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To develop and evaluate an automated clinical decision support system (CDSS) capable of computing both categorical and exact-percentage cardiovascular risk (CVR) in routine clinical practice. We developed and implemented an automated CDSS (AlinIQ®) for CVR assessment within the Clinical Laboratory Department of Hospital Universitari i Politècnic La Fe (València, Spain), applied to patients referred from Primary Care. The analytical profile-requested either via automatic trigger or proactive clinician order-included total cholesterol, HDL-C, LDL-C, non-HDL-C, triglycerides, lipoprotein(a) [Lp(a)], serum creatinine, and estimated glomerular filtration rate. Additional required inputs were smoking status, systolic blood pressure, country of origin, and age at diabetes onset. The CDSS automatically computed SCORE2, SCORE2-OP, SCORE2-Diabetes, and SCORE2 Asia-Pacific, generating both categorical strata and exact-percentage CVR. Lp(a)-adjusted CVR was derived using coefficients from the Spanish Atherosclerosis Society. Following the ESC 2025 Focused Update, patients meeting predefined clinical criteria for moderate, high, or very high CVR were directly assigned to the corresponding category without SCORE calculation. The system also incorporated modifying risk factors, generating standardized interpretive comments and personalized lipid targets. Over one month, 2289 screenings were requested; 189 (8.3%) were excluded. A total of 171 patients (7.5%) were classified as high risk based on score-based calculation (164 [95.9%] triggered automatically), and 29 (1.6%) as very high risk (23 [79.3%] triggered automatically). 119 individuals (6.8%) were reclassified to a higher risk category after Lp(a)-based adjustment. This CDSS provides a scalable and reproducible framework for laboratory-driven cardiovascular prevention. Show less

Supercritical fluid chromatography is traditionally employed for nonpolar and moderately polar analytes, while the analysis of ionic compounds remains a recognized limitation of the technique. Moreover, some polar lipids may contain a chromatographically challenging ionic group, which can interact with the metal surfaces of the instrument and column, resulting in poor peak shape and loss of sensitivity. Here, we introduce a novel ultrahigh-performance supercritical fluid chromatography-mass spectrometry (UHPSFC/MS) method using a bioinert column, enabling the separation of lipids with a broad polarity range from nonpolar to ionic species. The UHPSFC/MS method was optimized using 79 lipid species across 41 lipid subclasses, achieving a total run time of 7.5 min, including the column equilibration. The comparison of the separation with conventional and bioinert columns revealed a substantial improvement in peak shapes for ionic lipid classes, such as PS, LPS, PA, LPA, CerP, and SPBP. Additionally, we introduce a combination of the modified chloroform-free extraction followed by a hexane elimination step. The optimized methodology was applied for the untargeted analysis of human plasma and erythrocyte-rich fraction to achieve highly confident identification of 657 lipid species across 37 lipid subclasses in human blood. The method follows the recommendations for validation of (bio)analytical methods, and its accuracy was confirmed by quantitative analysis of the reference material NIST SRM 1950, with the determined concentrations in agreement with the consensus values from ring trials. The current methodology represents a novel high-throughput and comprehensive quantitative lipidomic method for biological samples. The modified MTBE extraction enhances workflow efficiency by reducing concentrations of nonpolar lipids, which enables injection of more concentrated lipid extracts while minimizes ion source contamination. Moreover, the findings highlight the potential for the development of bioinert components specifically designed for SFC platforms, enabling broader applicability of the technique. Show less

To examine associations between the 24-h composition of movement behaviors (sedentary behavior [SB], light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and sleep) and physical and mental health in older adults using compositional data analysis. Data came from 4,150 adults aged ≥ 60 in the 2015 China Health and Nutrition Survey. Multiple‑balance isometric log‑ratio regression and compositional isotemporal substitution models were used to assess relative associations and the effect of time reallocation. The 24‑hour geometric mean composition was 43.1% sleep, 30.6% SB, 21.8% LPA, and 4.5% MVPA. LPA was positively associated with physical (β = 0.062, Replacing sedentary time or sleep with LPA, even in small amounts, is associated with better physical and mental health in older adults, supporting integrated 24‑hour activity guidelines that emphasize light‑intensity movement. Show less

Because the prognostic value of lipoprotein(a) [Lp(a)] levels in Japanese patients remains unclear, we assessed their distribution and association with long-term outcomes in ST-segment elevation myocardial infarction (STEMI). In our retrospective analysis of 868 consecutive patients with STEMI, the median serum Lp(a) level was 15.75 mg/dL at admission, and the median follow-up was 736.5 days. Using restricted cubic spline analysis, we stratified patients into high (≥47.26 mg/dL) and low (<47.26 mg/dL) Lp(a) groups. The high Lp(a) group had a higher proportion of older and female patients, with lower body weight, estimated glomerular filtration rate, and stent use, and higher dyslipidemia prevalence than those in the low Lp(a) group. The 5-year cumulative incidence of the composite primary endpoint (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or any revascularization) was significantly higher in the high Lp(a) group, primarily because of a high rate of any revascularization. Patients with elevated Lp(a) levels demonstrated higher rates of any revascularization for both de novo and restenotic lesions than those with lower levels. After adjusting for confounders, a high Lp(a) level was identified as an independent predictor of the primary endpoint (hazard ratio:1.932; 95% confidence interval:1.255-2.974). In Japanese patients with STEMI, elevated Lp(a) levels were independently associated with worse long-term outcomes. Show less

