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Dyslipidemia is a central driver in the initiation and progression of atherosclerosis (AS). The chronic inflammation and endothelial injury triggered by dyslipidemia are key pathological events in AS development. Elucidating the molecular network underlying dyslipidemia and developing precise interventions are critical for achieving precision prevention and treatment of AS. Recent studies have demonstrated that sterol regulatory element-binding protein 1 (SREBP1) and lipoprotein(a) [Lp(a)] play pivotal roles in the regulation of lipid synthesis and transport. Additionally, gut microbiota-derived metabolites, such as trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), can activate inflammatory pathways and promote lipid deposition via inter-organ signaling axes, thereby accelerating the progression of AS. However, clinical studies have revealed that even when low-density lipoprotein cholesterol (LDL-C) levels are within the recommended range, a significant number of patients continue to experience cardiovascular events. This indicates the widespread presence of "residual risk". Such residual risk is primarily driven by elevated non-high-density lipoprotein cholesterol (non-HDL-C), abnormal levels of Lp(a), and imbalances in the triglyceride to HDL-C (TG/HDL-C) ratio, highlighting the limitations of traditional therapies in comprehensive lipid profile management. Emerging targeted therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, small interfering RNA (siRNA)-based treatments, and Lp(a)-lowering agents like pelacarsen, represent promising strategies for more precise lipid modulation. With the continuous advancement of related research, the precise management of AS will increasingly rely on deeper mechanistic insights and individualized therapeutic strategies. Current strategies for AS prevention and treatment focus on understanding key pathways, including lipid metabolism, inflammation, and vascular dysfunction, to develop targeted therapies. The integration of the 2023 Chinese Guidelines for Lipid Management, imaging, and AI-assisted decision-making will promote data-driven, precision medicine. Personalized drug selection, efficacy monitoring, and long-term follow-up will optimize clinical outcomes and enhance prevention strategies for high-risk patients. Show less

Right ventricular outflow tract (RVOT) anomalies in neonates and infants necessitate early intervention to restore adequate pulmonary blood flow and promote pulmonary artery (PA) growth. This study aimed to evaluate the immediate and intermediate-term outcomes of various transcatheter RVOT interventions in this vulnerable population. This prospective, single-center descriptive study enrolled 52 infants (aged <1 year) undergoing balloon pulmonary valvotomy (BPV, n=29), RVOT perforation with BPV and patent ductus arteriosus (PDA) stenting (n=11), or RVOT stenting (n=12) between February 2021 and November 2022. Key immediate outcomes included hemodynamic changes, procedural success, and in-hospital complications. Intermediate outcomes at three and six months assessed oxygen saturation (SpO2), weight gain, PA growth, and re-intervention rates. Overall six-month survival was high at 96.2% (50/52), with minimal procedural complications, which included two transient arrhythmias. In-hospital mortalities occurred in one BPV patient and one RVOT perforation patient, both attributed to non-procedural causes such as septic shock. BPV procedures achieved significant reductions in RV pressure (from 106±26.18 mmHg to 40.74±9.91 mmHg, p=0.04) and RVOT gradient (from 85.41±26.04 mmHg to 15.67±4.2 mmHg, p<0.0001), with a 14.3% re-intervention rate for restenosis by three months. For RVOT perforation with BPV and PDA stenting, there was marked hemodynamic improvement, with RV pressure decreasing from 105.36±18.98 mmHg to 40±12.06 mmHg (p<0.0001) and robust PA growth (RPA measuring 5.72±1.13 mm and LPA 5.10±0.93 mm at six months). Lastly, RVOT stenting was 100% successful, significantly improving SpO2 (from 73.83±5.46% to 86.83±4.61% at discharge) and enabling five infants to become candidates for complete intracardiac repair by six months. Transcatheter RVOT interventions are safe and effective strategies for managing RVOT anomalies in neonates and infants. These intervention strategies offer targeted benefits and improve clinical outcomes. Show less

Adverse childhood experiences (ACEs) can cause morphological brain alterations across the lifespan, contributing to increased vulnerability to mental and physical disorders. Despite extensive research on ACEs-related brain alterations, the protective or augmenting role of modifiable lifestyle factors such as physical activity has been largely underexplored, representing a key gap in our understanding of trauma-related neuroplasticity. To close this gap, we aimed to investigate how lifetime physical activity (LPA) influences the relationship between ACEs and morphological brain alterations. Moderation analyses using Hayes' PROCESS macro examined the interaction between ACEs and LPA on the volume of limbic system-related regions - hippocampus, amygdala, anterior cingulate cortex ( While LPA showed no moderating effect on hippocampal or anterior cingulate volume, the model concerning the volume of the amygdala was significant. This model explained 8.1% of the variance in amygdala volume ( Our findings underscore the behavioral dependency of the structural adaptations of the amygdala following childhood adversities. These results emphasize the therapeutic potential of incorporating physical activity into interventions for trauma-exposed individuals, offering a behavioral approach to mitigating stress-related neurobiological changes. Show less

