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Using a person-centered approach, this study examined the heterogeneity of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) co-occurrence among breast cancer patients and identified factors associated with distinct latent profiles. A total of 600 breast cancer patients undergoing chemotherapy at a tertiary hospital were recruited. Latent profile analysis (LPA) and multinomial logistic regression were conducted to identify PTSD - PTG profiles and to examine the predictive roles of caregiver burden and demographic variables. LPA identified three distinct profiles: (1) Show less

Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein implicated in cardiovascular disease, but its role in heart failure (HF) remains uncertain. Observational studies indicate a link between elevated Lp(a) and HF risk, but the dose-response relationship remains unexplored. This meta-analysis aimed to quantify the association between circulating Lp(a) levels and HF incidence. A systematic search of PubMed, Embase, and Web of Science identified prospective cohort studies reporting hazard ratios (HRs) for HF incidence across different Lp(a) levels. A random-effects model was applied to pool effect estimates while accounting for heterogeneity, and restricted cubic splines assessed dose-response relationships. Five prospective cohort studies with 400 631 participants were included. During a mean follow-up duration of 11.0 years, 10 598 (2.6%) patients developed HF. A high Lp(a) level was associated with an increased HF risk (HR: 1.34, 95% CI: 1.14-1.59, p < 0.001), with moderate heterogeneity (I² = 69%). Subgroup analysis showed a stronger association in studies using an Lp(a) cutoff of ≥ 50 mg/dL (HR: 1.68) compared to those with a cutoff of < 50 mg/dL (HR: 1.16, p for subgroup difference < 0.01), which completely explained the heterogeneity. The dose-response analysis revealed a nonlinear association (p for non-linearity = 0.001). HF risk increased nearly linearly below 55 mg/dL, then slowed, and plateaued at 160 mg/dL. Elevated Lp(a) is associated with an increased HF risk in a nonlinear pattern, with risk escalation slowing at higher concentrations. Show less

Frailty is associated with increased risks of falls, disability, hospitalization, and mortality. The 24-h movement behaviors (24HMB) framework conceptualizes sleep, sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) as mutually constrained components of daily time use and may inform frailty prevention and management. This scoping review maps evidence on associations between 24HMB and frailty and identifies methodological gaps to inform future research and nursing practice. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and follows Joanna Briggs Institute (JBI) guidance. We searched PubMed, Embase, CINAHL, and Web of Science. We included observational studies of adults aged ≥18 years. Exposures were objectively measured or validated self-reported sleep, SB, LPA, and MVPA, including step counts, breaks in SB, isotemporal substitution models (ISM), and compositional data analysis (CoDA). Outcomes were frailty or prefrailty assessed using validated instruments. Quality was appraised with JBI tools. Thirty-three studies showed good methodological quality. Longer SB, particularly prolonged, uninterrupted bouts, was associated with higher frailty. Greater MVPA was consistently associated with lower frailty. Light-intensity physical activity was generally beneficial but often attenuated when MVPA or total activity volume was modeled. Sleep fragmentation and poor sleep quality were associated with frailty. Isotemporal substitution models and compositional data analysis indicated that reallocating sedentary time to MVPA would yield the largest theoretical benefit, followed by reallocating to LPA. Higher daily step counts and more frequent or higher-intensity breaks in SB were associated with lower frailty. Evidence supports a 24-h integrated movement-behavior approach centered on MVPA, combined with reducing prolonged SB and improving sleep quality, for the prevention and nursing management of frailty. The study design and analytical protocol were prospectively registered on the Open Science Framework (OSF). The unique identifier is S39Y4, and the publicly accessible URL is https://doi.org/10.17605/OSF.IO/S39Y4. Show less

To ascertain the level of psychological resilience, examine the latent profiles of individuals within infertile couples who experience recurrent implantation failure (RIF), identify the relevant influencing factors, and lay a foundation for developing customized intervention strategies. Convenience sampling was adopted in this study. Participants were selected from individuals in infertile couples with RIF who attended the Second West China Hospital of Sichuan University between November 2024 and July 2025. Data were collected via a general information questionnaire and validated scales assessing psychological resilience, social support, sleep quality, family adaptability and cohesion, anxiety, and depression. Latent profile analysis (LPA) was performed to explore the psychological resilience profiles of individuals with RIF, while univariate analysis and multivariate Logistic regression analyses were employed to identify the influencing factors associated with different profile categories. A total of 303 valid questionnaires were collected, including 194 from females and 109 from males. The overall psychological resilience score was (26.66 ± 6.319). Latent profile analysis categorized psychological resilience into three subgroups: the low tenacity-low strength subgroup (31.4%), the moderate tenacity-moderate strength subgroup (53.1%), and the high tenacity-high strength subgroup (15.5%); Multivariate Logistic regression analysis indicated that gender, family adaptability and depression severity (all Marked interindividual heterogeneity exists in the psychological resilience of individuals with RIF. Gender, family adaptability and depression severity serve as the core influencing factors. In clinical practice, stratified and targeted interventions should be delivered according to distinct psychological resilience subgroups. It yields clinical implications for an association between improved psychological resilience among individuals from couples with RIF and enhanced treatment adherence. Show less