Yucha, a traditional fermented rice-fish product, faces challenges in inconsistent quality and safety. In this study, 69 lactic acid bacteria (LAB) were isolated from Yucha and shrimp paste in Hainan, China. Four strains, Lactiplantibacillus plantarum Lpl-YC37, Lacticaseibacillus paracasei Lpa-XJ120, and Pediococcus pentosaceus Ppe-YC39 and Ppe-XJ37 were selected as starters based on probiotic property and safety evaluation. Inoculation with these LAB starters significantly enriched beneficial metabolites, with Ppe-XJ37 showing a four-fold increase in acetic acid, the dominant short-chain fatty acids. Additionally, all LAB inoculation enhanced free amino acids, particularly L-glycine, improving flavor and nutritional value. Crucially, LAB inoculation drastically suppressed biogenic amines, reducing putrescine from 55.23 μg g Show less

Snacktivity—brief, high-frequency bouts of moderate-to-vigorous physical activity (MVPA) integrated into daily routines—may interrupt prolonged sitting and help accumulate total activity. Step count is a practical proxy for this pattern, yet the cadence thresholds that map short-bout stepping to MVPA and the relevance of bout–cadence patterns to adiposity remain unclear. This study aimed to examine the associations between accelerometer-derived step metrics and adiposity and to identify pragmatic step-based thresholds in older women. We conducted a cross-sectional study of 1,109 community-dwelling older women in Yantai, Shandong Province, China, with a mean age of 64.93 years (SD = 2.82). Step-based metrics (daily steps, MVPA and light-intensity physical activity (LPA) steps, cadence, and bout patterns) were derived from a waist-worn triaxial accelerometer. adiposity was defined using body-fat-ratio (BFR) categories assessed by multi-frequency bioelectrical impedance analysis. Multiple linear regression estimated associations with progressive adjustment for sociodemographic, lifestyle, and health-related covariates, with additional adjustment for total sedentary time. Sensitivity analyses replaced BFR with BMI and examined visceral fat mass (VFM) using linear regression. Receiver operating characteristic (ROC) analyses identified pragmatic step and cadence cut-points. MVPA step counts and cadence were consistently and inversely associated with adiposity ( Among older women, MVPA-oriented step metrics—particularly ~ 1,846 MVPA steps/day and ~ 94.3 steps/min cadence—showed inverse associations with adiposity and outperformed LPA metrics. These thresholds may serve as pragmatic, low-barrier activity targets, but causal relationships require confirmation in longitudinal and experimental studies. The online version contains supplementary material available at 10.1186/s12889-026-26912-5. Show less

Lipoprotein(a) (Lp(a)) is a causal risk-factor for atherosclerotic cardiovascular disease including acute ischemic stroke (AIS). The underlying pathomechanisms mediating this risk are less well understood, especially in AIS caused by large artery atherosclerosis (LAA). In this observational cohort study, we evaluated the association of Lp(a) with markers of LAA, namely carotid intima media thickness (cIMT) and the presence of extra- or intracranial vessel narrowing plaques. Among participants of the BIOSIGNAL cohort study we determined Lp(a) levels within 24 h after symptom onset in 1161 AIS patients from the single center of Zurich. cIMT was determined using a semi-automated computerized edge tracking software, internal carotid artery (ICA) stenosis was graded according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, intracranial ultrasound was performed by transcranial color-coded duplex (TCCD). Higher Lp(a) levels were not associated with an increased cIMT in univariable or multivariable regression models containing known cardiovascular risk factors. Higher Lp(a) levels were not associated with the presence of neither extracranial high-grade ICA-stenosis nor significant intracranial stenosis assessed by neurovascular ultrasound. In AIS patients higher Lp(a) levels were not associated with clinical markers of atherosclerotic burden despite its association with LAA-stroke etiology and an increased risk for stroke recurrence. Date of registration: 17–10-2014. Registration-URL: http://www.clinicaltrials.gov; Unique identifier: NCT-02274727. The online version contains supplementary material available at 10.1186/s12944-026-02913-6. Show less