Identifying quality-of-life (QoL) subgroups can optimize occupational therapy interventions for stroke survivors. To identify clusters among stroke survivors on the basis of perceived QoL using latent profile analysis (LPA). Cross-sectional study using LPA to classify QoL levels among stroke survivors and multinomial logistic regression to identify predictors. Hospital and university clinic. A total of 696 adult stroke survivors age 18 yr or older. Eligible participants were literate and had a Mini-Mental State Examination score of 23 or higher, excluding those with speech disorders or additional chronic neurological, psychiatric, or cognitive conditions. The participants were evaluated with the Stroke Impact Scale (SIS), Barthel Index, and the Impact on Participation and Autonomy Questionnaire (IPA). LPA was applied to the SIS data. Three latent classes were identified: high QoL (n = 232), moderate QoL (n = 322), and low QoL (n = 142). Participants in Class 2 (high QoL) demonstrated higher functional outcomes, whereas those in Class 3 (low QoL) displayed the lowest scores across all scales. Predictors of class membership included age, gender, social relationships, and education level. LPA effectively identified subgroups among stroke survivors, supporting tailored interventions in occupational therapy to improve rehabilitation outcomes. Further research is recommended to validate these findings in diverse populations. Plain-Language Summary: This study explored quality of life among stroke survivors. Three groups were identified: those with high, moderate, and low quality of life. Factors such as age, social relationships, and education level influenced quality of life after stroke. These findings can help occupational therapists create personalized care plans to support survivors in recovery, focusing on social connections, autonomy, and daily activities. Show less

Ageing endurance athletes have a higher prevalence of coronary artery disease (CAD) on coronary CT angiography (CCTA) than healthy controls, despite similarly low conventional cardiovascular risk. The predictive value of lipoprotein(a) [Lp(a)] for CAD in these low-risk individuals remains unclear. The Master@Heart study included 558 men (aged 45-70 years) without known cardiovascular risk factors: 191 lifelong athletes, 191 late-onset athletes, and 176 healthy controls. CCTA assessed coronary artery calcification (CAC) and plaques. The association between Lp(a) and subclinical CAD was assessed using logistic regression analysis to estimate odds ratios (ORs), adjusted for cardiovascular risk factors. Lp(a) was analysed dichotomously (<125 vs. >125 nmol/L) and continuously (per 10 nmol/L increase). 76 participants (13.6%) had elevated Lp(a) levels (>125 nmol/L). Elevated Lp(a) was significantly associated with age-specific CAC percentile≥75 (OR 1.80, p=0.049) and ≥1 mixed plaque (OR 1.76, p=0.046). Other CAD measures all tended to be more prevalent in those with elevated Lp(a). In the continuous analysis, Lp(a) was significantly associated with CAC>100 (OR 1.03, p=0.045), CAC percentile≥75 (OR 1.04, p=0.014), and ≥1 mixed or non-calcified plaque (OR 1.03, p=0.029).Lp(a) and prevalence of elevated Lp(a) were similar across lifelong athletes, late-onset athletes, and controls (p=0.586 and p=0.724, respectively). No significant interaction was found between Lp(a) and the exercise groups in predicting CAD. Lp(a) is independently associated with subclinical CAD in ageing endurance athletes and healthy controls, despite similarly low conventional cardiovascular risk. Lp(a) does not explain the higher CAD prevalence in lifelong athletes compared to controls, but may enhance risk stratification in this low-risk population. Show less

Lung cancer imposes a significant financial burden, including psychological financial hardship (PFH). This study aims to identify latent profiles of PFH in lung cancer patients and determine associated patient and caregiver factors. A cross-sectional analysis was conducted with 305 lung cancer patient-caregiver dyads. PFH was measured using the Comprehensive Score for Financial Toxicity (COST), while quality of life (QoL) and distress were also assessed. Latent Profile Analysis (LPA) identified PFH profiles, and one-way ANOVA examined their associations with QoL and distress. Multinomial logistic regression examined correlates of PFH profiles. Three PFH profiles were identified: high-level (COST 0-13), low-level (COST 14-29), and no PFH (COST 30-44). These profiles had medium effects on mental QoL (η Distinct PFH profiles and correlates were identified, highlighting the role of both patient and caregiver factors. Findings underscore the importance of early screening and family-centred interventions to mitigate financial hardship and support well-being in cancer care. Show less