Based on self-determination theory (SDT), this study aimed to identify latent profiles of health motivation characteristics among young and middle-aged individuals with prediabetes and to examine their associations with self-management behaviours and metabolic risk indicators. This cross-sectional study recruited individuals with prediabetes from January 2024 to January 2025 using a convenience sampling method, enrolling 309 participants. Health behaviour motivation, basic psychological needs, prediabetes-related disease knowledge and self-management were assessed using validated questionnaires. Latent profile analysis (LPA) was conducted to identify distinct subgroups. Multinomial logistic regression was used to examine demographic, lifestyle and clinical factors associated with profile membership. Three types of health motivation characteristics were identified: high psychological need satisfaction-autonomous motivation profile (24.0%), moderate psychological need satisfaction-externally controlled motivation dominant profile (15.0%) and low psychological need satisfaction-low motivation profile (61.0%). After adjustment, BMI, comorbidity history and occupation were significantly associated with profile membership, whereas distance to primary healthcare facilities showed a non-robust pattern. Significant heterogeneity exists in health motivation characteristics among young and middle-aged individuals with prediabetes, with the low psychological need satisfaction-low motivation profile representing the largest proportion. Incorporating motivation-oriented stratification into diabetes prevention strategies may provide a useful framework for delivering tailored interventions and supporting more sustainable self-management. Show less

Coronary microvascular dysfunction (CMD) is increasingly recognized as a major driver of myocardial ischemia, with important implications for cardiovascular prognosis and quality of life, particularly in populations with ischemia and non-obstructive coronary arteries (INOCA) and heart failure with preserved ejection fraction (HFpEF). Despite increasing recognition of its importance, the mechanisms underlying CMD remain incompletely defined, and disease-modifying therapies are lacking. Lipoprotein(a) [Lp(a)], a genetically determined and causal cardiovascular risk factor, has been extensively studied in epicardial coronary atherosclerosis; however, its role in the coronary microcirculation has received comparatively limited attention. Lp(a) exhibits unique structural and biological properties, including the antifibrinolytic effects of apolipoprotein(a) and carriage of oxidized phospholipids, which promote endothelial dysfunction, oxidative stress, inflammatory activation, microvascular remodeling, and microthrombotic susceptibility-key processes implicated in CMD pathophysiology. Observational studies link elevated Lp(a) levels to impaired coronary flow reserve and endothelial dysfunction in patients with microvascular angina and related syndromes. Imaging and interventional studies further suggest that reduction of Lp(a)-associated circulating factors can improve myocardial perfusion and perfusion reserve in clinical settings dominated by microvascular disease. This review synthesizes current mechanistic, translational, and clinical evidence linking Lp(a) to CMD, identifies key knowledge gaps, and highlights future research priorities. Show less

Lipoprotein(a) [Lp(a)] is a genetically determined cardiovascular risk factor. Additionally, Lp(a) levels are affected by dietary saturated fat (SFA) reduction. We previously reported an Lp(a) increase in response to SFA reduction in both white and black cohorts. However, less is known whether diets impact Lp(a)'s oxidized phospholipids (OxPL) and lipid components. We assessed responses of Lp(a)-OxPL concentration, Lp(a)-OxPL subspecies abundance, and the Lp(a)-lipidome to SFA reduction [from 16% energy with the average American diet (AAD) to 6% energy with a DASH-type diet] in 166 African-Americans. Responses by variability in Lp(a) levels and apolipoprotein(a) [apo(a)] sizes were tested. Mean age was 35 years; 70% were women; mean BMI was 28 kg/m Show less

While physical activity (PA), sedentary time (ST), and sleep each show individual associations with learning outcomes, their combined associations remain largely unexplored. This cross-sectional study examined the association between the 24-h movement behavior composition and arithmetic and reading fluency in children and adolescents, gender differences in these associations, and theoretical 30‑minute behavior‑change scenarios. Volunteered children (N = 253, mean age: 9.5 ± 0.4 years, 53% girls) and adolescents (N = 174, mean age: 13.7 ± 0.6 years, 63% girls) participated. Children's arithmetic fluency was measured using the FUNA test battery, and reading fluency with the Sentence Reading fluency test. Adolescents' arithmetic fluency was measured with the Basic Arithmetic Test, and reading fluency with the word reading task ALLU. Light PA, moderate PA, vigorous PA, and ST were measured using hip-worn accelerometers (ActiGraph GT3X +). Students recorded their sleep time. The associations were examined using compositional data analysis. The ratios of behaviors were predictors within linear mixed models, adjusted for age, gender, special educational needs, body fat percentage, and guardians' education. The light PA relative to other behaviors was inversely associated with reading fluency (β = - 0.98, p = 0.014) among children. No other behaviors were associated with reading or arithmetic fluency in children or adolescents. Among adolescents, there was a significant interaction effect of gender and the time spent in ST on reading fluency (β = - 2,85, p = 0.037), but not on arithmetic fluency. Together, the interaction and main effects indicate that higher ST is linked to better reading fluency for both genders, with a stronger association in boys. Among adolescents, predicted 30‑minute reallocations from ST to sleep, or moderate PA, as well as from LPA to sleep, increased the difference in reading fluency between girls and boys. Lower levels of light-intense PA were linked to better children's reading fluency. The association between the 24-h activity composition and reading fluency among adolescents may differ between boys and girls. From a 24-h movement behavior perspective, supporting reading may require strategies that are tailored by age and gender. Show less

