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Previous studies showed that obstructive sleep apnea (OSA) is associated with dyslipidemia. However, whether micro-arousals during rapid eye movement (REM) and non-rapid eye movement (NREM) sleep independently associated with dyslipidemia were unknown. 4472 participants with OSA-related symptoms were finally included in our cohort. Various sleep variables including micro-arousal index (MAI) were obtained from standard polysomnography (PSG) recordings. Fasting serum lipid levels were assessed at our hospital laboratory. Linear regression models were employed to investigate relationships between micro-arousals in REM and NREM sleep and lipid profile with adjusting for multiple confounding factors. Fully adjusted models demonstrated a significant dose-dependent positive correlation between the MAI during REM sleep (MAI MAI Show less

Suicide prevention in nursing homes requires a deeper understanding of the psychological mechanisms underlying suicidal ideation. This study aimed to identify mental health profiles in institutionalized older adults based on risk and protective variables, and to explore their association with suicidal ideation. A total of 231 older adults (60-97 years) from nine Spanish nursing homes were assessed on depression, hopelessness, perceived burden, purpose in life, resilience, and self-efficacy. Latent Profile Analysis (LPA) was used to identify distinct profiles, and ANCOVA tested differences in suicidal ideation across groups. Four psychological profiles were identified: (1) High Risk (high symptomatology, low protection), (2) Burdensomeness (low depression and hopelessness, high burden), (3) Weakened Strengths (low symptomatology, low resources), and (4) Optimal Mental Health (low risk, high protection). Suicidal ideation levels differed significantly across profiles, and these differences remained after controlling for age, sex, and perceived health. The High Risk group showed the highest levels of suicidal ideation, whereas the Optimal Mental Health group showed the lowest. These profiles offer a basis for more personalized and effective prevention interventions tailored to each group's risk-protection balance. Screening for suicidal ideation in nursing homes should incorporate both risk factors (depression, hopelessness, perceived burden) and protective factors (resilience, purpose in life, self-efficacy). A person-centered approach allows gerontologists to tailor prevention strategies to specific psychological profiles. Show less

This study explored latent mental health profiles among adolescents in southwestern China and the association with emotional regulation using the dual-factor model framework. 1,682 junior middle school students completed the LPA revealed three profiles: Troubled (31.51%, high negative symptoms/low well-being), complete mental health (61.30%, low negative symptoms/high well-being), and more troubled (7.19%, severe negative symptoms/extremely low well-being). Cognitive reappraisal positively predicted complete mental health (vs. Troubled; Three distinct profiles emerged, differing from the traditional dual-factor model. Cognitive reappraisal protects mental health, while expressive suppression correlates with poorer outcomes, highlighting the need for targeted interventions promoting cognitive reappraisal. Show less

In China, work connectivity behavior after-hours (WCBA) among operating room nurse who are parents (OR nurse-parents) are associated with increased occupational fatigue, whereas psychological detachment may serve as a potential protective factor. A thorough understanding of the relationship among the three factors is conducive to the management of occupational fatigue. Explore the relationship between OR nurse-parents' WCBA and occupational fatigue through Latent Profile Analysis (LPA), and analyze the mediating effect of psychological detachment. This study constituted a secondary analysis of cross-sectional data from a prior study involving OR nurse-parents in 15 tertiary hospitals in Shandong Province, China. Inclusion criteria were: (1) registered nurse with >1 year of OR experience; (2) parent of at least one child aged 0-18 years; (3) voluntary informed consent. Exclusion criteria were: (1) temporary staff or interns; (2) on extended leave during the study; (3) major comorbidities. A two-part analytical strategy was used. First, latent profile analysis identified subgroups by WCBA, psychological detachment, and occupational fatigue, with multinomial logistic regression then examining predictors of profile membership. Second, a parallel mediation analysis tested psychological detachment as a mediator between WCBA and occupational fatigue. Data came from the 724 included OR nurse-parents. LPA revealed a three-profile model: "low WCBA-high psychological detachment-low occupational fatigue group (22%)," "moderate WCBA-moderate psychological detachment-moderate occupational fatigue group (50%)," and "high WCBA-low psychological detachment-high occupational fatigue group (28%)." Multivariate analysis identified working over 10 h daily as a risk factor for the high-risk group. Furthermore, Psychological detachment partially mediated the WCBA- occupational fatigue relationship across all occupational fatigue dimensions, accounting for 17.73%-31.52% of total effects. Mediation analysis confirmed that psychological detachment partially mediates the relationship between WCBA and occupational fatigue. LPA of WCBA, psychological detachment, and occupational fatigue revealed a three-profile solution among operating room nurse-parents in Shandong Province. A critical finding of LPA is that WCBA moderates the relationship between occupational fatigue and psychological detachment, creating a dual effect: while psychological detachment generally reduces occupational fatigue, its benefit diminishes or reverses under moderate WCBA, likely due to unclear communication expectations. Therefore, effective interventions must address both aspects: managing after-hours connectivity to reduce its intrusion and proactively promoting genuine psychological detachment to mitigate fatigue. Show less