Lipoprotein(a) [Lp(a)] represents one of cardiovascular medicine's most profound implementation gaps: a genetically determined risk factor affecting 1.5 billion people worldwide, yet historically underutilized in clinical practice despite overwhelming evidence of its importance. This review examines the transformation of Lp(a) from an untreatable genetic burden to a promising therapeutic target through four interconnected perspectives. First, we document the implementation gap, where, despite affecting 20% of the global population, screening remains below 1%. The evolution from selective screening (2018 American College of Cardiology/American Heart Association (ACC/AHA)) to universal measurement (2024 National Lipid Association (NLA) Class I recommendation) reflects growing recognition, yet persistent barriers, including reimbursement challenges, provider knowledge gaps, and laboratory standardization issues, perpetuate underutilization. Second, we synthesize evidence establishing Lp(a)'s dual nature as both a biomarker and a causal factor. Observational studies demonstrate markedly increased cardiovascular risk with elevated Lp(a), while Mendelian randomization confirms causal relationships with coronary heart disease, large-artery stroke, peripheral artery disease, and aortic stenosis, with differential effects on stroke subtypes and non-atherosclerotic outcomes. Third, we examine the transformation from genetic determinism to pharmacological tractability. Despite 70-90% heritability, novel RNA-targeted therapies achieve unprecedented 80-95% reductions, with phase 3 cardiovascular outcome trials (completing 2026-2029) poised to determine whether dramatic Lp(a) lowering translates to clinical benefit. Finally, we provide a practical management algorithm bridging current evidence-based risk stratification with emerging therapies, stratifying patients by Lp(a) levels with corresponding interventions. The Lp(a) story exemplifies how genetic insights and technological innovation can transform immutable disease aspects into treatable conditions, offering a paradigm for precision cardiovascular medicine while highlighting the urgent need to close the gap between scientific knowledge and clinical implementation. Show less

To identify latent profiles and influencing factors of toxic leadership behaviors of nurse managers experienced by staff nurses. Cross-sectional study. A total of 12 public hospitals in Guiyang and Zunyi city, Guizhou Province, China. From May 7, 2024 to December 31, 2024, a total of 900 nurses participated, and 868 valid questionnaires were collected with a validity rate of 96.44%. Data was collected via the Toxic Leadership Behaviors of Nurse Managers scale and a demographic questionnaire. Using latent profile analysis (LPA), distinct profiles of toxic leadership behaviors among nurse managers were identified. Univariate and multiple logistic regression analyses were performed to identify the factors associated with the toxic leadership behavior of nurse managers. The toxic leadership behaviors suffered by nurses were divided into four profiles: low toxic leadership behavior group (55.07%), moderate toxic leadership behavior group (16.71%), high toxic leadership behavior group (13.36%), and high Intemperate behavior group (14.86%). The results of multiple logistic regression analysis showed that nurses who are male, employed as non-permanent staff, or working in general hospitals are more susceptible to toxic leadership behaviors. This study used latent profile analysis to identify four distinct subgroups and found that male nurses, non-permanent staff, and nurses in general hospitals are more susceptible to toxic leadership behaviors. These results emphasize the need for developing strategies to address toxic leadership behaviors in order to promote nurses' wellbeing. Show less

Physical activity is essential for health and well-being during adolescence, and active behaviour early in life predicts higher physical activity levels in adulthood. Although adolescents with intellectual disability (ID) consistently show lower activity levels than peers without ID, national environments—such as school structures, disability support systems, and access to inclusive leisure activities—may influence these patterns. There is limited evidence from Sweden, a country with distinct educational and support frameworks for youth with ID. The present study aimed to examine physical activity patterns among Swedish adolescents with and without ID using accelerometer data. Physical activity was measured objectively using hip-worn accelerometers (ActiGraph GT3X) over seven consecutive days. This cross-sectional study included 45 adolescents with mild-to-moderate ID (median [IQR], 17.0 [14.0–19.0] years; 45.2% females) and 70 adolescents without ID (16.0 [15.0-16.3] years; 62.2% females). Physical activity was categorised as sedentary behaviour (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) and analysed across school days, weekend days, and separately for daytime and evening periods on school days. Overall, the relative amount of SB was similar between groups ( Adolescents with ID were generally less physically active than peers without ID, except during school-day daytime, where the MVPA was similar and LPA was higher. Leisure time, particularly weekends and school-day evenings, seems to be a critical period in achieving sufficient MVPA among adolescents with ID. Targeted interventions and coordinated support from key stakeholders such as school health services, paediatric health care, social care services and organised sports, with a particular focus on unstructured time, may help promote active lifestyles and reduce health disparities in this population. The online version contains supplementary material available at 10.1186/s12887-026-06679-9. Show less

To investigate the association between vaginal microbiota structure in early pregnancy and gestational diabetes mellitus (GDM) and to characterize microbial signatures for early screening for GDM. The present study was a nested case-control study recruiting pregnant women from the Nanjing Gulou Maternal-Child Health Center, China. Vaginal swabs were collected before 20 weeks of gestation for 16S rRNA sequencing. Following 1:3 propensity score matching, 45 GDM cases and 135 controls were enrolled. The final analysis included 42 GDM cases and 121 controls. A random forest model was used to explore the genera of vaginal differential microbiota associated with GDM. Based on these findings, latent profile analysis (LPA) was conducted to explore potential types of vaginal microbiota, and logistic regression was used to analyze the association between vaginal microbiota types and GDM. The GDM group exhibited elevated alpha diversity (Chao1 index, The composition and structure of vaginal microbiota in early pregnancy are different in the two groups. The vaginal microbiota in early pregnancy, which is characterized by co-dominated by The online version contains supplementary material available at 10.1186/s12866-026-04910-2. Show less