Physical fitness in preschoolers, encompassing muscular strength, speed-agility, balance, and cardiorespiratory fitness, serves as a key health indicator. While preschools are ideal settings for promoting physical fitness, the association between preschool-based movement behaviors and physical fitness remains unclear. This cross-sectional study included 1144 Chinese preschoolers aged 3-6 years. Preschool-based movement behaviors including moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior (SB), were measured using ActiGraph GT9X accelerometers. Physical fitness was assessed via the PREFIT battery, which includes handgrip strength, standing long jump, 4 × 10 m shuttle run, one-leg stance, and 20 m shuttle run. Compositional linear regression and isotemporal substitution modeling were employed to examine associations and time-reallocation effects, respectively. Greater amounts of MVPA during preschool hours were positively associated with better performance in muscular strength, speed-agility, and cardiorespiratory fitness. Reallocating time from SB or LPA to MVPA enhanced physical fitness, whereas substituting MVPA with SB or LPA reduced fitness levels, demonstrating an asymmetric effect. Moderate-to-vigorous physical activity during preschool hours significantly enhances physical fitness. Prioritizing the implementation of physical activity programs to increase MVPA in preschool settings is crucial for improving physical fitness and addressing insufficient MVPA in this age group. First large-scale study (N = 1144) demonstrating preschool-based moderate-to-vigorous physical activity (MVPA) is essential for developing preschoolers' muscular strength, speed-agility, and cardiorespiratory fitness, complementing existing 24-h movement behavior research. Reveals critical asymmetry: Reducing MVPA time significantly harms fitness, with losses exceeding the benefits from equivalent MVPA increases. Provides objective evidence to guide policymakers in optimizing preschool schedules to prioritize MVPA for enhancing children's physical fitness. Show less

Current clinical guidelines lack clear, quantitative recommendations on intensity-specific physical activity (PA) levels for preventing back pain. Moreover, accelerometer-based evidence regarding dose-response relationships and interactions between PA and genetic susceptibility remains limited. To determine the relationships between accelerometer-measured total and intensity-specific PA and incident back pain, and to assess potential effect modification by polygenic risk scores (PRS). Prospective, large-scale, population-based study using UK Biobank data. UK Biobank participants who wore wrist accelerometers for 7 days (N=71,601). Incident back pain, defined as the first recorded ICD-10 dorsalgia code (M54). Total PA, light PA (LPA), and moderate-to-vigorous PA (MVPA) were derived using validated machine-learning algorithms from raw accelerometer data. Dose-response relationships were modeled using restricted cubic splines within Cox proportional hazards models, with adjustment for and stratification by a polygenic risk score (PRS). Point estimates for the population attributable fraction (PAF) were then calculated. Body mass index (BMI) mediation was assessed. Over a median follow-up of 7.0 years, total PA and MVPA exhibited nonlinear inverse associations with incident back pain, independent of genetic risk, with thresholds at approximately 35 milli-g (total PA) and 60 min/day (MVPA). The adjusted PAF was 15.9% for low MVPA and 9.9% for low total PA. Associations were strongest for MVPA, followed by total PA; no significant association was observed for LPA. Within both PRS strata, risk declined monotonically across PA quartiles, with similar effect sizes and no PA × PRS interaction. Notably, participants with high PRS and high PA had lower risk than those with low PRS and low PA. BMI mediated 26.2% of the total PA association and 15.5% of the MVPA association. Accelerometer-measured MVPA robustly reduces back-pain risk, independent of genetic predisposition. Future guidelines should provide clear, intensity-specific recommendations and account for the observed nonlinear dose-response to optimize prevention. Show less

Both lipoprotein(a) [Lp(a)] and peripheral artery disease (PAD) are associated with ischaemic events. We sought to assess the association between Lp(a) and major adverse cardiovascular events (MACE) and major lower extremity events (MALE) among patients with baseline PAD. The Mass General Brigham (MGB) Lp(a) registry includes all individuals with Lp(a) measured at two tertiary care centres from 2000 to 2019. Those with PAD were grouped according to Lp(a) percentile: 1st-25th [Q1, Lp(a) ≤ 14 nmol/L], 26th-50th (Q2, 14-<42 nmol/L), 51st-75th (Q3, 42-<132 nmol/L), and 76th-100th (Q4, 132-855 nmol/L). Outcomes were MACE [composite of cardiovascular (CV) death, myocardial infarction, or coronary revascularization] and MALE (composite of peripheral revascularization, acute limb ischaemia, or major lower extremity amputation). Cox proportional hazard modelling was used to assess the association between Lp(a) and the outcomes of interest after adjusting for traditional risk factors. Among 3757 individuals with PAD [39% female, median age 68 (IQR: 58-77)], individuals with Lp(a) levels in the third and fourth quartiles had a 24 and 30% increased hazard of MACE, respectively [adj. hazard ratio (HR): 1.24, P = 0.005; adj. HR: 1.30, P = 0.001] when compared with those in the first quartile. Individuals in the fourth quartile had a 19% greater hazard of MALE (adj. HR: 1.19, P = 0.043). Elevated Lp(a) in patients with PAD was associated with an increased risk of both MACE and MALE. Accordingly, measurement of Lp(a) may convey important prognostic value and allow for further risk stratification within this high-risk population. Show less