Toddler movement patterns challenge current accelerometer-based detection of physical activity (PA) and sedentary time (SED). The objectives of this study were to: (1) develop a novel machine learning (ML) model to detect toddlers' PA and SED; and (2) compare this ML model to existing cut-point methods to analyze toddlers' PA (independent sample cross-validation of existing methods). We recruited 111 toddlers (21 ± 7 months; 51% female) to two 1-hour semi-structured visits wearing a waist-worn ActiGraph wGT3X-BT accelerometer. Video recordings were manually annotated using a modified Children's Activity Rating Scale to determine a ground truth. We extracted 40 time and frequency domain features from raw accelerations and trained 4 gradient boosted tree ML models (distinguishing SED, total PA (TPA), light PA (LPA), moderate-to-vigorous PA (MVPA), and non-volitional movement (NVM)). Models were assessed using accuracy, F1 scores, and confusion matrices. For the validation of 11 existing methods, we calculated accuracy, F1, and mean absolute differences in TPA and MVPA estimation. ML models classifying NVM/SED/TPA and NVM/SED/LPA/MVPA reached 82% and 74% accuracy with mean absolute differences of 3.0 and 3.2 min/h, respectively. Independent sample cross-validation found accuracies from 33 to 74% and mean absolute differences from 7.6 to 18.6 min/h in TPA and 10.7 to 25.8 min/h in MVPA. We recommend the NVM/SED/TPA or NVM/SED/LPA/MVPA models' given alignment with toddler TPA guidelines and MVPA link to health outcomes, respectively. We additionally present an open-access interface for using these ML models that does not require coding knowledge. This presents a substantial step forward in the measurement of toddlers' physical activity. Show less

Clinical trials have shown that interleukin-6 (IL-6) signaling inhibitors reduce lipoprotein(a) [Lp(a)] levels, though the relevance of this reduction to atherosclerotic cardiovascular disease (ASCVD) risk is uncertain. We leveraged Mendelian randomization (MR) to investigate the extent to which Lp(a) reduction mediates the effects of IL-6 signaling inhibition on ASCVD. IL-6 signaling inhibition was proxied by the IL6R variant p.Asp358Ala and scaled to C-reactive protein (CRP) levels. Genetic associations with Lp(a) were obtained from UK Biobank (n = 343,681). Outcomes included large-artery atherosclerotic stroke (LAAS: 6399 cases), carotid plaque (29,760 cases), and coronary artery disease (CAD: 181,522 cases). MR analyses estimated the association of IL-6 signaling inhibition with Lp(a) and ASCVD, and we quantified the proportion of the IL-6-ASCVD association mediated by Lp(a). Individual-level analyses tested whether effects of IL-6 signaling inhibition on Lp(a) and CAD were amplified in carriers of Lp(a)-raising variants. Genetically proxied IL-6 signaling inhibition modestly reduced Lp(a) (-3.01 mg/dL per 1-ln(CRP) reduction, 95% CI -4.79, -1.23) and protected against all ASCVD outcomes (ORs: 0.34-0.69). Lp(a) mediated only a small proportion of the IL-6-ASCVD association (range: 1.3%-4.8%). In carriers of Lp(a)-raising variants, the IL-6-Lp(a) association was stronger (-9.8 mg/dL, 95% CI -14.6, -5.1; p These findings suggest that Lp(a) minimally mediates and does not modify the cardiovascular benefits of IL-6 signaling inhibition, supporting these targets as independent and complementary for ASCVD. The amplified IL-6-Lp(a) association in carriers of Lp(a)-raising variants warrants replication. Show less

This study investigated the relationships between vacant land and key adverse health behaviors, including smoking, insufficient sleep, and no leisure-time physical activity (No LPA), across census tracts in Chicago, Illinois. Using both global regression and geographically weighted regression (GWR), we evaluated whether neighborhood vacant land ratios (VLRs) were associated with the prevalence of these adverse health behaviors and assessed how these associations varied spatially across the city. We found significant spatial clustering in both vacant land and health behavior indicators, and the spatial clustering patterns of neighborhood vacancy and adverse health behaviors were broadly consistent. In global models, higher VLRs were associated with higher prevalence of adverse health behaviors; after accounting for spatially autocorrelated errors, the associations remained robust for smoking and insufficient sleep but were attenuated for No LPA. GWR results further revealed clear spatial non-stationarity, with stronger positive local associations concentrated in low-income neighborhoods on the south and west sides. When overlaid with Healthy Chicago Zones (HCZs), the strong vacancy-behavior associations aligned primarily with the West, Southwest, Near South, and Far South zones, highlighting these HCZs as priority areas where vacancy was most strongly linked to adverse health behaviors. Our findings support theories of neighborhood disorder and spatial inequality, emphasizing that vacant land is a potentially modifiable environmental determinant of health behaviors and calling for tailored interventions that consider local social and economic contexts to improve community health and advance health equity. Show less