High-grade serous ovarian cancer (HGSC) is the most aggressive subtype of ovarian epithelial cancer (OEC), with characters of late-stage diagnosis, high recurrence rate, and poor survival outcomes. Fucosyltransferase 8 (FUT8) is responsible for α1,6-core fucosylation biosynthesis, and aberrant FUT8/α1,6-core fucosylation level is involved in tumor progression. However, the roles and mechanisms of protein FUT8 and α1,6-core fucosylation in HGSC tumorigenesis and progression remain elusive. Here, our study confirms that elevated levels of FUT8/α1,6-core fucose in the tissues and serum of HGSC patients, and the elevation is associated with poor patient prognosis. By applying glycoproteomic assay, we globally screen and identify NCEH1 as the specific scaffold protein of α1,6-core fucosylation. Alpha 1,6-core fucose modification stabilizes NCEH1 by preventing its degradation through proteasomal pathway. Importantly, combined with non-targeted metabolomics analysis, α1,6-core fucosylated NCEH1 facilitates LPA secretion, driving M2-like polarization of tumor-associated macrophages in the tumor microenvironment, thus leading to oncogenesis and peritoneal metastasis of HGSC in vitro and in vivo. These findings broaden the understanding of FUT8/α1,6-core fucosylation/NCEH1 in HGSC progression and metastasis, and offer glycosylated diagnostic indicators and targets for therapeutic strategies in HGSC. Show less

The impact of obstructive sleep apnea (OSA) on subsequent cardiovascular events in patients with acute coronary syndrome (ACS) remains debated. This study aims to investigate whether the association of OSA with cardiovascular events is affected by lipoprotein (a) [Lp(a)] levels. This is a sub-analysis of prospective cohort study (OSA-ACS, NCT03362385) enrolled ACS patients. OSA defined as an apnea-hypopnea index ≥15 events/h. The effects of OSA on subsequent cardiovascular outcomes were evaluated across varying Lp(a) thresholds. Coronary plaque features by coronary computed tomography angiography were also analyzed. A total of 1137 patients were enrolled, 608 patients (53.5%) were diagnosed with OSA. At a median follow-up of 3.6 years, OSA was associated with a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with Lp(a) level > median (HR 1.59, 95% CI 1.12-2.26, p=.009), but not in patients with Lp(a) level ≤ median (HR 1.09, 95% CI 0.80-1.49, p=.60). There were consistent increases in HRs for MACCE in the OSA group with Lp(a) levels rising, as stratified by tertiles or quartiles of Lp(a). In patients with Lp(a) level > median, OSA demonstrated a higher prevalence of ≥1 high-risk plaque (HRP) feature (51.4% vs. 33.3%, p=.03) and low-attenuation plaque (50.0% vs. 32.8, p=.04) per vessel than non-OSA. OSA was associated with a continuously increased cardiovascular risk and a higher prevalence of HRP features as Lp(a) levels rose. Lp(a) may help identify ACS patients at higher cardiovascular risk, in whom the efficacy of OSA treatment should be further investigated. Show less

Fear of disease progression (FoP) is a common psychological concern among patients with unruptured intracranial aneurysms (UIAs). However, heterogeneity in FoP and the role of psychological resilience before treatment remain insufficiently understood. In this cross-sectional study, patients with UIAs scheduled for endovascular treatment were recruited. FoP was assessed using the Fear of Progression Questionnaire-Short Form (FoP-Q-12), and psychological resilience was measured with the Connor-Davidson Resilience Scale (CD-RISC-25). Latent profile analysis (LPA) was conducted to identify distinct FoP profiles. Least Absolute Shrinkage and Selection Operator (LASSO) regression followed by multinomial logistic regression were used to examine factors associated with profile membership. Five distinct FoP profiles were identified: Minimal Fear-Good Adjustment, Mild Emotionally Elevated Fear, Moderate Emotionally Reactive Fear, Moderate Functionally Concerned Fear, and High Pervasive Fear. Multinomial logistic regression showed that higher psychological resilience-particularly the tenacity dimension-was associated with lower odds of belonging to the Mild Emotionally Elevated Fear, Moderate Emotionally Reactive Fear, and Moderate Functionally Concerned Fear profiles, compared with the Minimal Fear-Good Adjustment profile. No significant association was observed between tenacity and the High Pervasive Fear profile. Sensitivity analyses using alternative resilience indicators yielded consistent results. Among patients with UIAs prior to endovascular treatment, FoP exhibits marked heterogeneity. Psychological resilience, especially tenacity, is differentially associated with specific FoP profiles. These findings support the value of profile-based psychological assessment to inform targeted psychosocial support during treatment planning. Show less