To explore the latent categories of volume management behaviors in patients with chronic heart failure (CHF) and analyze their relationship with symptom distress. This cross-sectional study utilized a convenience sampling method to select 552 CHF patients from the cardiology departments of Nantong Sixth People's Hospital and Nantong Fourth People's Hospital. Volume management behaviors were assessed using the Volume Management Behavior Scale, and symptom distress was evaluated using the Symptom Distress Questionnaire (SDQ), which measures the severity of eight core symptoms. Latent Profile Analysis (LPA) was employed to identify behavioral categories. Multivariate Analysis of Variance (MANOVA) and multiple linear regression were used to analyze differences in symptom distress across behavioral categories and to examine the independent predictive effect of behavioral classification on symptom distress. The volume management behaviors of CHF patients were classified into three latent categories: active management type (43.1%), selective adherence type (27.7%), and passive dependence type (29.2%). Symptom distress scores showed a significant increasing trend across the three categories (active type: 10.5 ± 3.8; selective type: 13.2 ± 4.1; passive type: 16.3 ± 5.2, CHF patients exhibit three distinct clinical patterns of volume management behaviors, with the passive dependence type associated with the highest symptom burden. Behavioral category is a significant predictor of symptom distress. These findings provide an empirical basis for developing precise intervention strategies tailored to different behavioral phenotypes. Show less

Ketamine-assisted therapy is emerging as a fast-acting intervention for treatment-resistant depression and anxiety. However, individual response to treatment varies, and little is known about how personality traits and trauma history influence outcomes. This study investigated whether distinct personality profiles emerge in a real-world sample of patients undergoing ketamine therapy and examined how these profiles, along with trauma history, relate to baseline symptoms and short-term treatment outcomes. A total of 184 patients seeking ketamine-assisted therapy at a Canadian clinic completed baseline assessments, including the Mini-IPIP (personality), PHQ-9 (depression), GAD-7 (anxiety), and WHOQOL-BREF (quality of life). Latent profile analysis (LPA) was used to identify personality-based subgroups. Paired-sample t-tests and ANOVAs were conducted to examine differences in symptom severity and change scores after treatment. Three personality profiles were identified: Easygoing Extraverts, Average, and Reserved Introverts. Reserved Introverts reported significantly higher baseline depression and anxiety than other profiles. While all profiles showed improvements in depression and anxiety one-week post-treatment, the personality profiles did not predict differential symptom change. However, participants with a trauma history showed greater reductions in depression and improvements in physical quality of life than those without. Personality traits relate to baseline mental health severity but not short-term response to ketamine. Trauma history may predict greater benefit from treatment. These findings support further integration of personality and trauma assessments into personalized care approaches. Show less

Recent researches highlight the interdependence of lipoprotein(a) [Lp(a)] and Lp(a)-associated cardiovascular risk with the background inflammatory burden. This study aimed to investigate whether systemic inflammation modulates Lp(a)-associated coronary stenosis in chronic coronary syndromes (CCS). A total of 1513 participants undergoing angiography at a tertiary cardiology center in China were included in our retrospective, cross-sectional study. Participants were categorized into normal, mild, and severe groups based on the Gensini Scores, which quantitatively assess stenosis severity. Multinomial logistic models were calculated according to accompanying systemic inflammation concentration. Participants with elevated Lp(a) levels had a high coronary stenosis risk: fully adjusted model odds ratios (ORs) [95% confidence intervals (CIs)] for the mild vs. normal and severe vs. normal groups were 1.47 (1.11-1.96) and 1.68 (1.21-2.33). Notably, the strongest Lp(a)-coronary stenosis associations after multi-variable adjustment persisted only in low inflammation concentration [systemic inflammation response index (SIRI) < 0.64)] [mild vs. normal, OR 2.03, 95% CI 1.17-3.54, Elevated Lp(a) correlates with coronary stenosis only in low inflammation concentration. Considering systemic inflammation in personalized Lp(a)-lowering therapies is more conducive for CCS managements. Show less