Following the publication of the above paper, it was drawn to the Editor's attention by a concerned reader that, for the cell invasion assay experiments shown in Fig. 4B, the 'Con' and 'LPA+HF' data panels contained an overlapping section, such that data which were intended to show the results of differently performed experiments appeared to have been derived from the same original source. The authors were contacted by the Editorial Office to offer an explanation for this possible anomaly in the presentation of the data in this paper, although up to this time, no response from them has been forthcoming. Owing to the fact that the Editorial Office has been made aware of potential issues surrounding the scientific integrity of this paper, we are issuing an Expression of Concern to notify readers of this potential problem while the Editorial Office continues to investigate this matter further.  [International Journal of Oncology 44: 309‑318, 2014; DOI: 10.3892/ijo.2013.2157]. Show less

Atherosclerosis is an active interaction between lipoproteins and inflammatory cells. Monocytes and macrophages are the most important immune cells involved in the process of atherosclerosis. They interact with atherogenic lipoproteins, in particular low density lipoprotein (LDL) cholesterol and lipoprotein(a) (Lp(a)). The increased concentration of the LDL cholesterol and Lp(a) accelerates the polarization of monocytes and macrophages toward proinflammatory phenotype and the formation of the foam cells. These cells then release large quantities of inflammatory cytokines that stimulate the oxidation of atherogenic lipoproteins that are even more atherogenic and contribute to the formation of foam cells and the secretion of the pro-inflammatory cytokines, thus creating a vicious circle. Surface marker C-C chemokine receptor type 2, expressed on monocytes/macrophages, enables their adhesion and migration into the subendothelial layer. The rupture of the atherosclerotic plaque on one hand, and the ability of the oxidized LDL cholesterol and Lp(a) to trigger arterial thrombosis by different mechanisms on the other hand, result in acute cardiovascular event. Here, we summarize the role of the monocytes and macrophages in atherosclerosis and explore the influence of LDL cholesterol and Lp(a) on monocytes and macrophages during the entire process of atherosclerosis, from its initiation to progression. Show less

Elevated levels of lipoprotein(a) have been linked to an increased risk of Atherosclerotic Cardiovascular Disease (ASCVD). Conventional lipid-lowering medications have modest to no impact on Lp(a) levels. Emerging RNA-based modalities significantly decrease Lp(a) by silencing the apo(a) mRNA at the post-transcriptional level. Pelacarsen (TQJ230) is a GalNAc-conjugated novel Antisense Oligonucleotide (ASO) that selectively inhibits apo(a) synthesis in hepatocytes. This updated review aims to elucidate the mechanism of action, pharmacokinetics, clinical efficacy, and safety profile of Pelacarsen (TQJ230), with a focused appraisal of its potential role in the prevention of Atherosclerotic Cardiovascular Disease (ASCVD). We conducted a literature search on PubMed, Google Scholar, and Scopus using keywords such as "Pelacarsen", "antisense oligonucleotide" OR "ASO", and "lipoprotein(a)" from inception to March 2025. Pelacarsen demonstrated a dose-dependent sustained reduction in Lp(a) levels, achieving up to a 97% reduction at the highest dose in Phase 1 and 2 trials. It was well-tolerated with a favorable safety profile. Phase 3 trials are underway to provide robust data on its long-term safety and impact on Atherosclerotic Cardiovascular Disease (ASCVD) outcomes. Pelacarsen (TQJ230) is a potent Lp(a)-lowering agent with promising efficacy and a favorable safety profile. However, its definitive role in reducing atherosclerotic cardiovascular events remains to be established. Ongoing Phase 3 trials will be critical in determining whether its lipid-lowering effects translate into meaningful long-term cardiovascular outcomes. Show less

Left-behind adolescents in China may face heightened risks of involvement in cyberbullying due to their psychological vulnerability and complex social circumstances. Considering the potential heterogeneity within this population, this study aimed to identify distinct patterns of cyberbullying and cybervictimization among left-behind adolescents and to explore how reactive anger, left-behind patterns, gender, and grade level predict membership in these subgroups. A total of 1,351 junior high school students (752 left-behind, 599 non-left-behind) were recruited from five schools. Latent profile analysis (LPA) was used to identify distinct patterns, and multinomial logistic regression was used to examine the relationships between predictors and various profiles. (1) Three distinct profiles of cyberbullying and cybervictimization were identified among left-behind adolescents. (2) Left-behind adolescents were more likely to experience cybervictimization compared to their non-left-behind peers. (3) Reactive anger, left-behind patterns, gender, and grade level significantly predicted subgroup membership. These findings underscore the importance of developing targeted interventions and considering the specific psychosocial vulnerabilities of left-behind youth. Show less

