-LPC), lysophosphatidylethanolamine (LPE), lysophosphatidylinositol (LPI), lysophosphatidic acid (LPA), and phosphosphatidylcholine (PC). Several lipid species correlated positively with the pro-inflammatory cytokine IL-18, the anti-inflammatory suppressor IL-1RA, and the immune checkpoint proteins IDO and S100A8/A9. Pre-treatment lipid and immune dysregulation was associated with post-SVR metabolic events in HIV/HCV-coinfected participants, suggesting that HCV may leave a lasting metabolic imprint that contributes to adverse outcomes after viral clearance. Show less

Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising intervention for Autism Spectrum Disorder (ASD), but objective markers for rTMS tolerance remain lacking. This case-control study explored gaze behavior variability toward emotional faces in ASD children undergoing rTMS, focusing on identifying subgroups associated with rTMS intolerance. Eye-tracking data (Tobii technology, preferential-looking paradigm) were collected from 104 ASD children (48 intolerant, 56 tolerant) receiving DLPFC-targeted rTMS (left high-frequency, right low-frequency). Latent Profile Analysis (LPA) identified fixation subgroups across eight conditions. Demographic (sex, age), clinical (CARS scores) differences, and profile-tolerance associations were analyzed. LPA revealed three gaze profiles: moderate non-preferential fixation (80.76%), low diverse fixation (9.62%), and increased fixation with mild variability (9.62%). Sex and CARS scores differed across profiles (age did not). Intolerance rates were 38.1%, 60.0%, and 100%, with profiles predicting rTMS intolerance (OR = 0.210, 95% CI: 0.079-0.557). ASD children exhibit heterogeneous emotional face gaze patterns. Findings highlight the need for personalized rTMS interventions, especially for those with higher CARS scores and increased emotional face fixation-at elevated intolerance risk. Show less

The competency of specialist nurse clinical educators is crucial for the effectiveness of specialist nurse training programmes. However, variability in teaching competency and training needs among educators remains insufficiently studied, especially in the context of rapidly evolving healthcare education in China. This study aimed to identify distinct core competency profiles among clinical educators for specialist nurses, examine associated socio-demographic factors, and explore differences in training needs across profiles. A cross-sectional online survey was conducted with 3,945 specialist nurse clinical educators from 30 Chinese regions. The Chinese version of the Nurse Educator Core Competency Scale (NECCS) and a self-developed training needs questionnaire were used. Latent Profile Analysis (LPA) identified competency subgroups, while multinomial logistic regression and Kruskal-Wallis tests examined associated variables and training needs. Latent Profile Analysis identified three competency profiles: foundational (8.6%), intermediate (43.0%), and advanced (48.4%), with mean scores of 43.89, 68.24, and 91.68, respectively. Educators without prior training were significantly more likely to belong to the foundational (OR = 3.195, p < 0.001) and intermediate (OR = 1.676, p < 0.001) groups compared to those with training experience. Advanced-competency educators showed the highest demand for curriculum design training, with 75% rating it as highly necessary. In contrast, educators in the intermediate group identified clinical teaching methods and techniques as their top training need (58.7%). Those in the foundational group prioritised common pedagogical methods and instructional technologies (54.7%). Clinical educator competencies vary by background characteristics and training exposure. Tailored, competency-based training is needed to address these gaps and enhance the quality of specialist nursing education. Show less

Physical activity-related mechanical loading may alter the structural and mechanical properties of the infrapatellar fat pad (IFP), a pain-sensitive tissue. Echo intensity and stiffness reflect the mechanical properties of the IFP and are clinically relevant. This study aimed to investigate the associations between physical activity levels and ultrasound-derived properties of the IFP in older adults. Forty-six older adults participated in this cross-sectional study. Physical activity, including light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), was measured using a triaxial accelerometer. Echo intensity and stiffness of the IFP were assessed using ultrasound imaging and shear wave elastography. Simple and multiple linear regression analyses were conducted to examine associations between physical activity levels and IFP characteristics. MVPA was significantly negatively correlated with IFP echo intensity (r = -0.32), and LPA was significantly negatively correlated with IFP stiffness (r = -0.29). In multiple regression analyses, the association between LPA and IFP stiffness remained significant after adjusting for demographic variables. These findings suggest that physical activity influences the biological and mechanical properties of the IFP in older adults. Increasing both LPA and MVPA may help maintain or improve IFP condition, potentially contributing to better knee joint health. UMIN000053230. Show less