Lipoprotein(a) [Lp(a)] is an independent, genetic, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). There are limited data on its impact on premature ASCVD, including in diverse populations and with family history. We examined Lp(a) in relation to premature ASCVD (male aged <55, female aged <65 years) compared to later onset ASCVD, and differences by family history, sex, and race/ethnicity in a large, multi-ethnic U.S. cohort. We analyzed data from 27,756 individuals without prior ASCVD at baseline from a pooled cohort consisting of five U.S. prospective studies. Lp(a) levels were stratified by cohort-specific percentiles. Multivariable Cox regression assessed the association of Lp(a) with composite incident premature and non-premature ASCVD events by sex, race, and family history. Among 5276 ASCVD events over a mean follow-up of 21.1 years, 773 (14.7 %) were premature ASCVD events. A higher proportion of women (65.2% vs. 38.3%) and Black individuals (45.8% vs. 27.7%) were observed in individuals with premature ASCVD compared to those with non-premature ASCVD events. For each 50 mg/dL increase in Lp(a), the risk of premature ASCVD increased by 30 % (HR: 1.30, 95% CI: 1.28-1.51), compared to a 24 % increase for non-premature ASCVD (HR: 1.24 [1.14-1.33]). Compared with Lp(a) levels <50th percentile, Lp(a) levels ≥ 90th percentile had adjusted HRs of 1.39 (1.10-1.75) and 1.39 (1.26-1.54) for premature and non-premature ASCVD events, respectively. We observed a trend for elevated Lp(a) levels predicting premature ASCVD events more strongly in those with a family history of ASCVD and in White individuals. Elevated Lp(a) is an important predictor of both premature and later onset ASCVD events. Show less

End-stage kidney disease (ESRD) patients on dialysis face pronounced cardiovascular and metabolic risks due to disruptions in lipoprotein(a), phosphorus, potassium, uric acid, and lipid balance. Current therapeutic options offer limited capacity to address these multifaceted abnormalities. Niacin is unique in this regard, as it not only lowers lipoprotein(a) but also influences phosphorus and uric acid metabolism. This study evaluates the efficacy of niacin therapy in improving these biochemical markers, thereby addressing an important therapeutic gap in this vulnerable population. In a randomized, controlled trial, 50 hemodialysis patients were divided into two groups of twenty-five each. The control group continued standard care, while the niacin group received 500 mg/day niacin alongside standard therapy. Patients were followed for 3 months. Systolic and diastolic blood pressure were stabilized by niacin administration, in contrast to the control group, where both parameters rose significantly. Phosphorus decreased significantly in the niacin group (5.59 to 4.85 mg/dL, Niacin (500 mg/day) offers significant cardiovascular and metabolic benefits for hemodialysis patients, supporting its role as an adjunctive therapy in managing ESRD-associated risks. https://clinicaltrials.gov/, NCT06406140. Show less

Given the high co-occurrence of various forms of childhood maltreatment (CM) and its negative effects on non-suicidal self-injury (NSSI) urges, investigating the mechanism between multiple CM and NSSI urges is crucial. Study 1 (a cross-sectional study) recruited 5181 adolescents from China (M Latent profile analysis (LPA) was used to explore the potential profiles based on different types of CM. Then, a mediation model was constructed to explore the mediating role of relative deprivation between profiles of CM and NSSI urges. All variables were assessed using self-report questionnaires. Three subgroups were identified: low CM, high emotional neglect, and high CM groups. Study 2 confirmed the results of Study 1 that relative deprivation (T2) mediates the association between subgroups and NSSI urges (T3). Compared to the low CM group, the mediating effect via relative deprivation is 0.39 (95 %CI = [0.20, 0.62]), 0.49 (95 %CI = [0.20, 0.83]) in the high emotional neglect and high CM groups, respectively. This study highlights the importance of using a person-centered approach to consider the heterogeneity of subgroups based on CM in understanding NSSI urges. It suggests that experiencing CM has a multifaceted negative effect on adolescents and exacerbates urges involving NSSI by inducing relative deprivation. Show less

Prior research has consistently demonstrated that higher levels of digital health literacy contribute positively to improved mental health outcomes and overall quality of life among patients. Nevertheless, the interplay between digital health literacy and the experience of perceived stigma-particularly among burn patients-remains underexplored, and the potential heterogeneity within this relationship has not been adequately addressed. This cross-sectional study, conducted from June to July 2025, recruited 534 burn patients (mean age 31.05 ± 9.52 years; 61.0% male) from three tertiary hospitals in Sichuan Province, China. Participants completed validated scales assessing digital health literacy, social support, appearance anxiety, perceived stigma, and demographics. Data were analyzed using Pearson correlations, latent profile analysis (LPA) with fit indices, univariate analyses (chi-square tests and Digital health literacy was negatively correlated with perceived stigma ( This study confirms heterogeneity in digital health literacy and perceived stigma among burn patients, with social support and appearance anxiety as key influencers. Findings support targeted interventions to enhance digital health literacy and reduce perceived stigma, advancing precision psychological care for burn survivors. Show less