Epstein-Barr virus (EBV) is an enveloped, double-stranded DNA virus that selectively infects primates. Periodontitis, a common inflammatory disease characterized by alveolar bone destruction, affects more than half of the global adult population. While EBV has been linked to periodontitis due to its pro-inflammatory effects and presence in the human periodontium, its effects on bone metabolism, particularly alveolar bone resorption, remain unclear. This study demonstrated that EBV infection in humanized mice induced osteoclast differentiation and alveolar bone resorption, resulting in sparse trabecular bone patterns and increased lacunae resorption. Extracellular vesicles (EVs) from EBV-infected cells contained M-CSF, essential for osteoclast differentiation, and increased CTSK and RANKL expression in osteoclast precursor cells after uptake. EBV infection increased the expression of group IIA-secreted phospholipase A Show less

Autotaxin (ATX), the enzyme responsible for generating lysophosphatidic acid (LPA), is a validated target for fibrosis and cancer immunotherapy. Current ATX inhibitors face challenges related to insufficient efficacy or safety concerns, reflecting trade-offs between zinc engagement and selectivity. Here, we report a rigid triazolyl-azabicyclo[3.1.0]hexanyl-oxadiazolyl-pyrimidine scaffold developed through structure-based design, designed to potentially enhance ATX selectivity by promoting defined binding geometry. Systematic studies identified 14e as the most potent inhibitor (IC Show less

Swiss adolescents fall short of the WHO's guideline of 60 min of moderate-to-vigorous physical activity (MVPA) per day. Developing targeted interventions or policies requires an understanding of adolescents' daily activity patterns. Since adolescents spend much time at school, it is essential to consider not only leisure but also school segments when assessing physical activity (PA). Therefore, this study investigates how Swiss adolescents' PA is distributed across different school time segments and examines to what extent they meet recommended activity levels. This cross-sectional study uses baseline data from the Active School project. The sample included 666 7th-grade students (mean age = 13.27 ± 0.55 years, 47.7% boys, 51.8% girls, 0.5% diverse) from 12 secondary schools. PA data, gathered over five schooldays using wrist-worn GENEActiv accelerometers, were segmented into physical education (PE), recess, classroom time, entire school time, and leisure time. Activity levels were categorized into inactivity (IN), light physical activity (LPA), and MVPA. Descriptive and inferential statistics (ANOVAs, Within school time, MVPA varied significantly by segment (PE: 30.59%, recess: 18.80%, classroom: 5.69%, Substantial opportunities for PA are lost across all school segments in the Swiss context, with girls consistently less active than boys. Based on these findings, segment-specific and gender-sensitive school PA policies are discussed, and a comprehensive school approach to PA promotion is recommended to support more effective and equitable PA promotion among adolescents. German Clinical Trials Register (DRKS00033362). Date of registration: January 25, 2024. Retrospectively registered. Show less

A growing body of research highlights the crucial role of self-regulated learning (SRL) strategies in enhancing teaching effectiveness and promoting continuous professional growth. Teachers’ ability to plan, monitor, and evaluate their own learning processes has been linked to improved instructional quality and adaptability. While prior studies have explored the effects of accountability on teacher motivation and pedagogical practices, limited evidence exists regarding how teachers’ self-regulation patterns differ and how these variations relate to perceived accountability. This study aimed to identify distinct SRL profiles among teachers and examine their associations with internal and external accountability perceptions. A total of 339 primary and secondary school teachers in Türkiye participated in the study. Using latent profile analysis (LPA), teachers were classified based on their reported SRL strategies. Differences in accountability perceptions across the resulting profiles were examined through multivariate analyses. The LPA revealed three meaningful SRL profiles: Low Self-Regulators (Profile 1), High Self-Regulators (Profile 2), and Moderate Self-Regulators (Profile 3). Teachers in the High Self-Regulators profile reported significantly higher levels of both internal and external accountability than those in the other two groups, whereas the Low Self-Regulators profile was characterized by lower accountability across all measures. Moreover, internal accountability emerged as a stronger motivational factor than external mechanisms for teachers with well-developed SRL skills. These results indicate that SRL is a multidimensional construct closely linked to how teachers perceive and respond to accountability demands. The findings underscore the importance of fostering teachers’ self-regulatory capacities as part of professional development initiatives. Teacher education programs should adopt differentiated approaches that consider individual SRL profiles and accountability orientations to enhance reflective and autonomous teaching practices. Future research is encouraged to explore the longitudinal development of these profiles and evaluate the impact of accountability-driven interventions on sustained professional growth. Show less