Given the heightened risk of complications during pregnancy in women of advanced maternal age (AMA), it is crucial to understand the metabolites in amniotic fluid and umbilical cord blood in this demographic.  METHODS: We analyzed the metabolites in amniotic fluid from 60 women, divided into two groups: the AMA group (aged 35 or above, n = 29), and the control group (aged below 35, n = 31). We then conducted a follow-up analysis on the metabolites of umbilical cord blood from a sample of 19 women (9 from the AMA group, and 10 from the control group). In total, we identified 96 differential metabolites in the amniotic fluid and 146 in the cord blood between the two groups. The significant changes in the metabolites of the amniotic fluid mainly involved sphingolipid metabolism, steroid hormone biosynthesis, and cholesterol metabolism. Conversely, the preliminary significant changes in cord blood metabolites were mainly linked to metabolism of arginine and proline, degradation of valine, leucine, and isoleucine, fatty acid metabolism, alanine, aspartate and glutamate metabolism, and the biosynthesis of unsaturated fatty acids. Further analysis revealed a significant upregulation of lysophosphatidylcholine (LPC), phosphatidylcholine (PC), and taurodeoxycholic acid in the amniotic fluid. In the cord blood, various forms of lysophosphatidic acid (LPA), sphingomyelin (SM), phosphatidylglycerol (PG), LPC, and PC were found preliminarily to be either upregulated or downregulated. Our results preliminarily showed that the metabolites of amniotic fluid and cord blood in AMA women differed significantly from the control group. These findings provide crucial insights for future research to explore the role of metabolomics in adverse pregnancy outcomes in AMA women. Show less

Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives. We constructed and validated a multi-state microsimulation Markov model for a population of 10,000 individuals aged between 40 and 69 years without CVD, selected randomly from the UK Biobank. The model evaluated Lp(a) testing in individuals not initially classified as high-risk based on age, diabetes status, or the SCORE-2 algorithm. Those with an Lp(a) level ≥105 nmol/L (50 mg/dL) were treated as high risk (initiation of a statin plus blood pressure lowering). The Lp(a) testing intervention was compared to standard of care. The primary analyses were conducted from the Australian and UK healthcare perspectives in 2023AUD/GBP. A cost adaptation method estimated cost-effectiveness in multiple European countries, Canada, and the USA. Among 10,000 individuals, 1,807 had their treatment modified from Lp(a) testing. This led to 217 and 255 quality-adjusted life years gained in Australia and the UK, respectively, with corresponding incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving). From a societal perspective, Lp(a) testing saved $85 and £263 per person in Australia and the UK, respectively. Lp(a) testing was cost-saving among all countries tested in the cost adaptation analysis. Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD. Show less

Lipoprotein(a) [Lp(a)] is a unique, genetically determined lipoprotein particle that has emerged as a significant independent risk factor for a wide spectrum of diseases beyond its well-established role in cardiovascular disease. Elevated Lp(a) levels are notoriously difficult to manage with conventional lipid-lowering therapies, posing a major clinical challenge. Recent advances have illuminated its complex pathophysiology, involving pro-inflammatory, pro-atherogenic, and pro-thrombotic pathways, which implicate Lp(a) in a diverse range of conditions including renal diseases, autoimmune disorders, and neurological conditions. Understanding the multifaceted role of Lp(a) across different organ systems is therefore of critical importance for developing targeted therapeutic strategies. A comprehensive synthesis of the evidence linking Lp(a) to these various pathologies is essential not only to consolidate our understanding of its mechanisms but also to identify patients at high risk across multiple disease domains. This review explores the molecular mechanisms by which Lp(a) contributes to disease pathogenesis, with a particular focus on inflammation and oxidative stress. We highlight the latest advances in novel, targeted therapeutic agents, such as antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs), which offer promising potential for specifically lowering Lp(a) levels. Furthermore, we discuss the implications of these therapies for modifying disease risk and improving clinical outcomes, offering hope for a paradigm shift in the management of Lp(a)-associated disorders. Show less

Post-hemorrhagic hydrocephalus (PHH) is a neurological disease that primarily affects premature infants and involves infiltration of blood into the brain's ventricles followed by excessive accumulation of cerebrospinal fluid (CSF), leading to ventricular enlargement and increased intracranial pressure. The precise mechanisms driving PHH development and persistence are incompletely understood and lack disease-modifying treatments. Using a mouse model of PHH, we have identified transcriptomic, proteomic, and cellular features of PHH involving neuroimmune and neurovascular alterations recapitulating those reported in human disease. Improvement upon a lysophosphatidic acid (LPA)-induced PHH mouse model was combined with unbiased proteomic and single-nucleus transcriptomics that identified microglial molecular pathways propagating PHH. Pharmacological depletion of microglia in vivo significantly reduced PHH-associated ventriculomegaly. These data identify microglial and neurovascular elements in the development of PHH, implicating them as other potentially tractable therapeutic targets beyond LPA receptors, towards developing medical treatments for PHH. Show less