An increasing number of university students report feeling lonely, a negative experience arising from a mismatch between perceived and actual social relationships. Loneliness has been linked to poorer mental health. However, the relationship between qualitative (sources of loneliness) and quantitative (high or low) differences in loneliness and mental health is under researched. The aims of this research were to (a) identify profiles of loneliness among university students across three indicators of loneliness, namely, social, family, and romantic indicators, using latent profile analysis (LPA); (b) examine the differences among identified profiles based on dimensions of mental health indicators (depression, anxiety, and stress), social support, and life satisfaction; and (c) assess profile membership based on demographic variables (gender, social isolation, relationship status, and education characteristics) and the Big Five personality traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism). A cross-sectional survey was conducted on 912 university students from five cities in Uttar Pradesh, India. Participants completed questionnaires covering demographic details and validated measures assessing loneliness, depression, stress, anxiety, social support, life satisfaction, and the Big Five personality traits. Data were analyzed using the latent profile module in Jamovi and fit indices, namely, BIC, AIC, and BLRT, and entropy was used to select the best profile. The latent profile analysis identified four profiles for university student loneliness, including Social and emotional lonely (31.4%), Moderate romantic lonely (23.8%), Moderate social lonely (8.2%), and Severe romantic lonely (36.6%). Moreover, the Social and emotional lonely profile scored the highest on depression, anxiety, and stress. The Moderate romantic lonely profile scored the highest on life satisfaction and social support. Being in a relationship decreased the likelihood of being categorized as Severe romantic lonely. In terms of personality, neuroticism was the strongest predictor of profile membership. This study is a step towards identifying at-risk lonely individuals with varying sources of loneliness. Identifying different profiles of lonely individuals will have direct implications for designing interventions that cater to a particular group rather than a one-size-fits-all approach. Show less

Borderline Personality Disorder (BPD) is a complex and heterogeneous condition characterized by diverse patterns of emotional, interpersonal, behavioral, and identity-related dysfunctions. This study employed both variable-centered and person-centered approaches to examine the relationship between specific BPD domains and key pretreatment client characteristics. A total of 801 combined sample of university students (n = 513, Mean age = 25.30, SD = 6.74, 39.80 % male) and psychiatric outpatients (n = 288, Mean age = 34.96, SD = 8.92, 38.20 % male) completed the Five Factor Borderline Inventory-Short Form (FFBI-SF) alongside measures of defense mechanisms, insight, interpersonal problems, and attachment styles. Confirmatory factor analysis supported the a priori four-factor structure of the FFBI-SF which included Affective Dysregulation, Interpersonal Difficulties, Behavioral Dysregulation, and Identity Problems domains. Variable-centered analyses revealed that these domains showed distinct patterns of associations with client variables. Furthermore, latent profile analysis (LPA) identified five distinct profiles based on FFBI-SF domain scores, which showed clinically important differences in pretreatment client variables, including defense mechanisms, insight, interpersonal problems, and attachment patterns. Overall, findings highlight the importance of integrating variable- and person-centered approaches to understanding BPD as a multidimensional construct. Also, recognizing domain-specific patterns and subgroup differences can support the development of more individualized and clinically responsive interventions. Show less