Lipoprotein(a) [Lp(a)] is underutilized in short-term atherosclerotic cardiovascular disease (ASCVD) risk prediction. This study investigates Lp(a) contribution to short-term ASCVD event prediction using contemporary real-world data and machine learning (ML). A cohort of 731,983 individuals from a claims database was used to investigate the association of Lp(a) with incident ASCVD and all-cause mortality using Cox proportional hazards models. Novel ML models were developed to predict incident ASCVD events at 1, 2, and 3 years after Lp(a) testing. The models were validated in an independent cohort of 53,930 patients. An increase of 50 nmol/L in Lp(a) was independently associated with incident ASCVD events (HR: 1.072; 95% CI: 1.059-1.084) and all-cause mortality (HR: 1.041; 95% CI: 1.015-1.068) after adjustment for age, sex, and race/ethnicity. Novel ML models featuring Lp(a) predicted incident ASCVD events at 1, 2, and 3 years with robust discrimination (C-statistic: 0.83-0.84) in both the derivation and validation cohorts. Modest underestimation of risk was observed in the validation cohort for the 1-year model (calibration slope 1.25). Lp(a) contributed more to 1-year ASCVD prediction than smoking, diabetes, and other lipid parameters. Inclusion of Lp(a) in the 1-year model led to an integrated discrimination improvement of 0.03 and an optimal net reclassification improvement of 10% at a risk threshold of 26%. Lp(a) is a significant predictor of short-term ASCVD risk. Assessing Lp(a) and imminent ASCVD risk may assist in identifying patients who may benefit from escalation of preventative therapies. Show less

The aim of this study is to identify psychological wellbeing profiles based on the variables of tolerance, patience, compassion satisfaction, and psychological flexibility within the context of Türkiye sample, and to examine whether these profiles differ across demographic subgroups. The study was conducted with Data were collected using the Patience Scale, Compassion Satisfaction Scale, Tolerance Scale, Psychological Flexibility Scale, and Psychological Well-Being Scale. The construct validity of the scales was tested through confirmatory factor analysis (CFA), and the fit indices were found to be at acceptable levels. Internal consistency was confirmed using Cronbach's alpha coefficients. Latent profile analysis (LPA) was used to identify distinct psychological profiles. The relationship between participant profiles and socio-demographic variables was examined using the chi-square test. Considering parsimony and theoretical interpretability, a three-cluster solution was selected as the final model. The profiles corresponded to high, moderate, and low levels across all indicators and were labeled as "High," "Moderate," and "Low Psychological Well-Being and Psychological Resources." Correlations among the variables were generally found to be moderately positive. After considering demographic variables, it was found that profiles with higher psychological wellbeing and psychological resources were associated with being female, married, and having a high level of education. Overall, the findings suggest that psychological wellbeing in Türkiye sample can be better understood through heterogeneous subgroups and provide insights for the design of culturally sensitive interventions and programs. Show less

Venous thromboembolism (VTE) are rare but potentially life-threatening conditions in children, usually associated with underlying medical conditions. Some children with diagnosed VTE have genetic risk factors for the development of VTE, as well as for recurrent complications. This study reports risk factors for developing VTE in a homogeneous population of children and adolescents. A total of 155 children and adolescents, aged 0-21 years, who were diagnosed with VTE at the University Children's Hospital, UMC Ljubljana, between July 2006 and October 2021, were included. The median age at the time of the VTE diagnosis was 12.0 years (interquartile range: 1-7 years). Associated medical conditions were present in 75.5% of patients, and thrombophilia was diagnosed in 43.2% of patients. Oncological disease accounted for 27.7% of cases, while infections were found to be the most significant acquired risk factor (17.4%), followed by the presence of a central venous catheter (15.5%). Genetic thrombophilia markers were identified in 27.1% of patients, with the highest frequency in adolescents (62.5%). Factor V (FV) Leiden heterozygote was the most common marker (9.6% of patients), followed by elevated factor VIII (FVIII) activity (5.8%) and elevated Lp(a) levels (5.2%). Combined thrombophilia markers were found in 52.2% of patients. In addition to inherited thrombophilia, 83.3% of patients had acquired risk factors. Compared to previously reported prevalence, a lower occurrence of FV Leiden heterozygote, elevated Lp(a) levels, elevated FVIII activity and antiphospholipid syndrome was observed in our population. Show less

Lysophosphatidic acid (LPA) has anti-inflammatory and protective effects in sepsis, yet clinical evidence on its correlation with sepsis progression and outcomes is limited. This study aimed to evaluate the association of plasma LPA levels with sepsis development, severity, and mortality. A total of 42 sepsis patients and 29 controls with common infections were included. Among the sepsis patients, 15 succumbed during hospitalization. Plasma LPA levels were measured, and clinical data were retrospectively analyzed. Plasma LPA was significantly lower in sepsis patients compared to controls, and further reduced in non-survivors. Notably, correlation analyses suggested that LPA levels were negatively correlated with neutrophil count, procalcitonin, interleukin-6, and Sequential Organ Failure Assessment (SOFA) score. Multivariate regression analysis identified LPA as an independent risk factor for sepsis onset and in-hospital mortality. Receiver operating characteristic (ROC) curve analysis revealed that LPA had a high diagnostic accuracy for sepsis (area under the ROC curve [AUC] = 0.92, 95% CI = 0.86-0.99, P < 0.001) and was a strong predictor of in-hospital mortality (AUC = 0.86, 95% CI = 0.76-0.97, P < 0.001). Reduced plasma LPA levels in sepsis patients are inversely correlated with infection/inflammation markers and SOFA scores. Together, these results suggest that LPA may serve as a potential diagnostic and prognostic biomarker for sepsis, supporting its potential as a complementary tool to enhance early risk stratification and guide bedside clinical decision-making. Show less