in the last decades, social networking sites (SNSs) use among adolescents has dramatically increased, feeding the adolescents' needs. However, younger users might be more vulnerable to problematic social networking. Scholar research increasingly highlighted the need to explore the underlying mechanisms of problematic use of SNSs. Difficulties in emotion regulation, general distress, experiences of shame, and specific motivations for SNSs use might represent risk factors for problematic social networking. On the contrary, other variables adolescence-related and potentially involved in problematic SNSs use (emptiness, boredom, emotional autonomy, and self-concept clarity) need further exploration. the present person-centered study aimed at profiling SNSs teen users (13-19 years) based on their (problematic) social networking, by comparing their SNSs-related behaviors and motivations, emotional dysregulation, distress symptoms, emptiness, boredom, shame, self-concept clarity, and emotional autonomy. the study involved 774 Italian adolescents (57% females; mean age = 15.74 ± 1.62 years) and four different profiles characterized by unique patterns of (problematic) social networking were identified through the latent profile analysis (LPA): (1) non-problematic SNSs users, (2) at-risk SNSs users, (3) problematic SNSs users, and (4) defended SNSs users (ntp=218; AIC=39125.44; BIC=39988.37; SSABIC=39296.00; entropy=.97; LMP-LRT p <.05; BLRT p <.05). concerning the emerging profiles, problematic and non-problematic SNSs users displayed the highest and lower levels of risk factors related to social networking, respectively. The so-called "Defended" profile might include participant adolescents who defensively avoided thinking about the psychological and emotional experiences of SNSs use, showing very low levels in all the variables exploring SNSs-related behaviors and motivations, and psychological risk. Show less

The present study explores how family relationship quality is associated with psychological and cognitive health among grandparents who had primary responsibility in raising their grandchildren and examines whether co-residence with adult children moderates this relationship. The study uses data from 589 grandparents who completed the Midlife Development in the United States (MIDUS) survey. Latent profile analysis (LPA) is used to identify grandparent-family relationship types. Ordinary Least Squares (OLS) regression models are used to estimate the association between relationship types and psychological and cognitive health (i.e., psychological distress, psychological well-being, episodic memory, and executive function). LPA identified four grandparent-family relationship types: amicable, ambivalent, neutral, and disharmonious. Compared to grandparents with amicable family relationships, those with ambivalent family relationships had significantly higher levels of psychological distress, reduced psychological well-being, and poorer episodic memory. Further, the association between ambivalent relationships and episodic memory was stronger among respondents who co-resided with their adult children. Emotional closeness with family is essential for grandparents who are raising their grandchildren. This study contributes to a more detailed understanding of the role of relationships with family and suggests that emotional and instrumental support from family is important for increasing grandparent caregivers' psychological and cognitive well-being. Show less

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a global health issue due to its high prevalence, yet the impact of accelerometer-measured physical activity on clinical outcomes remains unclear. This study aims to examine the associations of physical activity with the risk of liver cirrhosis, cancer, cardiovascular disease (CVD) incidence and mortality. 32 681 MASLD participants with accelerometer-derived physical activity data from the UK Biobank were analysed. Physical activity intensity was categorised into light (LPA), moderate (MPA) and vigorous (VPA) intensity. Cox proportional hazard and acceleration failure models were employed to assess associations between physical activity duration and outcomes. During a median follow-up of 7.5-7.9 years, 1883 deaths, 151 liver cirrhosis, 3312 cancers and 6657 CVD events were recorded. Physical activity, regardless of intensity, was consistently associated with a reduced risk of liver cirrhosis, CVD and all-cause mortality. Compared with non-MASLD individuals, our analysis indicates that longer duration of physical activity, specifically >1945 min/week of LPA or >383 min/week of MPA may theoretically eliminate the excess risk of mortality associated with MASLD. Among MASLD individuals, longer physical activity duration, regardless of intensity, was associated with reduced risks of liver cirrhosis and mortality. MPA and VPA were associated with lower CVD risk, while VPA was associated with reduced cancer risk, highlighting the potential benefits of increasing the intensity and duration of physical activity in MASLD management. Show less