Menopause may coincide with rising Lp(a) levels, a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Characterizing changes in Lp(a) across menopause may inform risk stratification and testing recommendations. . We examined changes in serum Lp(a) levels by menopausal status among women with Lp(a) measured at visits 1 and 2 in the UK Biobank. Lp(a) analyses were examined by menopausal status: those who underwent menopause (N=415), those who remained premenopausal (N=532), and those who remained postmenopausal (N=3,615) between visits. We examined the change in Lp(a) between visits stratified by visit 1 Lp(a) levels. The primary outcome was incident Lp(a) ≥125 nmol/L at visit 2, estimated using Poisson regression with adjustment for baseline age. Data were available for 4,562 women (mean age at visit 1 = 57±7 years; median Lp(a) at visit 1 = 22 (IQR: 47) nmol/L; median time between visits = 4 (IQR: 1) years). At visit 1, median Lp(a) was slightly higher in postmenopausal women (23 nmol/L) than premenopausal women (19 nmol/L). Overall, median changes in Lp(a) between visits 1 and 2 were modest. Among women with intermediate visit 1 Lp(a) levels (75-125 nmol/L), those who transitioned through menopause experienced a median increase of 34.9 (-6.7, 53.0) nmol/L between visits, an approximately fourfold greater increase than for women who remained pre- (7.9 nmol/L) or postmenopausal (8.0 nmol/L). Further, 56% of women with intermediate visit 1 Lp(a) levels who transitioned through menopause between visits had incident Lp(a) ≥125 nmol/L at visit 2, compared with 29% and 28% of women who remained pre- or postmenopausal, representing an age-adjusted risk ratio of 2.26 (95% CI: 1.31, 3.90). Relying on a single lifetime Lp(a) measurement may miss clinically relevant increases during menopause. Repeat testing in women as they age may improve identification of those at high risk for ASCVD. Show less

This study aimed to explore the association between serum lipoprotein(a) [Lp(a)] levels and recurrent acute coronary syndrome (ACS) and revascularization of target lesions in patients with ACS who showed no functional ischemia on fractional flow reserve (FFR) testing during coronary angiography (CAG). The retrospective observational study was conducted at the General Hospital of Northern Theater Command and included 513 patients with new ACS recruited from 23 February 2016 to 6 November 2023 and followed up. These patients underwent CAG examination and were found to have at least one coronary artery with moderate or greater stenosis, and also underwent FFR measurement with FFR value >0.80. Patients experienced recurrent ACS and underwent unplanned revascularization were defined as the revascularization group, while patients did not experience recurrent ACS and undergo unplanned revascularization were assigned to the no revascularization group. The study employed propensity score matching (PSM) and receiver operating characteristic (ROC) curve analysis to evaluate the correlation between serum Lp(a) and recurrent ACS and unplanned revascularization in target lesion with FFR value >0.80. Serum Lp(a) levels were higher in female patients. There were no statistically significant differences in the basic clinical characteristics, medication use, laboratory test results or ejection fraction values between the two groups. During a average follow-up of 6.5 years, 119 patients (23.2%) experienced recurrent ACS and unplanned revascularization in the target lesion. The level of serum Lp(a) in the patients that underwent unplanned revascularization was significantly higher than in the group that did not undergo repeated revascularization (65.80 mmol/L vs. 60.57 mmol/L, Serum Lp(a) is an independent risk factor for recurrent ACS and unplanned revascularization in patients with ACS and FFR negative plaque. Show less

Compared with non-left-behind children (NLBC), left-behind children (LBC) face a higher risk of academic stress, depression, and anxiety symptoms due to separation from their parents; however, the heterogeneity of academic stress profiles and their relationships with the symptom network remain insufficiently explored. To address this gap, a cross-sectional survey of 10,524 Chinese children compared LBC (n = 2487) and NLBC. Latent profile analysis (LPA) was first conducted to identify academic stress subgroups among LBC. Subsequently, depression-anxiety symptom networks were estimated using Ising and Gaussian graphical models (GGM), with edge weights derived from regularised logistic regression (Ising) and partial correlation (GGM). Simulated interventions were further evaluated via the NodeIdentifyR algorithm (NIRA). Overall, compared to NLBC, LBC exhibited higher levels of academic stress, depression, and anxiety (ps < 0.001, Cliff's δ = 0.076; Cohen's d = 0.067). LPA revealed three academic stress subgroups: moderate (31.44%), high (9.17%), and low (59.39%). The severity of depression and anxiety symptoms increased with the level of academic stress. The high stress subgroup displayed a sparse network with stronger edges (e.g., A1 'Sudden Fear'-A4 'Physical Symptoms', edge weight = 2.10) compared to moderate- and low-academic stress subgroups. Core nodes with the strongest expected influence were A8 ('Decision Hesitation', moderate subgroup), A2 ('Worry', high subgroup), and D1/D6 ('Sadness' and 'Failure', low subgroup). Simulated interventions indicated that alleviating A8 'Decision Hesitation' or A2 'Worry' most effectively reduced symptom risk (16.66%-30.76%), whereas D8 'Motor' and A7 'Early Departure' were associated with maximal symptom aggravation. Taken together, by integrating LPA-derived academic stress profiles with symptom network analysis, this study reveals distinct symptom associations across subgroups. In the high stress subgroup, symptom A2 ('Worry') is a core intervention target; in the low stress subgroup, A7 ('Early Departure') holds preventive potential. These findings underscore subgroup-specific interventions tailored to individual stress profiles. Show less