This study aimed to assess the childbirth readiness of women in their third trimester of pregnancy and to identify distinct readiness profiles using latent profile analysis (LPA). Additionally, it explored the factors influencing childbirth readiness in order to guide targeted interventions for improved maternal and neonatal outcomes. A cross-sectional study was conducted among women in their third trimester of pregnancy between May and November 2024. Eligible participants completed a general information questionnaire, the Childbirth Readiness Scale (CRS), the Childbirth Attitude Questionnaire (CAQ), and the Perceived Social Support Scale (PSSS). LPA identified three groups with distinct childbirth readiness levels: "Low Readiness - Childbirth Knowledge Deficit" (37.9%), "Moderate Readiness - Good Lifestyle Habits" (47.9%), and "High Readiness - Rich Health Knowledge" (14.2%). In addition, gestational age, previous childbirth history, adverse pregnancy outcomes, childbirth attitudes, and social support had different influences on women in different latent profiles of childbirth readiness. There was significant heterogeneity in childbirth readiness among women in their third trimester. Women with lower readiness-especially in childbirth knowledge-would greatly benefit from targeted educational programs, whereas those with moderate readiness levels would find enhanced emotional and psychological support most advantageous. These findings support the implementation of profile-based, personalized prenatal care strategies to improve childbirth preparedness and optimize maternal and neonatal outcomes. Show less

Hemodialysis, as one of the main alternative treatment methods for end-stage renal disease, has received much attention in recent years. Due to the particularity of hemodialysis treatment, patients have a relatively high risk of infection during the treatment process. Hemodialysis nurses, who are the main executors of the treatment operations and have the most contact with patients, have a close relationship with the infection risk of patients. The level of their hospital infection prevention and control literacy is closely related to the infection risk of patients. To explore the current level of knowledge, attitudes, and practices (KAP) of hospital infection prevention and control among haemodialysis nurses in the Sichuan Province, China, and identified their potential categories. This provided evidence-based recommendations for improving infection control management in hemodialysis departments. A cross-sectional study was conducted From July 15 to August 15, 2025 using a convenience sampling method to survey 470 hemodialysis nurses from 78 hospitals in Sichuan Province. Participants were licensed nurses with over 3 months of hemodialysis experience. Data were collected using the A total of 460 valid questionnaires were collected, with an effective response rate of 97.87%. The average scores for knowledge, attitudes, and practices related to hospital infection prevention and control among haemodialysis nurses were 4.67 ± 0.43, 4.59 ± 0.43, and 4.74 ± 0.34, respectively. Three latent profile models were constructed, with the two-class model identified as the optimal solution, which were defined as the "Low KAP Group" (25.9%) and "High KAP Group" (74.1%). Logistic regression analysis revealed that sex, responsibility for infection control, hospital level, annual number of infection control training sessions, organizational support, and work engagement were significant influencing factors ( The KAP level of haemodialysis nurses in hospital infection prevention and control was relatively high. Hospital managers should tailor supportive work environments on the basis of the individual characteristics and work engagement of haemodialysis nurses to improve the KAP level of nosocomial infection prevention and control among haemodialysis nurses. Show less

Coronary artery calcification (CAC) signifies advanced atherosclerosis and portends increased cardiovascular risk. Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerosis; however, its association with in vivo lesion morphology and clinical outcomes in patients with symptomatic, advanced CAC remains incompletely characterized. This study aimed to investigate the association between elevated Lp(a) levels and both in vivo lesion morphology and clinical outcomes in this high-risk population. In this retrospective cohort, 292 patients with intravascular ultrasound(IVUS)-confirmed CAC were stratified into elevated (≥50 mg/dL,n = 77) or low (<50 mg/dL,n = 215) Lp(a) groups. The primary endpoint was major adverse cardiovascular events (MACEs). Associations were assessed via multivariable Cox models adjusted for clinical covariates. Patients in the elevated Lp(a) group presented a greater incidence of aortic valve calcification (p < 0.001). IVUS revealed constrictive remodeling with a smaller lumen and vessel dimensions. During a median follow-up of 17.2 months, the elevated Lp(a) cohort had a significantly higher MACE rate (37.7% vs. 15.8%; adjusted hazard ratio [aHR] 2.60, 95% CI 1.55-4.35, p < 0.001). Elevated Lp(a) independently predicted increased risks of ischemic stroke (aHR 7.14) and in-stent restenosis (aHR 2.78). In symptomatic patients with IVUS-confirmed CAC, elevated Lp(a) identifies a high-risk phenotype characterized by constrictive vascular remodeling and a markedly increased risk of MACEs, driven particularly by ischemic stroke and in-stent restenosis. These findings support the integration of routine Lp(a) testing into the risk stratification of patients with severe CAC, thereby identifying a precise high-risk phenotype that warrants intensified monitoring and represents an ideal target for emerging Lp(a)-lowering therapies. Show less