We report a case involving a hepatocellular carcinoma with massive bleeding from a large (retrohepatic inferior vena cava) RHIVC laceration during laparoscopic posterior sectionectomy, complicated by the exceedingly rare migration of surgical gauze into the left pulmonary artery (LPA). Hemostasis was achieved by manual compression and two anchoring Prolene sutures at both ends of the laceration, allowing effective RHIVC wall approximation. Given the low central venous pressure during hepatectomy, edge approximation significantly reduced bleeding and improved repair visibility. Postoperative imaging showed the gauze was lodged in the LPA, constituting an intravascular foreign body (IFB). The gauze was successfully retrieved via endovascular intervention without additional complications. Anchoring sutures with manual compression may be a helpful technique for managing a large RHIVC injury, and endovascular retrieval may provide a safe alternative to reoperation for a large IFB. Show less

The aim of the study was to evaluate the predictive value of Mayo Adhesive Probability (MAP) and the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scores for postoperative complications in laparoscopic total adrenalectomy (LTA) and partial adrenalectomy (LPA). This study included 140 patients who underwent transperitoneal laparoscopic adrenalectomy at our clinic. Patients were grouped based on the presence (group 1, n = 11) or absence (group 2, n = 129) of complications. Preoperative, perioperative, and postoperative data were collected. A MAP score ≥2 was defined as high. Group 1 had a higher incidence of chronic pulmonary and coronary artery disease (p < 0.001). Operative time and estimated blood loss (EBL) were also significantly greater (p = 0.036 and p = 0.041). High MAP scores were more common in this group (p = 0.008), and E-PASS scores were significantly elevated. Univariate logistic regression analysis revealed predictive value for both MAP and Comprehensive Risk Score (CRS) (OR: 5.8, 95% CI: 1.6-21.1, p = 0.008; OR: 18.77, 95% CI: 4.75-74.3, p = 0.000, respectively) for complications. However, multivariate analysis identified only CRS and EBL as independent predictors (OR: 13.5, 95% CI: 2.26-80.6, p = 0.001 and OR: 1.007, 95% CI: 1.001-1.010, p = 0.013, respectively). The MAP and E-PASS scores are both useful for predicting postoperative complications in patients undergoing LTA and LPA. However, the E-PASS score was found to have independent predictive value for postoperative complications. Show less

Examining resilience to adversity across multiple behavioral domains (e.g., psychological well-being, social functioning) can better characterize positive development and inform novel prevention and intervention efforts. However, few studies have employed person-centered methods to examine individual profiles of resilience across multiple domains in youth. Further, research exploring contextual predictors of resilience has rarely used genetically informed designs, which are critical for eliminating potential confounds. The current study employed latent profile analysis (LPA) to extract profiles of resilience across psychological, social, and academic domains in 708 adolescent twins exposed to neighborhood disadvantage, a pervasive form of early life adversity. Next, associations between profile membership and parenting, peer, and neighborhood social processes were examined. Lastly, co-twin control analyses were conducted to explore whether associations between resilience profile membership and social processes were environmental versus genetic in origin. Youth were grouped into three resilience profiles: (1) High Multidomain Resilience (63%), (2) Low Psychological Resilience, High Social Resilience (19%), and (3) Low Multidomain Resilience (18%). Profiles differed in experiences of parenting (i.e., parental involvement, conflict), peer characteristics (i.e., friend drug-related behaviors, popularity), and neighborhood processes (i.e., social cohesion, informal social control, positive social norms). Follow-up analyses within-twin pairs revealed that the association between higher resilience and parenting (higher nurturance, lower conflict) was at least partially environmental in origin. Youth show distinct profiles of resilience across psychological, social, and academic domains, which are uniquely related to processes at the family, peer, and neighborhood level. Further, the association between resilience and parenting is in part environmentally mediated, suggesting a modifiable pathway to boost resilience in adolescents exposed to neighborhood disadvantage. Show less

This study aimed to examine how profiles of perceived HIV/AIDS stigma and psychological well-being (PWB)-defined by positive/negative affect, life satisfaction, and health-related quality of life-relate to embodiment among people living with HIV (PLWH). It also explored the role of minority stress, particularly among sexual minorities, in shaping these experiences. A total of 540 PLWH completed validated measures of HIV/AIDS stigma, psychological well-being, embodiment, and minority stress. Latent profile analysis (LPA) was used to identify subgroups based on levels of stigma, PWB, and minority stress. Multivariate analyses examined differences in embodiment indicators across profiles, controlling for sociodemographic and medical variables. Three distinct profiles emerged: (1) high stigma and low PWB,(2) low stigma and high PWB, and (3) average levels of all indicators. Embodiment levels differed significantly across profiles: Profile 2 showed the highest levels of positive embodiment, while Profile 1 reported the lowest. Minority stress was significantly higher in Lesbian, Gay, Bisexual, Transgender (LGBT) participants in Profile 1, supporting the concept of stigma accumulation. PLWH are a heterogeneous group with varying experiences of stigma, well-being, and embodiment. Greater psychological well-being and lower perceived stigma are associated with higher embodiment. LGBT PLWH face compounded minority stress, further impacting their embodiment and well-being. Findings highlight the importance of personcentered, intersectional approaches in stigma-reduction and mental health interventions for PLWH. Show less