To explore the latent classes and their associated factors of sleep quality among police officers, and to analyze the potential heterogeneity in sleep quality within this population. A total of 1162 police officers were selected using cluster random sampling in the Inner Mongolia Autonomous Region between September and December 2021. Participants completed a basic information questionnaire and the Pittsburgh sleep quality index(PSQI). Latent profile analysis(LPA) was employed to examine heterogeneity in sleep quality, and multinomial Logistic regression was used to identify associated factors of the latent profiles. The mean age of participants was(43.08±8.98) years. The sample comprised 920 males(79.2%) and 242 females(20.8%), 987(84.9%) were married and 175(15.1%) were single, 644(55.4%) had a high school education or below, and 518(44.6%) had college education or above. By department, 607(52.2%) worked in grassroots police stations, 200(17.2%) were criminal police, and 355(30.6%) served in other units. Significant heterogeneity in sleep quality was identified, revealing four distinct latent classes: good sleep group(n=821, 70.6%), moderate sleep group(n=46, 4.0%), sleep-disordered group(n=249, 21.4%), and medication-assisted sleep group(n=46, 4.0%). Using the good sleepers as the reference group, multinomial Logistic regression indicated that older age was a significant risk factor for belonging to the medication-assisted sleep group(OR=1.348, 95%CI 1.078-1.822). Higher education level was a protective factor against membership in the moderate sleep group(OR=4.101, 95%CI 1.304-12.893). Serving as a grassroots police station officer or criminal police officer was a significant risk factor for membership in both the moderate sleep group(OR = 3.329, 95%CI 1.338-8.284; OR=4.188, 95%CI 1.415-12.396) and sleep-disordered group(OR=1.701, 95%CI 1.196-2.420; OR=1.587, 95%CI 1.073-2.533). Sleep quality among police officers demonstrates significant heterogeneity. Age, police department assignment, and educational level are key associated factors of distinct latent classes of sleep quality. Show less

Low-density lipoprotein cholesterol (LDL-C) has traditionally been the primary biomarker used to assess cardiovascular risk. However, a substantial proportion of cardiovascular events occur in individuals with LDL-C levels within the normal range, highlighting the need for additional risk markers. Lipoprotein(a) [Lp(a)] has emerged as an independent and genetically determined cardiovascular risk factor that is not adequately captured by conventional lipid profiling. Elevated Lp(a) levels are associated with an increased risk of atherosclerotic cardiovascular disease, including coronary artery disease, ischemic stroke, and calcific aortic valve stenosis, and appear to be particularly relevant in the context of premature cardiovascular events. The pathogenicity of Lp(a) is driven by distinct mechanisms that extend beyond cholesterol transport. These include pro-atherogenic, pro-inflammatory, and pro-thrombotic effects mediated largely by oxidized phospholipids carried by the particle and by the structural properties of apolipoprotein(a), which interfere with fibrinolysis. Despite its strong and stable genetic determination, Lp(a) remains underrecognized and inconsistently measured in clinical practice, partly due to historical limitations in assay standardization and reporting. This minireview summarizes current knowledge on the pathophysiological mechanisms underlying elevated Lp(a), discusses its clinical implications for cardiovascular risk assessment, and highlights the importance of standardized Lp(a) measurement in routine practice, particularly in light of emerging Lp(a)-targeted therapies. Show less

Although previous studies have demonstrated that lipoprotein(a) (Lp[a]) and body mass index (BMI) are associated with atrial fibrillation (AF), their joint effect on AF remains poorly understood. Our primary objective was to examine the combined influence of BMI and Lp(a) on AF occurrence. The study included 8886 patients, among whom 205 were diagnosed with persistent AF. The joint association of BMI and Lp(a) with AF was evaluated. A mediation Mendelian randomization (MR) analysis was also performed. In comparison with the individuals with a higher Lp(a) level (≥30 mg/dl) and BMI equal to or above 24 kg/m2, those with a lower Lp(a) level and BMI had the lowest prevalence of AF (odds ratio, 0.96; 95% CI, 0.95-0.97; P <0.001), especially at the age of 50-69 years, and the lowest risk of stroke (hazard ratio [HR], 0.28; 95% CI, 0.12-0.68; P = 0.004), heart failure (HF; HR, 0.24; 95% CI, 0.08-0.66; P = 0.006), and major adverse cardiovascular events (MACE; HR, 0.35; 95% CI, 0.18-0.66; P = 0.001). Mediation MR analysis highlighted the coexposure effects of Lp(a) levels and BMI on AF and their independent influence on AF development. Lower BMI and Lp(a) levels were associated with a reduced prevalence of AF as well as a lower risk of stroke, HF, and MACE. Mediation analysis showed that neither BMI nor Lp(a) mediated the effect of the other, suggesting that their contributions to AF risk operate through independent pathways. Show less