Guided by the stress-diathesis model, this study employed latent profile analysis to investigate heterogeneity in suicide risk profiles and inform targeted intervention strategies among college vocational students. Data were collected from 1,620 vocational college students identified as high-risk for suicide. Validated instruments-including the Adolescent Life Events Scale (ASLEC), Symptom Checklist-90 (SCL-90), and Social Support Rating Scale (SSRS)-were used to assess stress factors (negative life events), symptom factors (depression, anxiety, psychosomatic symptoms), diathesis traits (neuroticism, adverse childhood experiences), and protective factors (social support). Latent profile analysis (LPA) was applied to identify distinct risk subgroups. LPA revealed three distinct risk subgroups: a High-risk group (17.4%), characterized by severe psychological symptoms, elevated suicide preparation, and impaired social functioning; a Moderate-risk group (46.5%), defined by neuroticism, persistent despair, and intermediate symptom severity; and a Low-risk group (36.1%), distinguished by robust social support and minimal psychopathological manifestations. Regression analyses indicated that negative life events, depressive symptoms, and neuroticism significantly predicted suicide risk, while social support served as a protective factor. These findings validate the stress-diathesis framework and advance suicide prevention research by operationalizing heterogeneous risk profiles through LPA. The tripartite classification system offers actionable insights for tiered campus mental health interventions, suggesting crisis management for high-risk individuals, resilience-building for moderate-risk groups, and preventive support for low-risk populations. Show less

Lipoprotein(a) (Lp(a)) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and has been linked to ventricular arrhythmias (VA). Beyond its role in cholesterol metabolism, Lp(a) promotes endothelial dysfunction, thrombogenesis, and inflammation, which may contribute to arrhythmogenesis independent of ASCVD. This study aimed to evaluate the association between Lp(a) levels and the incidence of VA in a large, population-based cohort. Adults aged ≥18 years with available Lp(a) measurements were identified from the TriNetX research network. Patients were stratified into low (≤75 nmol/L) and high Lp(a) groups (>75 nmol/L). The primary outcome was the incidence of VA, defined as ventricular tachycardia, fibrillation, flutter, or cardiac arrest owing to cardiac causes. Propensity score matching was used to adjust for demographics, ASCVD risk factors, and comorbidities. Kaplan-Meier survival analysis and Cox proportional hazards models were performed after matching. Before propensity score matching, 75,655 patients were in the low Lp(a) group and 40,860 in the high Lp(a) group. After matching, each cohort included 39,414 patients. VA occurred in 889 patients in the low and 718 in the high Lp(a) cohort. Mean follow-up was 3.35 years [low Lp(a)] and 1.90 years [high Lp(a)]. The high Lp(a) group had lower VA-free survival (84.30% vs 86.06%, Elevated Lp(a) levels are independently associated with a higher incidence of VA, even after adjusting for ASCVD and its downstream consequences. Future research should explore mechanisms and therapeutic implications. Show less

Patients with systemic lupus erythematosus (SLE) frequently experience poor sleep quality. This cross-sectional study aimed to identify distinct sleep disturbance profiles in SLE patients and examine their associations with demographic, disease-related, and psychosocial factors. A total of 331 patients with SLE were included. Latent profile analysis (LPA) was conducted using the tidyLPA package. Logistic regression models were constructed to assess associations between the identified sleep disturbance clusters and physical and psychological outcomes, based on factors significantly influencing the LPA results. The physical and psychological outcomes were estimated using the Hospital Anxiety and Depression Scale (HADS) and the Fatigue Severity Scale (FSS). Sleep clusters were analyzed through multivariate logistic regression. Three distinct sleep disturbance profiles were identified: Cluster 1 (severe sleep disturbance) (n = 42), Cluster 2 (moderate sleep disturbance) (n = 174), and Cluster 3 (mild sleep disturbance) (n = 115). LPA yielded an entropy value of 0.996 for the three-cluster model. The mean total Pittsburgh Sleep Quality Index (PSQI) score for the SLE samples was 7.59 ± 3.44. Among the various sleep quality domains, sleep latency and subjective sleep quality were the most significantly affected in SLE patients. The analysis revealed that disease duration, severity of fatigue, use of calcium supplements, impaired renal function, anxiety, and depression were all significant factors influencing cluster membership. This study identified three distinct patterns of sleep disturbance among SLE patients. Cluster 1 (severe sleep disturbance) was characterized by prolonged sleep latency despite high sleep efficiency and subjective sleep quality scores. Cluster 2 (moderate sleep disturbance) exhibited longer sleep duration than Cluster 1, while Cluster 3 (mild sleep disturbance) had the lowest scores across all sleep quality domains. These findings suggest that sleep disturbance profiling may facilitate personalized sleep management strategies for patients with SLE. Show less