To investigate the association between quantitative retinal vascular parameters and coronary artery disease (CAD) and to evaluate the efficacy of a retinal phenotype-based diagnostic model as a non-invasive tool for early CAD screening. A retrospective cross-sectional study. A single-centre study conducted at the Cardiovascular Center of Beijing Tongren Hospital, Capital Medical University, China, between January and October 2024. 417 patients with suspected angina undergoing their first coronary angiography (CAG) were enrolled. Inclusion criteria were age >18 years and high-quality fundus photography within 24 hours pre-CAG. Major exclusions were prior coronary interventions, severe systemic/valvular heart diseases and ocular conditions impairing retinal vascular visualisation. The primary outcome was the association between quantitative retinal vascular parameters and the presence of CAD (defined as ≥50% stenosis). Secondary outcomes included the diagnostic performance area under the receiver operating characteristic curve (AUROC) of three predictive models: one based on quantitative retinal vascular parameters alone, one based on traditional risk factors and a combined model integrating both retinal and clinical variables. This study enrolled 417 patients undergoing initial CAG. Compared with non-CAD controls (n=190), patients with CAD (n=227) had higher prevalence of hypertension, dyslipidaemia and diabetes, along with elevated levels of fasting blood glucose, lipoprotein(a) (Lp(a)), triglyceride (TG) and glycated haemoglobin (HbA1c) (all p<0.05). Quantitative fundus analysis revealed that multiple retinal vascular parameters were independently associated with CAD after multivariable adjustment, including fractal dimension (FD), vessel density (VD) and specific zonal measures of vessel diameter and tortuosity (all p<0.05). Multivariable logistic regression incorporating both fundus and clinical variables identified the following independent predictors of CAD: a decrease in FD (OR=0.26, 95% CI 0.16 to 0.41, p<0.01), reduced optic disc long-to-short axis ratio (OR=0.04, 95% CI 0.004 to 0.46, p=0.01) and optic disc-to-macula distance (OR=0.91, 95% CI 0.86 to 0.97, p<0.01), male sex, dyslipidaemia and elevated levels of Lp(a), TG, low-density lipoprotein cholesterol and HbA1c (all p<0.05). The final diagnostic model achieved an AUROC of 0.802 (95% CI 0.76 to 0.845), with a sensitivity of 0.797 and a specificity of 0.679 at the optimal cut-off. Internal validation via bootstrap resampling (1000 iterations) confirmed the robustness of the identified predictors. Our findings, derived from an artificial intelligence-based fully automated quantitative retinal vascular parameters measurement method, revealed that multiple quantitative fundus parameters-including FD, VD and other morphological parameters were significantly associated with CAD risk. The CAD diagnostic model we developed demonstrates strong performance and high interpretability, making it suitable for early CAD screening and diagnosis. Show less

Methodological challenges diminish the number and reliability of longitudinal studies on executive functions (EFs) starting in infancy. To address this, the current study used latent profile analysis (LPA) to examine EF task performance across three age points: 8 months, 2.5 years, and 5 years. Participants were children (N = 830; 55.5% boys; > 95% White) from the FinnBrain Birth Cohort Study. Three profiles were identified: constant below average EF profile (14.2%), and two average EF profiles differentiated by Spin the Pots performance (working memory) at 5 years (above average 29.8%, below average 56%). Expected associations between the below average EF profile, male sex, and lower general cognitive performance were found, further supporting the validity of the profiles. Show less

Lipoprotein(a) [Lp(a)] is a well-established, genetically determined risk factor for atherosclerotic cardiovascular disease, but its short-term response to aggressive lipid-lowering therapy after acute coronary syndrome (ACS) remains unclear. To evaluate 1-month changes in Lp(a) and assess whether baseline Lp(a) levels are associated with low-density lipoprotein cholesterol (LDL-C) goal achievement in statin-naive ACS patients undergoing triple oral lipid-lowering therapy. We retrospectively analyzed 345 patients with ACS treated with rosuvastatin (20-40 mg), ezetimibe (10 mg), and bempedoic acid (180 mg) for 1 month after percutaneous coronary intervention. Lp(a) and LDL-C were measured at baseline and 1 month. Multivariable logistic regression identified predictors of achieving the LDL-C goal (<50 mg/dL). Despite a 59.1 ± 17.3% reduction in the mean LDL-C, the average Lp(a) increased by 91% (from 42.2 ± 39.2 mg/dL to 80.5 ± 66.3 mg/dL, P < .001). LDL-C targets of <50 mg/dL and <55 mg/dL were achieved in 68.9% and 78.6% patients, respectively. Baseline Lp(a) independently predicted failure to reach LDL-C goals (adjusted odds ratio [OR] 0.97; 95% CI 0.96-0.98; P < 0.001), while diabetes mellitus increased the likelihood of achieving targets (adjusted OR 2.69; 95% CI 1.36-5.61; P = .006). A strong inverse relationship was observed between Lp(a) change and LDL-C goal achievement (ρ = -0.38, P < 10⁻¹²). In Indian patients with ACS, aggressive triple oral lipid-lowering therapy quickly reduces LDL-C, while being accompanied by a substantial rise in Lp(a) levels, likely reflecting an acute-phase response. Baseline Lp(a) may independently limit LDL-C target attainment. Early Lp(a) testing may improve residual risk assessment and help guide the use of emerging Lp(a)-focused treatments. Show less

Hemolytic disease of the fetus and newborn (HDFN) is a potentially life-threatening condition caused by maternal alloimmunization against fetal red blood cell (RBC) antigens. While most cases involve well-characterized antibodies such as anti-D, anti-c, or anti-K, antibodies against low-prevalence antigens (LPAs) - particularly those within the MNS blood group system - remain underrecognized and underreported. We report a case of maternal alloimmunization against the paternally inherited LPA MUT (MNS35), carried on a hybrid glycophorin ( This case supports the pathogenicity of anti-MUT as a cause of severe HDFN. It underscores the diagnostic challenges posed by antibodies against LPAs and highlights the importance of extended serological, molecular, and functional testing. Crossmatching maternal plasma with paternal RBCs and systematic evaluation of serological discrepancies can reveal otherwise undetectable alloantibodies. Early identification, functional assessment, and multidisciplinary management are key to optimizing outcomes in pregnancies complicated by rare RBC alloimmunization. Anti-MUT should be considered a clinically significant antibody with the potential to cause severe HDFN, warranting proactive perinatal surveillance. Show less