Elevated Lipoprotein(a) [Lp(a)] is a genetic risk factor for cardiovascular diseases affecting 20% of the world's population, with multiple published consensus statements that recommend testing and management strategies. However, elevated Lp(a) remains under-detected and under-treated worldwide. Our qualitative study explored the perspectives of cardiology healthcare professionals regarding the barriers and enablers for Lp(a) detection and management. Guided by Theoretical Domains Framework, we conducted 41 qualitative semi-structured one-on-one interviews in a cardiology department at a high-volume hospital in Singapore from October to December 2023. Healthcare professionals were purposively sampled across role and seniority to include doctors (specialists and interns), specialist nurses and dedicated pharmacists. Through an inductive process, we constructed qualitative codes followed by code-mapping to arrive at higher-order sub-categories, categories, and eventually themes. Analysis revealed 4 themes: rationale for routine testing, barriers to testing and follow-up, enablers of testing and follow-up, and ideal system to enhance patient management. Critical barriers to Lp(a) testing included a perceived lack of guidance in testing and follow-up, and misperception that Lp(a)-mediated cardiovascular risk cannot be managed resulting in low confidence of healthcare professionals to detect and manage elevated Lp(a). Inadequate institutional support to alleviate workload and presumed patient aversion to testing further hindered Lp(a) testing. We identified enablers and strategies to testing and management of Lp(a), notably these were the need for hospital-wide adequate training and education, guidelines and risk management pathways applicable to local settings, integration of Lp(a) testing into existing clinical pathways for high-risk patients, and user-friendly decision aids for healthcare professionals. Effective education for healthcare professionals and optimised clinical workflows may help to address current knowledge gap and implementation barriers in the detection and management of elevated Lp(a) in hospital. Show less

Despite advancements in treatment, coronary artery disease (CAD) remains a significant global health concern. Although lipoprotein(a) [Lp(a)] is recognized as a crucial cardiovascular risk factor associated with increased risk, the prognostic value of using Lp(a) levels in patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) remains debatable. This review aimed to investigate the association between Lp(a) levels and recurrent ischemic events in patients with ACS undergoing PCI. This systematic review included studies with individuals aged ≥18 years diagnosed with ACS who underwent PCI and had Lp(a) measurements. The included studies were sourced from the PubMed database, with a focus on articles published between January 2020 and January 2025. Keywords related to Lp(a) and cardiovascular diseases were used in the search. Data extraction involved a review of titles and abstracts followed by quality assessment using the QUADAS-2 tool. The final analysis included 10 studies with a combined population of 20,896 patients from diverse regions, including Japan, India, Egypt, China, and South Korea. Key findings indicate that elevated Lp(a) levels are significantly associated with adverse cardiovascular outcomes, including myocardial infarction and mortality, both in hospital and during long-term follow-up. This review highlights Lp(a) as a critical biomarker for predicting recurrent cardiovascular events in ACS patients post-PCI. The consistent correlation between elevated Lp(a) levels and adverse outcomes underscores the necessity of routine monitoring and targeted management of Lp(a) to mitigate residual cardiovascular risk. Show less

Lipoprotein(a) [Lp(a)], one of the major residual cardiovascular risks, is a highly polymorphic low-density lipoprotein (LDL)-like particle. Epidemiological and Mendelian randomization studies have suggested that elevated Lp(a) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) due to its pro-inflammatory, pro-atherogenic and pro-thrombotic properties. However, metabolic and pathological mechanisms of Lp(a) remain under-investigated. Recent genomic and population studies show that very low Lp(a) levels are associated with increased risk of type 2 diabetes mellitus (T2DM). Thus, whether potent Lp(a)-lowering therapies might increase the risk of T2DM incident has been raised as a potential issue from recent guidelines. This review details Lp(a)-induced inflammation and thrombosis evidences, the underlying mechanisms of Lp(a) in ASCVD, and the complicated associations and potential mechanistic effects of Lp(a) on the development of T2DM. Current evidences tend to favor that the anti-atherogenic benefits of lowering Lp(a) shall override the paradoxical negative impact on the new-onset T2DM. The risk-benefit assessments for potent Lp(a)-lowering therapies are warranted. Show less

Early identification of individuals with low advance care planning (ACP) engagement remains a critical component of clinical care. However, we know little about the heterogeneity of ACP engagement at the individual level. This study identified latent subgroups of ACP engagement using latent profile analysis (LPA), and explored their associations with death attitudes. This study recruited 302 end-stage renal disease (ESRD) patients undergoing dialysis. Data included sociodemographic characteristics, the Advance Care Planning Engagement Survey (ACPES; Chinese version), and the Death Attitude Profile-Revised (DAP-R). Based on multidimensional indicators, LPA was employed to identify distinct ACP engagement profiles. Model fit and classification quality in LPA were evaluated based on class sizes and entropy values. All analyses were completed in SPSS 26.0 and Mplus 8.3, with R3STEP and BCH methods employed to uncover underlying patterns and relationships. Among dialysis-dependent ESRD patients, ACP engagement was categorized into two latent profiles: a "low-ACP Engagement" profile (n = 162, 53.6%) and a "high-ACP Engagement" profile (n = 140, 46.4%), with good classification quality (entropy = 0.909). The profile membership was significantly associated with dialysis vintage, and educational level (both This study identifies two distinct ACP engagement profiles among dialysis-dependent ESRD patients. Findings emphasize the need for tailored interventions, particularly for patients with shorter dialysis vintage and lower education level, and highlight the role of death attitudes in shaping ACP engagement. These findings should be interpreted with caution due to the cross-sectional design and single-center setting. Show less