Although low-density lipoprotein cholesterol (LDL-C) is established as the primary cardiovascular disease (CVD) risk factor, some individuals with LDL-C within desirable limits still develop coronary artery disease (CAD). Lipoprotein(a) (Lp(a)) has emerged as a genetically determined independent risk factor for CVD. This study aims to investigate Lp(a) by determining its association with coronary artery stenosis severity, identifying its ethnic-specific genetic determinants and assessing its relationship with an energy-dense dietary pattern. The PUTRA-CV study is a 3-year, multicentre, case-control observational study involving adult patients who have undergone coronary angiography. The primary outcome is the association between Lp(a) levels and the severity of angiographic CAD (assessed by Gensini or Syntax score). Secondary outcomes include the frequencies of Lp(a)-associated single nucleotide polymorphisms (SNPs) (rs10455872 and rs3798220) and the association between dietary patterns and Lp(a) levels. Lp(a) will be measured using a particle-enhanced immunoturbidimetric method, and SNPs will be genotyped using high-resolution melting. Dietary intake will be assessed using a validated semiquantitative food frequency questionnaire. Data will be analysed using SPSS. Descriptive statistics will be used to summarise population characteristics. Bivariate analyses will use chi-square (χ2), independent t-tests or Mann-Whitney U tests as appropriate. The independent association between Lp(a) and coronary artery stenosis severity will be determined using multivariable logistic regression, adjusting for confounders. Empirically driven dietary patterns will be derived using reduced rank regression, and their association with Lp(a) will be assessed. For genetic analysis, allele frequencies of the Ethical approval has been obtained from the ethics committees of the Ministry of Health Malaysia (NMRR ID-24-00877-2ID-IIR), Universiti Putra Malaysia (JKEUPM-2024-246), Universiti Teknologi MARA (REC/07/2024-OT/FB/2) and Universiti Malaya Medical Centre (MREC ID NO: 2 02 453-13692). The findings will be disseminated via peer-reviewed journals and conferences. Show less

Calcific aortic valve stenosis (CAVS) is the most prevalent valvular heart disease and a growing global health concern. Aortic sclerosis (ASc) and aortic stenosis (AS) represent a continuum of progressive disease characterized by leaflet thickening, inflammation, lipid deposition, and calcification. Lipoprotein(a) [Lp(a)], with its pro-atherogenic, pro-inflammatory, and pro-calcific properties, has emerged as a key contributor to this process. While its role in atherosclerotic cardiovascular disease is well established, the relationship between Lp(a) and CAVS has been demonstrated in several key studies; however, the available evidence remains limited in volume, and important gaps persist in understanding mechanisms, risk stratification, and therapeutic implications. A systematic literature search was conducted in PubMed, Cochrane Library, ScienceDirect, Medline, ResearchGate, Embase, and Google Scholar in accordance with PRISMA guidelines. Eligible studies included observational designs (cross-sectional, cohort, case-control) and randomized trials evaluating associations between Lp(a) levels, genetic variants, and CAVS. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Eighteen studies met the inclusion criteria, comprising six case-control, six cohort, and six cross-sectional studies with a total of 153,192 participants. No randomized controlled trials were identified. Elevated Lp(a) levels were consistently associated with an increased risk of AS and aortic valve calcification (AVC), with a dose-dependent effect. The risk was highest at levels ≥50 mg/dl, though some evidence supported risk at ≥30 mg/dl. Genetic analyses identified rs10455872 as a significant risk allele, while rs3798220 showed inconsistent associations. Multi-ethnic cohorts highlighted racial variability: Afro-Caribbean individuals had higher baseline Lp(a) levels but lower AVC prevalence than Caucasians. Lp(a) is an independent risk factor for CAVS, influenced by both concentration and genetic variation. Early screening and emerging Lp(a)-lowering therapies, including antisense oligonucleotides, small interfering RNA, and PCSK9 inhibitors, may help mitigate disease progression. Further randomized trials are needed to determine whether Lp(a) reduction translates into cardiovascular and valvular benefit. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024533835, PROSPERO CRD42024533835. Show less