Prostate adenocarcinoma (PRAD) is a common malignancy with marked clinical heterogeneity, complicating prognosis and disease monitoring. Traditional tools like the Gleason score lack molecular and microenvironmental insights, underscoring the need for biomarker-driven predictive models. Single-cell RNA-seq data from GEO and bulk RNA-seq data from TCGA were analyzed. scRNA-seq processing used the Seurat package, with cluster-specific genes identified via FindAllMarkers. Differentially expressed genes (DEGs) from bulk data were obtained using limma, and key gene modules were identified through WGCNA. Using univariate Cox regression and LASSO analysis, a prognostic model was developed based on cluster-specific genes, key module genes, and differentially expressed genes. Clinical validation included comparison of tumor and adjacent normal tissues, revealing significantly elevated GDPD3 expression, further confirmed by immunohistochemistry. In this study, through integrated single-cell sequencing and Bulk-RNA-seq analyses, we established a 21-gene prognostic model. QPCR confirmed significant upregulation of three candidates, including GDPD3, which was also elevatedin malignant tissues. Knockdown of GDPD3 inhibited tumor cell proliferation, invasion, and migration. Mechanistically, GDPD3 regulated the levels of lysophosphatidic acid (LPA), which in turn induced EMT in tumor cells. Inhibition or knockdown of the LPA receptor LPAR1 suppressed EMT. LPA promoted EMT through activation of the AKT signaling pathway, and inhibition of this pathway reversed LPA-induced EMT. This study underscores key molecular mechanisms underlying prostate cancer progression, with GDPD3 emerging as a potential therapeutic target. Show less

This study investigates the heterogeneity in kindergarten teachers' perceptions of organizational climate and its impact on job burnout. Guided by the AGIL model from social systems theory and the Job Demands-Resources (JD-R) model, it addresses the need to move beyond variable-centered approaches to understand how distinct climate profiles are associated with teacher well-being. A person-centered latent profile analysis (LPA) was employed. A sample of 1,008 kindergarten teachers from China completed measures assessing organizational climate and burnout. The analysis aimed to identify distinct climate profiles and examine their relationships with demographic variables (kindergarten type, assessment level, teaching experience) and the three dimensions of burnout (emotional exhaustion, depersonalization, reduced personal accomplishment). The LPA revealed five distinct organizational climate profiles: Controlled, Moderate, Indifferent, Positive, and Authoritative. Profile membership was significantly predicted by kindergarten assessment level and teachers' years of experience, but not by kindergarten type. Crucially, the profiles differed significantly across all burnout dimensions. Teachers in Positive climates reported the lowest burnout levels, whereas those in Controlled and Indifferent climates experienced the highest. The findings underscore the structural diversity of organizational climates in early childhood settings and their profound psychological consequences. This study validates the application of social systems theory and the JD-R model in this context, revealing how different configurations of job demands and resources shape teacher well-being. The results provide a theoretical lens for understanding educational organizations and offer practical implications for developing tailored, climate-specific intervention strategies to mitigate burnout and support sustainable professional development. Show less

To identify the various profiles of social isolation among 18-59-year-old patients with cancer in Western China and examine their demographic, clinical, and cultural predictors. This cross-sectional study included 300 patients from a tertiary hospital who completed standardized assessments of social isolation (Social Avoidance Scale, UCLA Loneliness Scale) and family functioning. Latent Profile Analysis (LPA) was used to identify the subgroups, and multinomial logistic regression was used to analyze predictors of the profiles. Three distinct latent profiles were identified: "avoidance-dominant" (52.3%), which was characterized by high levels of social avoidance (12.52 ​± ​1.38) and low loneliness (30.87 ​± ​6.89), "loneliness-dominant" (27.0%), which was characterized by high levels of loneliness (53.15 ​± ​6.24) and low social avoidance (2.07 ​± ​1.38), and "balanced" (20.7%), which was characterized by balanced scores on both the measures. Individuals with fatigue, employment status, personality traits, and family dynamics significantly predicted profile membership ( Social isolation was heterogeneous among young and middle-aged patients with cancer. Fatigue significantly predicted distinct patterns of social isolation. Furthermore, exploratory findings indicated a potential role of religious beliefs in the avoidance-dominant profile; however, replication with larger samples is required. Family dynamics may buffer the risk of isolation in patients prone to avoidance, whereas those dominated by loneliness may lack such safeguards. Health care providers can implement tailored interventions to mitigate social isolation based on these varying profiles. Show less