Canine Cognitive Dysfunction (CCD) is an increasingly prevalent naturally occurring neurodegenerative condition in senescent dogs that share neuropathological and clinical features with human Alzheimer's disease (AD). Metabolic profiling allows for identification of new candidates for AD biomarkers, diagnostics, and therapeutics. Despite its translational potential, plasma metabolomic profiling of dogs with CDD has not been previously characterized. This case-control study analyzed plasma samples from ten client-owned geriatric dogs, including five with severe CCD and five age-matched, clinically healthy controls. Untargeted plasma metabolomics was performed using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Multivariate and univariate statistical analyses identified significant metabolic differences between the groups. Metabolites were considered significant based on a variable importance in projection (VIP) score > 1.5, fold change (FC) > 2.0, and adjusted Fifteen metabolites across seven chemical classes were significantly altered in CCD dogs compared to controls, including glycerophospholipids, steroid derivatives, indoles, and mitochondrial-related compounds. Notably, elevated lysophosphatidic acid (LPA 20:2/0:0) and reduced ubiquinone-2 levels suggest dysregulation in neuroinflammatory and oxidative stress pathways. Cholesterol exhibited the highest FC and VIP scores, further reinforcing its role in AD pathogenesis. Hierarchical clustering and pathway enrichment analyses supported distinct metabolic signatures in CCD that mirror those observed in human AD. This is the first untargeted plasma metabolomic profiling of dogs with CCD, revealing systemic metabolic disturbances that align with AD pathophysiology. Data was collected from senescent community-dwelling companion dogs, which enhances the study's ecological and translational relevance. It supports the utility of CCD as an AD model and highlight candidate plasma biomarkers that warrant further investigation. Future longitudinal studies integrating metabolomics with neuroimaging, histopathology, and behavioral assessments are required to validate these findings and contribute to AD biomarker discovery and therapeutic development. Show less

Given that abnormal lipid metabolism is a hallmark of metabolic dysfunction-associated steatotic liver disease (MASLD), this study seeks to investigate the relationship between serum lipoprotein(a) [Lp(a)] levels and the progression or regression of MASLD. A total of 12,962 participants undergoing transient elastography at the Health Promotion Center of the First Affiliated Hospital of Nanjing Medical University were included in the first cross-sectional study (Study 1). The longitudinal study (Study 2) included 17,661 individuals from the same center, each with at least two health check-ups involving abdominal ultrasonography. Another cross-sectional study (Study 3) included 5,927 individuals from the UK Biobank cohort who had undergone both magnetic resonance imaging proton density fat fraction (MRI-PDFF) and Lp(a) testing. Cross-sectional analysis (Study 1) revealed that elevated Lp(a) levels were inversely correlated with the severity of both hepatic steatosis and fibrosis. Longitudinal data (Study 2) further demonstrated that baseline serum Lp(a) levels were decreased in participants with the incident of MASLD, while increased in participants with the regression of MASLD during the follow-up period. A lower baseline Lp(a) level was an independent factor for new-onset MASLD and non-regression of MASLD: the fully adjusted hazard ratios (HR) were 0.895 (95%CI 0.834-0.962, Serum Lp(a) levels are inversely associated with both the progression and regression of MASLD, indicating its potential role in reflecting disease dynamics. Show less

Elevated lipoprotein(a) [Lp(a)] is an important genetic risk factor for cardiovascular diseases (CVDs). Because Lp(a)-lowering therapies are limited, prevention focuses on identifying individuals with elevated Lp(a) and optimizing other modifiable risk factors. We aimed to assess the distribution of Lp(a) levels in Finnish adults and examine its association with other CVD risk factors, as well as the awareness, treatment, and control of dyslipidemia. Data were derived from the Healthy Finland health examination survey conducted in 2023, comprising a nationally representative sample of 5,484 adults. Lp(a) levels were categorized using a cut-point at 125 nmol/L. Other CVD risk factors included were dyslipidemia, abnormal glucose metabolism, hypertension, and obesity. Analyses were weighted taking into account the sampling design and non-participation to provide nationally representative results. Mean Lp(a) levels were 41.7 nmol/L (95% CI 39.0-44.3) in men (M) and 41.9 nmol/L (39.7-44.1) in women (W). Elevated Lp(a) was observed in 11.0% of men and 10.4% of women. Dyslipidemia was more prevalent among individuals with elevated Lp(a) (M: 88.1% vs. 78.4% p = 0.003, W: 79.2% vs. 73.2% p = 0.030) but this association reversed after correcting cholesterol for Lp(a). No associations were found between Lp(a) and other cardiometabolic risk factors. Individuals with elevated Lp(a) had slightly lower unawareness (M: 42.3% vs. 47.5%, p = 0.180, W: 38.8% vs.48.4%, p = 0.042) and better treatment (M: 38.1% vs. 31.7%, p = 0.010, W: 29.2% vs. 24.7%, p = 0.090) of dyslipidemia than those with lower levels while no association was found between Lp(a) and dyslipidemia control (M: 81.4% vs. 84.1%, p = 0.520, W: 74.6% vs. 73.0%, p = 0.740). Approximately one in ten Finnish adults had elevated Lp(a), a lower prevalence than in many other European populations but still affecting a substantial share of the population. Elevated Lp(a) was associated with higher prevalence of dyslipidemia prior to Lp(a) correction, but not with other CVD risk factors, and these individuals also showed slightly greater awareness and treatment of dyslipidemia. These findings emphasize the need for comprehensive management of modifiable CVD risk factors to reduce the overall burden of CVDs. Show less