Lipoprotein(a) (Lp(a)) is a genetically determined causal risk factor for cardiovascular disease, with approximately 20% of the population exhibiting elevated levels. While there are promising drugs in development, there are currently no approved therapies specifically designed to lower Lp(a) levels. For high-risk individuals with extreme levels of Lp(a), liver-directed genome editing could be an effective one-time solution. Genome editing approaches such as CRISPR and TALENs can reduce Lp(a) in LPA-transgenic mouse models, but they frequently induce large and potentially harmful genomic deletions. Here, we report the first application of TadA-derived cytosine base editing (CBE), delivered via helper-dependent adenovirus (HDAdV) and adeno-associated virus (AAV) vectors, to introduce premature stop codons into LPA. This strategy produced robust and durable lowering of circulating apolipoprotein(a) (apo(a)) in LPA-transgenic mice. Using SMRT-seq with single-molecule unique molecular identifiers, we quantified deletion events and found that CBE did not induce large deletions when targeting a single LPA site and produced only a small fraction (<4%) of large deletions when editing across multiple sites. In contrast, CRISPR-Cas9 cutting of LPA resulted primarily in large deletions. These findings demonstrate that CBE enables sustained reduction of circulating apolipoprotein(a) in an LPA-transgenic mouse model while largely preserving genomic integrity. Show less

Carboxymethylcellulose (CMC), a common food emulsifier, induces microbiota dysbiosis and systemic inflammation; however, its impact on transplant immunity remains unclear. Allogenic heart rejection was observed in CMC-fed recipient mice, with increased abundance of lysophosphatidic acid (LPA)-producing bacteria and increased serum LPA concentration. CMC-induced transplant rejection was caused by the gut microbiota, as confirmed by fecal microbiota transplantation and gut microbiota depletion. Furthermore, LPA-treated macrophages demonstrated a proinflammatory ability to accelerate allograft rejection in cytotoxic T lymphocyte-associated protein 4 immunoglobulin-induced allograft survival by upregulating glycolysis. Conversely, the administration of a glycolysis inhibitor resulted in allograft survival and abrogated the detrimental effect of LPA. Mass spectrometry and single-cell RNA sequencing confirmed that transplant patients with rejection showed significantly elevated serum LPA levels and LPA receptor 6 (LPAR6) expression in graft-infiltrate macrophages. Mechanistically, LPA preferentially promoted LPAR6 expression, which interacted with Rho-associated protein kinase 2 to activate the mammalian target of rapamycin/hypoxia-inducible factor 1-alpha pathway, thereby enhancing glycolysis and inducing proinflammatory macrophage polarization. Treatment with Ki16425, an LPAR antagonist, prolonged allograft survival in CMC-fed recipients. Our findings reveal a major detrimental effect of CMC on macrophage physiology and suggest that controlling LPAR6 expression or glycolysis in macrophages may improve allograft survival in transplant recipients. Show less

Physical activity (PA) is known to enhance brain health; however, prior research has predominantly concentrated on the total volume of PA, often overlooking the frequency of daily PA on an hourly basis. This prospective cohort study examined 69,393 middle-aged and older adults, utilizing wrist-worn accelerometer data to assess PA. A novel PA frequency score was developed, which integrated light PA (LPA) and moderate-to-vigorous PA (MVPA) across 18 hourly segments (6:00 AM-12:00 AM). Participants were categorized into Inactive, Active, and Very Active groups. After adjusting for potential confounders, it was observed that individuals in the Active and Very Active groups exhibited a reduced risk of developing brain disorders such as dementia, anxiety, depression, migraine, Parkinson's disease, and stroke over a median follow-up period of 7.41 years. Magnetic Resonance Imaging (MRI) findings demonstrated that each unit increase in the PA frequency score correlated with a 51.55 mm Show less

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality worldwide despite intensive lipid-lowering therapy. Residual cardiovascular risk persists even in patients achieving optimal lipoprotein-cholesterol (LDL-C) levels, indicating that additional lipid mediators contribute to disease progression. Lysophosphatidylcholine (LPC), a bioactive lysophospholipid generated from phosphatidylcholine by cytosolic or lipoprotein-associated phospholipase A₂ (PLA₂), has emerged as a critical mediator linking dyslipidemia, inflammation, and vascular injury. LPC is highly enriched in oxidized LDL (oxLDL), electronegative LDL (LDL(-)), and lipoprotein(a) [Lp(a)], all of which represent highly atherogenic lipoprotein subclasses. This review delineates the metabolic origins of LPC, its transport via LDL, VLDL, and albumin, and its accumulation within atherosclerotic plaques. LPC promotes endothelial dysfunction, monocyte recruitment, foam-cell formation, and platelet activation, collectively driving plaque development and instability. Elevated LPC levels are consistently observed in metabolic disorders such as type 2 diabetes mellitus (T2DM) and non-alcoholic steatohepatitis (NASH), both of which exacerbate ASCVD risk. Although statins, ezetimibe, and PCSK9 inhibitors effectively lower LDL-C, they do not directly target LPC or its downstream inflammatory pathways. Clinical trials of lipoprotein-associated PLA₂ inhibitors (e.g., Darapladib) failed to reduce cardiovascular events, underscoring the complexity of LPC-related signaling. Future therapeutic approaches may involve enhancing lysophospholipase A Show less