Progressive atherosclerotic cardiovascular disease (ASCVD) associated with high Lp(a) (>60 mg/dl) has been approved as indication for regular lipoprotein apheresis (LA) in Germany since 2008. This observational multicenter study enrolled 170 consecutive patients with high Lp(a) and progressive ASCVD despite effective treatment of other ASCVD risk factors as required for approval of reimbursement to analyse the long-term effect of LA on cardiovascular event rates. Additionally cardiovascular event rates were compared to an appropriate UK-Biobank cohort (UKBBC) with established ASCVD and verified impact of elevated Lp(a) on ASCVD risk. Investigations were conducted on patients retrospectively over a 5-year period before the initiation of regular LA, prospectively 5 years after the commencement of LA, and again retrospectively until the completion of 12 years of LA. 154 patients (90.6 %) completed 5 years follow-up, 129 patients (75.9 %) were available in year 12. A decline in the mean annual rate of cardiovascular events per patient was observed from y-5 to y-1 (0.27 ± 0.25) versus y+1 until y+12 (0.06 ± 0.08) (p < 0.001). One year before commencing LA mean event rates per 100 patient years of the primary composite endpoint parameter of major adverse cardiac events (MACE) including nonfatal ischemic stroke (IS) were significantly higher in Pro(a)LiFe patients compared to the UKBBC. Most importantly they were significantly lower one year after commencing LA. Regular LA was associated with a decreased rate of cardiovascular events in patients with high Lp(a) (>60 mg/dl) and progressive ASCVD up to 12 years. Comparison with corresponding incidence rates in the UKBBC supports the clinical efficacy of LA to bring progressive ASCVD associated with high Lp(a) to a halt. However, this comparative analysis cannot replace a true control group or determine the exact effect size. Show less

The atherogenic lipoprotein(a) [Lp(a)] is recommended to be measured at least once in each adult person's lifetime. However, the testing frequency and its impact on lipid-lowering therapy is uncertain. This retrospective analysis included patients 40-79 years old with at least two ambulatory clinic visits to a Midwestern healthcare system between 2018-2022. Within those patients, Lp(a) testing dates to 2004. Parameters included age, sex, race, traditional ASCVD risk factors, Lp(a) levels, and lipid-lowering therapy (LLT) prevalence. Lp(a) was considered elevated if Lp(a) ≥50 mg/dL or ≥125 nmol/L, respectively. Patients ( Although testing for Lp(a) has improved, there is room for significant improvement, particularly in those with ASCVD. The higher use of LLT in all risk categories indicate that Lp(a) testing may have influenced treatment decisions. Show less

Recent evidence suggests that elevated lipoprotein(a) [Lp(a)] contributes to atherosclerotic cardiovascular disease (ASCVD). The predictive value of specific Lp(a) cutoff points of 30 mg/dL remains to be established. This study investigated the relationship between Lp(a) concentrations and cardiovascular outcomes in Taiwanese individuals, stratified by pre-existing ASCVD status. We conducted a retrospective analysis of 51,934 subjects from the Chang Gung Research Database (January 2004 to June 2019), comprising 49,363 individuals without ASCVD and 2,571 with established ASCVD. The primary outcome was major adverse cardiovascular events (MACEs), encompassing acute myocardial infarction, ischemic stroke, revascularization procedures, peripheral arterial interventions, and cardiovascular mortality. Individuals were followed until their last visit to our institutions or December 31, 2019. During a mean follow-up of 6.6 years (standard deviation: 5.0 years), the study population demonstrated a median Lp(a) of 9.6 mg/dL (interquartile range: 4.6-18.5). In ASCVD-free individuals, Lp(a) concentrations ≥30 mg/dL were associated with increased MACE risk (adjusted subdistribution hazard ratio [aSHR]: 1.24; 95% confidence interval [CI]: 1.07-1.43). Similarly, in the ASCVD cohort, elevated Lp(a) predicted higher MACE occurrence (aSHR: 1.36; 95% CI: 1.07-1.74). Restricted cubic spline analysis confirmed a progressive risk elevation beyond the 30 mg/dL threshold in both groups. Lp(a) levels ≥30 mg/dL independently predicted adverse cardiovascular outcomes, regardless of baseline ASCVD status. This threshold appears suitable for cardiovascular risk stratification in both primary and secondary prevention settings. Show less