Lipidomic analysis enables the detailed characterization of platelet concentrates from donors of different ages, offering valuable insights into the role of lipid mediators in aging and transfusion-related adverse reactions (AR). In this study, we analyzed lipidomic profiles from a cohort of single-donor apheresis platelet concentrates, classified into three age groups: 20-44, 45-59, and 60-70 years. Total levels of LPC, LPA, S1P, and eicosanoids did not exhibit significant age-related changes. However, LPA 18:1, LPC 18:1, and S1P levels decreased with advancing age. When examining the relationship between different age groups and their association with AR, we found that LPA, LPC, and eicosanoids are associated with AR in an age-dependent manner. Based on these findings, we investigated the effect of age-related levels of LPA, LPC, and S1P on platelet and endothelial cell biology. These lipid mediators were found to modulate platelet activation, as demonstrated by increased expression of P-selectin, phosphatidylserine, platelet aggregation, as well as endothelial activation, marked by elevated expression of ICAM-1, VCAM-1, and CD40. Our findings present a comprehensive lipidomic profile of single-donor apheresis platelet concentrates across various age groups, highlighting several lipid mediators that may be implicated in aging and AR. Show less

The persistence of latent HIV-1 reservoirs remains a major barrier to achieving a cure for HIV. While latency-reversing agents (LRAs) have been extensively studied, latency-promoting agents (LPAs) offer a complementary strategy to silence viral transcription and prevent immune activation. Here, we propose that modulation of IRF7-driven transcription may represent a novel approach to control HIV-1 latency, by characterizing the role of the Janus kinase 2 inhibitor (JAK2i) pacritinib as a novel latency-promoting agent (LPA). The impact of JAK2i on HIV-1 reactivation, immune activation, and IRF7 expression were evaluated in lymphoid and myeloid HIV-1 latency models, as well as Pacritinib effectively suppressed HIV-1 latency reversal induced by LRAs without triggering immune activation. Mechanistically, pacritinib downregulated IRF7 expression at both transcript and protein levels, correlating with reduced HIV-1 transcription. Overexpression of IRF7 restored LTR transactivation, confirming its central role in HIV-1 transcription and latency. Co-immunoprecipitation assays revealed a direct interaction between IRF7 and the viral transactivator Tat. Furthermore, pacritinib selectively inhibited multiply spliced HIV-1 transcripts, suggesting a blockade at late transcriptional stages. Pacritinib acts as a potent LPA by silencing HIV-1 transcription through IRF7 downregulation, supporting a promising "block and lock" strategy for functional cure approaches. Targeting IRF7 may enable durable suppression of the viral reservoir without immune activation, supporting the development of "block and lock" therapies. Show less

The effects of extruded flaxseed-pulse mixture (LinPRO-24) on growth performance, tissue fatty acid composition, carcass traits, and meat quality in broilers were investigated. A total of 540-day-old male 308 Ross chicks were placed in pens (30 chicks/pen) and allocated to three diets (n = 6) in a completely randomized design. The diets were: CON (basal corn-soybean meal diet); LPA (CON+2.5% LinPRO-24); and LPB (CON+ 5.0% LinPRO-24). Diets were isocaloric and isonitrogenous, formulated for starter (day 1-10), grower (day 11-24), and finisher (day 24-34). Feed intake and body weight (BW) were recorded daily, and mortalities as they occurred to calculate average daily gain (AWG) and FCR. On day 34, visceral organs, breast tissue, and leg tissue were sampled. The CON group exhibited higher overall BW, AWG, and AFI than LPB (P < 0.05). Breast and leg tissues of birds fed LPB had the highest concentration of Alpha-linolenic acid (ALA) and total ω-3 PUFA followed by LPA; both had a higher ALA concentration than the CON group (P < 0.05). Thus, the ω-6:ω-3 ratio in these tissues was lower for LPA and LPB groups (P < 0.05). Additionally, both LPA and LPB groups had lower Docosatetraenoic acid (DTA, C22:4 ω-6), higher Docosapentaenoic acid (DPA, C22:5 ω-3) and total PUFA content, resulting in a reduced SFA:PUFA ratio in leg tissue compared with the CON group (P < 0.05). However, LPB negatively affected the water-holding capacity (WHC) in breast meat compared with the CON and in leg tissue compared with LPA treatment (P < 0.05). Moreover, LPB increased muscle hardness and gumminess in the breast compared with the CON group (P < 0.05), thereby negatively affecting meat textural qualities. Overall, both LPA and LPB diets increased the ω-3 PUFA content in poultry meat, thereby reducing the ω-6:ω-3 ratio. However, the current study suggests that the use of LinPRO-24 at 2.5% may be more appropriate for improving the fatty acid profile of broiler meat without compromising production performance and meat quality. Show less

Pancreatic ductal adenocarcinoma (PDAC) is characterized by dense stromal fibrosis that promotes immune exclusion and treatment resistance, yet the upstream drivers of this pro-fibrotic cascade remain poorly defined. Here, we identify phosphoinositide 3-kinase δ (PI3Kδ) as a previously unrecognized driver of fibrosis in PDAC. Pharmacological inhibition of PI3Kδ reduces collagen deposition while enhancing the infiltration of activated CD8 Show less