Continuous glucose monitoring (CGM) offers a unique opportunity to assess Q6 glucose patterns across the 24-hour day, including nighttime. In individuals with pregnancy hyperglycemia, evidence suggests that optimizing nocturnal glucose levels reduces the risk of large-for-gestational-age births and future metabolic dysfunction. However, the behavioral correlates of nocturnal glucose levels remain poorly understood. Continuous movement devices assess physical activity (PA) and sedentary behavior (SED) across 24-hour days, and to the best of our knowledge, have not been paired with CGM data in individuals with pregnancy hyperglycemia. This secondary analysis of a feasibility trial explored the association of day-time PA and SED with nighttime (i.e., 12-6 AM) interstitial glucose levels in individuals with gestational diabetes mellitus (GDM) or gestational glucose intolerance (GGI). Participants (N = 13; ~31 weeks gestation) wore a Dexcom G6 CGM and ActiGraph Insight Watch for 7 days. Mixed effects models examined associations between daytime moderate-tovigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior (SED) with nocturnal glucose metrics, including mean glucose, time in range (TIR; 60-99 mg/dL), and area under the curve (AUC). Adjusted models revealed that each 10-minute increase in MVPA was associated with 0.86 mg/dL [95% confidence interval (CI) 0.002, 1.73] higher mean glucose and 313 mg/ dL*min (CI 0.98, 624.55) higher AUC. No associations were observed for total activity, LPA, or SED. These findings illustrate the feasibility and potential of combining CGM with activity monitor data, and the need to further integrate dietary intake data. Improvements in glucose and activity monitoring technology hold great promise for improving scientific and clinical understanding and supporting the development of personalized, data-driven glucose management tools during pregnancy. Show less

Peripheral artery disease (PAD) is a major global health issue. This study investigated the relationship between lipoprotein(a) [Lp(a)], high-density lipoprotein cholesterol (HDL-C) to blood cells ratios, and PAD development. The study included 361 patients categorized into groups based on the presence of stenotic atherosclerosis in lower limb arteries (LLAs) diagnosed via duplex ultrasound. Group 1 (n = 238) had atherosclerosis at the first visit. A second visit involved 281 patients: 158 from Group 1, 32 new diagnoses (Group 2), and 91 with no atherosclerosis at either visit (Group 3). Laboratory analysis included lipid profiles, Lp(a), and complete blood counts, calculating ratios like Lp(a)/HDL-C and monocyte-to-HDL-C ratio (MHR). Showed patients with stenotic atherosclerosis had significantly higher Lp(a) (20.2 vs. 12.1 mg/dL, Show less

This study systematically examines the relationship between mindfulness and metacognition among Chinese college students through a person-centered analytical approach. Using latent profile analysis (LPA) of Five Facet Mindfulness Questionnaire (FFMQ) responses, we identified four distinct mindfulness profiles: (1) High Observation/Low Non-reactivity, (2) High Awareness/Judging, (3) Moderately Mindful, and (4) Highly Mindful. Gender differences were observed across profiles, with female students more represented in the Highly Mindful group. Hierarchical regression analyses revealed that mindfulness profiles significantly predicted metacognitive ability, with the Highly Mindful group demonstrating superior metacognitive self-regulation and learning strategy application. These findings contribute to the literature by identifying distinct mindfulness subtypes and their differential relationships with metacognition. The results suggest that educational interventions emphasizing non-judgmental present-moment awareness may be particularly effective for fostering students' metacognitive development, while highlighting the importance of considering individual differences in mindfulness training approaches. Show less

Alzheimer's Disease (AD), the leading cause of dementia, is characterized by complex pathological mechanisms that extend beyond amyloid-β plaques and tau tangles. This study investigates the dysregulation of lipids with a focus on phospholipids and sphingolipids, in human post-mortem AD brain tissue using lipidomics methodology. By employing a ZIC-HILIC LC-MS/MS platform, the lipidome of AD ( Show less