Study DesignRetrospective Single-center propensity score-matched cohort study.ObjectiveAdjacent segment disease remains a major cause of revision surgery after multilevel lumbosacral fusion, and muscle-preserving approaches may help reduce this risk. This study compared clinical and radiographic outcomes between a muscle-preserving fusion combining standalone anterior plus lateral lumbar interbody fusion (A + LLIF) vs circumferential lateral plus posterior lumbar interbody fusion (L + PLIF).MethodsPatients who underwent multilevel lumbosacral fusion (2016-2023) with either A + LLIF or L + PLIF were included. L + PLIF patients with contraindications to standalone A + LLIF were excluded. Propensity score matching, based on age, BMI, PI-LL mismatch and stenosis severity, yielded 90 1:1-matched patients. The primary outcome was revision surgery. Secondary outcomes included spinopelvic alignment, cage subsidence, and perioperative metrics.ResultsBaseline characteristics were comparable between groups (mean age 57 ± 10 years; median fusion levels: 2 [range 2-4]). The 5-year cumulative incidence of revision surgery was significantly lower with A + LLIF (1/45 events; 2.2%) than with L + PLIF (14/45 events; 31.1%; Show less

To describe the network structure and heterogeneity of symptom burden in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), and to examine factors associated with different symptom burden profiles to inform risk-stratified management after PCI. A convenience sample of 261 patients with ACS who underwent PCI at a tertiary hospital in Chongqing between November 2024 and August 2025 was recruited. Data were collected using a demographic questionnaire, the Cardiac Symptom Survey, and the Seattle Angina Questionnaire. Network analysis was conducted to identify inter-symptom associations and the structural characteristics of the symptom network. Latent profile analysis (LPA) was performed to classify symptom burden patterns, and multinomial logistic regression analysis was used to explore factors associated with profile membership. Network analysis indicated that depression was the most central symptom (strength Symptom burden in patients with ACS after PCI demonstrates substantial individual heterogeneity. Depression occupies a central position within the symptom network, and BMI is associated with moderate and high symptom burden profiles. These findings suggest that integrating symptom network characteristics and BMI status into post-PCI assessment may facilitate risk-stratified management and targeted psychological and weight-related interventions to improve recovery outcomes. Show less

Lipoprotein(a) (Lp(a)) is a highly atherogenic lipoprotein and the target of investigational therapies. Using a Mendelian randomization study design, we aimed to clarify associations between genetically predicted Lp(a) levels and cerebrovascular disease outcomes and related phenotypes. We obtained genetic associations with Lp(a) levels ( Genetically predicted Lp(a) levels associated with significantly increased risk of all-cause ischemic stroke (odds ratio [OR], 1.04 [95% CI, 1.02-1.07], Elevated Lp(a) is primarily associated with ischemic stroke due to large artery atherosclerosis, while showing no link to cerebral small vessel disease. These findings support prioritization of patients with atherosclerotic cerebrovascular disease in Lp(a)-lowering stroke prevention trials. Show less

Depression and anxiety are highly prevalent and often co-occurring mental health issues among adolescents, with comorbidity leading to poorer outcomes and additional challenges. Left-behind adolescents-a unique group experiencing disrupted parent-child relationships and limited social support-may face a higher risk of such comorbidity. Yet, few studies have examined the depression-anxiety network in this population. Latent profile analysis (LPA) identified subgroups with similar symptom patterns, and network analysis visualized the structure of comorbidities. Network comparison tests evaluated differences across subgroups. Based on the "Science Database of People Mental Health" managed by the National Population Health Data Center (China), a total of 3,205 left-behind adolescents (1,538 males; 1,667 females) were included. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Scale-7 were used to assess depression and anxiety among left-behind adolescents. Three distinct profiles were identified: high-comorbidity (8.2%), moderate-comorbidity (28.7%), and low-comorbidity (63.1%). Network structures and global strength differed significantly between subgroups. "Restlessness" was the central bridge symptom in the high-comorbidity group, while "Nervousness" was central in the moderate- and low-comorbidity groups. These findings suggest tailored interventions targeting subgroup-specific bridge symptoms-such as restlessness or nervousness-may improve outcomes for left-behind adolescents with comorbid depression and anxiety. Show less

Lipoprotein (a) [Lp(a)] is a lipoprotein similar to low-density lipoprotein (LDL), which binds to a characteristic component: apolipoprotein (a). The plasma Lp(a) level is mainly determined by genetic factors, with variations across ethnic groups. In adults, various epidemiological and genetic studies have shown that elevated Lp(a) levels are an independent risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis, associated with inflammatory, atherogenic, and thrombotic mechanisms. Given that the distribution, variability, and prognostic value of this marker in the pediatric population have been less investigated, the objective of this review is to analyze the available evidence on the behavior of Lp(a) as a risk marker in children and adolescents, current recommendations for its measurement in pediatrics, and treatment prospects. Show less