To investigate the relationship between different physical activity (PA) patterns and stroke incidence among middle-aged and elderly populations in China. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative prospective cohort encompassing 2011 to 2020. PA was calculated based on the International Physical Activity Questionnaire. Different patterns of PA included moderate-to-vigorous PA (MVPA, ≥ 150 min/wk vs. < 150 min/wk), vigorous PA (VPA, ≥ 75 min/wk vs. < 75 min/wk), moderate PA (MPA, ≥ 150 min/wk vs. < 150 min/wk), light PA (LPA, ≥ 300 min/wk vs. < 300 min/wk), and total PA (TPA, ≥ 600 metabolic equivalent of task [MET]-min/wk vs. < 600 MET-min/wk). Cox proportional hazards models evaluated stroke risk associations, while restricted cubic splines (RCS) characterized TPA dose-response effects. There were 5090 participants in total (mean age, 59.23 [standard deviation, 9.43] years; 54.5% were female), and 378 (7.4%) incident stroke cases were documented at a 9-year follow-up. Achieving the World Health Organization (WHO) guideline of ≥150 min/wk MVPA was associated with a 24% lower stroke risk (adjusted hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.62-0.96, p = 0.019). No significant association was observed between VPA (HR = 0.79, 95% CI 0.63-1.01), MPA (HR = 0.82, 95% CI = 0.67-1.01), LPA (HR = 0.86, 95% CI = 0.70-1.07), or TPA (HR = 0.84, 95% CI = 0.65-1.08) and stroke risk. Additionally, RCS analysis demonstrated a non-significant dose-response relationship between TPA and stroke risk. This study validates WHO's MVPA guidelines (≥ 150 min/wk) for stroke prevention in Chinese elders. However, the predominantly self-reported and occupation-based PA in this cohort highlights the need for future research focusing on objective measurements of leisure-time PA. Show less

Elevated lipoprotein(a) [Lp(a)] is a common risk factor for cardiovascular disease (CVD) affecting ∼1.4 billion people globally, with novel treatments under development. Guidelines recommend one-lifetime measurement, yet <1% are tested. Population-wide screening faces cost and implementation challenges. We developed a machine learning (ML) model to help prioritise patients for Lp(a) testing. Ethnicity-calibrated ML models were developed to identify individuals with elevated Lp(a) in UK Biobank. Participants ≥37 years old (N=438,579) were split into feature importance/selection(20%), derivation(60%), and validation(20%) datasets. Performances across risk-enhancing Lp(a) thresholds recommended by clinical guidelines (90, 125, 430 nmol/L) or entry criteria for ongoing Lp(a)-lowering trials (150, 175, 200 nmol/L) were evaluated. External validation was conducted in NHANES III. Screening one million people using a universal approach would identify 222,717 cases above 90 nmol/L and 1950 above 430 nmol/L. In contrast, applying ML-targeted testing using the same number of tests would identify 280,899 (+26%; 95%CI:20-28%) and 6881 (+253%; 95%CI:192-310%) cases, respectively. At the thresholds of 125, 150, 175, and 200 nmol/L, yield increases were 38% (95%CI:35-40%), 51% (95%CI:47-54%), 59% (95%CI:55-63%), and 66% (95%CI:61-71%). Across thresholds 90-430 nmol/L, ML-targeted testing (Number Needed to Screen [NNS] 3.6-145, AUC 0.61-0.84) required 21%-72% fewer tests to identify one million cases. NHANES III validation demonstrated similar performance. Top 4 predictors included age, height (proxy for sex), total cholesterol and statin use. A ML-guided approach to prioritise testing for elevated Lp(a) would require fewer tests to identify those above risk-enhancing thresholds or potentially eligible for emerging therapies, offering a scalable interim compromise between the low current testing rates and universal screening aspirations. Show less

The role of parenting styles during early adolescence has always been a subject of significant concern. However, previous studies have predominantly treated parenting styles as a static construct, leading to a limited understanding of their dynamic patterns. This study employed a longitudinal person-centered perspective to examine the stability of and transitions in parenting style profiles during this critical period, as well as their associations with adolescents' internalizing and externalizing problem behaviors. Data were obtained in November 2023 (T1) and November 2024 (T2) from 893 Chinese students (53.5% female; M The analysis identified three distinct parenting profiles: harsh, supportive, and low-involved. Each profile demonstrated a high degree of stability over time, although some meaningful transitions were observed. Adolescents who consistently experienced supportive parenting or transitions toward the supportive profile generally reported lower levels of internalizing and externalizing problems. Conversely, those exposed to stable harsh parenting or a shift toward the harsh profile showed higher levels of these problems. Furthermore, internalizing problems appeared to be more susceptible to changes in parenting profiles than externalizing problems. The findings underscore the potential for positive shifts in parenting styles to serve as protective factors against problem behaviors in early adolescence, offering valuable implications for prevention and intervention strategies. Show less

Individuals differ in their sensitivity to external stimuli. The Highly Sensitive Child (HSC) scale can be used to measure sensitivity in children and adolescents. However, the German version has yet to be validated. We examined the psychometric properties of the German self- and the parent report version of the HSC. Measurement invariance (MI) across age groups was tested for the parent report version and latent profile analysis (LPA) was used to identify sensitivity groups. Pooled data from German-speaking countries ( The online version contains supplementary material available at 10.1007/s12144-026-09244-w. Show less