The present study aimed to clarify heterogeneity in music performance anxiety (MPA) by identifying latent profiles, examining sociodemographic and psychological predictors of profile membership, and testing mediation pathways. A total of 819 Chinese musicians participated in an online survey that assessed MPA, performance worry (PW), and perceived memory reliability (PMR), along with demographic variables. Latent profile analysis (LPA) revealed a three-profile solution that distinguished low, moderate, and high MPA groups. Multinomial logistic regression indicated that older age, higher education levels, lower household income, and unstable employment were significantly associated with membership in the moderate and high MPA profiles. In addition, PW emerged as a significant psychological predictor of elevated MPA, whereas PMR showed a protective effect and was negatively associated with MPA. Mediation models further demonstrated that PW played an important role in transmitting the effect of PMR on MPA, suggesting that cognitive factors related to memory reliability shape worry processes, which, in turn, intensify performance anxiety. These findings advance understanding of MPA by demonstrating that Chinese musicians can be meaningfully categorized into distinct risk groups, each shaped by sociodemographic vulnerabilities and cognitive-emotional pathways. From a practical perspective, the results highlight the importance of targeted prevention and intervention strategies that address both memory-related cognitions and performance worry in order to reduce MPA in vulnerable populations. Show less

We assessed the coverage of molecular drug susceptibility testing (mDST) among patients with pulmonary multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in South Korea and identified factors influencing the lack of mDST implementation. This retrospective study included patients with pulmonary MDR/RR-TB who initiated tuberculosis (TB) treatment between January 2015 and September 2021. Data were obtained from the K-TB-N cohort, an integrated national TB database linking three datasets. We assessed mDST coverage, temporal trends and factors associated with the lack of mDST implementation. mDST was defined as the use of the Xpert MTB/RIF assay or line probe assay (LPA) for isoniazid and rifampicin (first-line LPA). In total, 4637 patients were included in the analysis. Of the 4637 patients, 1342 (28.9%) did not undergo mDST; whereas, 3295 (71.1%) underwent mDST. Over the study period, a statistically significant annual increase in mDST coverage was observed, escalating from 49.1% in 2015 to 96.9% in 2021 (p<0.001). Throughout the study, the coverage of the Xpert MTB/RIF assay remained lower than that of LPA (22.1% vs 64.2%, p<0.001). Multivariable logistic regression analysis identified several factors independently associated with a decreased likelihood of mDST being conducted, including TB treatment initiation in secondary general hospitals, small hospitals or primary clinics, as well as in non-public-private mix (PPM) participating institutions. In addition, transfers between PPM-participating and non-participating institutions during the treatment period and sputum acid-fast bacilli smear-negative status were significantly associated with lower mDST uptake. Although the increasing mDST coverage is a positive development, further efforts are needed to achieve nationwide and universal implementation, particularly for the Xpert MTB/RIF assay, in South Korea. Show less

Lipoprotein(a) [Lp(a)] is a recognized risk factor for atherosclerotic cardiovascular disease. However, its potential association with the risk of recurrent atrial fibrillation (AF) after ablation remains unexplored. This study aimed to investigate whether Lp(a) serum levels are linked to the risk of recurrent AF following pulsed field ablation (PFA). A retrospective cohort analysis was conducted on patients who underwent PFA at the Cardiology Clinic of the Ferrara University Hospital from October 2023 to January 2025. Lp(a) percentile groups were established, with the first 50th percentile serving as the reference. Cox proportional hazards modeling was used to assess the relationship between Lp(a) percentile and recurrent AF after PFA. The study included 133 patients (mean age 59.6 years, 29.3% women). Over a median follow-up of 7.8 months after the blanking period (range: 6.4-9.3 months), 29 patients (21.8%) experienced confirmed recurrent AF. A continuous increase in the hazard of recurrent AF was observed with rising Lp(a) levels. Specifically, individuals in the 51st-70th, 71st-90th, and 91st-100th Lp(a) percentiles had adjusted hazard ratios of 1.13 [95% confidence interval (CI): 1.04-1.22, P < 0.001], 1.21 (95% CI: 1.11-1.31, P < 0.001), and 1.26 (95% CI: 1.13-1.39, P < 0.001), respectively. Elevated Lp(a) levels are associated with an increased risk of recurrent AF after PFA, suggesting that Lp(a)-lowering therapies may be beneficial for these patients. Show less

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, and current predictors such as lipoprotein (a) [Lp(a)] and risk scores have limitations. Automated machine learning (AutoML) offers the potential to improve CVD risk prediction by processing large datasets and developing tailored models without the need for extensive data science expertise. Using clinical datasets from the LURIC (n = 3316) and UMC/M (n = 423) studies, we built AutoML models to predict Lp(a), specific CVDs and CVD-related mortality in three phases. Phase 1 identified key CVD determinants such as age, Lp(a), troponin T, BMI and cholesterol with good accuracy (AUC 0.6249 to 0.9101). Phase 2 validated models in the UMC/M dataset and showed robust performance (AUC 0.7224 to 0.8417), with SHAP analysis highlighting predictors like statin therapy, age and NTproBNP. Phase 3 focused on cardiovascular mortality prediction, achieving high AUC values (0.74 to 0.85) and showed data drift, highlighting the need for model adjustment. Show less