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Article
Chemistry and Materials Science
Nanotechnology

Weitao Li

,

Zeyun Dong

,

Zhengyu Zhang

,

Luoman Zhang

,

Qizhe Wang

,

Shang Li

,

Shuai Li

,

Lei Wang

,

Jialin Liu

Abstract: Industrial dye wastewater poses severe environmental and health risks, creating an urgent demand for efficient and sustainable remediation technologies. Herein, hierarchically porous hollow TiO2 nanofibers (HNFTi) were constructed through electrospinning and coupled with blue-, green-, and orange-emissive graphene quantum dots (b-, g-, and o-GQDs) to fabricate visible-light-responsive heterojunction photocatalysts. By tailoring the surface functional groups and heteroatom doping of GQDs, a progressive fluorescence redshift was achieved, which effectively narrowed the bandgap and extended visible-light absorption. Benefiting from the synergistic effects of the hierarchically porous hollow TiO2 architecture and the fluorescence-tuned GQDs, the resulting composites exhibited enhanced light harvesting, accelerated charge separation, and improved interfacial charge transfer. Among them, the 0.5 wt% o-GQDs/HNFTi composite showed the best photocatalytic performance, delivering a methylene blue degradation efficiency of 99.5% within 2 h under visible-light irradiation, markedly higher than that of pristine HNFTi (77.7%). Photoelectrochemical and Kelvin probe force microscopy analyses further confirmed the promoted carrier dynamics and effective interfacial separation of photogenerated electron-hole pairs. This work provides a feasible strategy for integrating structural engineering and fluorescence modulation to develop high-performance TiO2-based photocatalysts for wastewater treatment.

Article
Engineering
Metallurgy and Metallurgical Engineering

Petr Baron

,

Jozef Mikita

,

Vladimír Simkulet

Abstract: This study presents a comprehensive characterization of recycled aluminum briquettes produced by cold pressing of Al–Si–Mg alloy machining chips, along with an evaluation of their behavior during subsequent remelting. The objective was to assess the density, porosity, chemical composition, and metallurgical yield of the briquettes before and after melting, as well as to determine their suitability for use as deoxidizing additives in steelmaking. The cold-pressed briquette (Sample A) exhibited a low density of 2.29 g.cm-³ and a porosity of 12.1%, resulting from intergranular voids and residual lubricants. After melting and resolidification (Sample B), the density increased to 2.388 g.cm-3 and the porosity decreased to 8.15%. XRF chemical analysis confirmed a high degree of elemental homogeneity after melting with no indication of segregation, while SEM–EDS microstructural analysis verified the absence of significant intermetallic phases and revealed only a thin surface oxide layer. The metallurgical yield reached 94.2% with a low dross content (2.25%). The results demonstrate that, following appropriate preprocessing and optimized compaction, recycled aluminum briquettes constitute a stable and efficient secondary aluminum material suitable for steel deoxidation, and they can significantly reduce the environmental impact of metallurgical production.

Article
Computer Science and Mathematics
Artificial Intelligence and Machine Learning

Jaehwan Kim

Abstract: We propose the Knowledge Landscape hypothesis: a large language model’s forward pass encodes whether it knows the answer before producing any output token. Well-learned knowledge traverses deep convergence valleys in the activation landscape; unlearned queries traverse flat plains where signals disperse. These geometric properties manifest as two probe-free, single-pass signals—token-level entropy and layer-wise hidden-state variance— that precede and causally influence output uncertainty. Across two architecturally distinct models (Qwen2.5-7B and Mistral-7B) on TriviaQA, token entropy strongly discriminates known from unknown questions with large effect sizes, replicated at 300 samples per condition with a 95% bootstrap confidence interval entirely above 0.64. Hidden-state variance further localises a metacognitive locus in both architectures, consistently at 61–69% of total network depth, suggesting this is a universal structural property of transformer LLMs. Activation patching confirms causality: injecting a known- question hidden state into an unknown-question forward pass monotonically reduces output entropy. A lightweight abstention system built on these signals achieves a ROC-AUC of 0.804 and a 5.6 percentage-point accuracy gain over the unaided baseline, without any fine-tuning or additional training data.

Article
Biology and Life Sciences
Other

Sifan Ai

,

Yu Wang

,

Jiao Pan

,

Gang Hu

,

Ruiting Zhao

Abstract: Dajue Temple, a representative ancient architectural heritage in North China, houses numerous lacquered wooden components of exceptional historical and artistic value. Despite their significance, this study is the first to investigate the severe dark discoloration and black spotting afflicting these lacquer surfaces—damage triggered by prolonged environmental exposure that endangers structural integrity and long-term conservation. To address this unstudied threat, we confirmed the microbial origin of black spots using ATP bioluminescence assays, then characterized microbial communities via culture-dependent methods and ITS sequencing—identifying Cladosporium spp. as the dominant biodeterio-gen driving lacquer deterioration. Functional assays on carboxymethylcellulose (CMC) and guaiacol-amended potato dextrose agar (PDA) media verified the wood-degrading potential of isolated Cladosporium spp. Antifungal susceptibility screening against ten agents demonstrates that thymol and clove essential oils achieved significant efficacy at 200 mg/mL, while nano silver gel also provided durable suppression. We proposed targeted, relic‑friendly microbial control strategies tailored for ancient lacquered wooden components. These findings provided scientific guidance for the sustainable conservation and restoration of lacquered architectural elements in historic temples and comparable cultural heritage sites. In future work, environmental monitoring should be involved, which will help to clarify microbe–environment interactions and enable early warning of biodeterioration risks.

Article
Engineering
Metallurgy and Metallurgical Engineering

Marzanna Ksiazek

,

Lukasz Boron

,

Adam Tchorz

Abstract: High Velocity Oxy-Fuel (HVOF) thermal spraying is widely used for the deposition of dense coatings with low porosity, high hardness, and superior fracture resistance. Tungsten carbide–cobalt (WC–Co) coatings are extensively employed in industrial and aerospace applications due to their excellent wear resistance and mechanical performance; however, further improvement in crack resistance and adhesion remains a key challenge. In this study, WC–Co+Ni composite coatings were deposited on ductile cast iron by HVOF, with particular emphasis on the role of Ni particle addition in tailoring coating microstructure and performance. Microstructural characterization was carried out using light, scanning, and transmission electron microscopy (LM, SEM, TEM), while phase composition and chemical analysis were determined by X-ray diffraction (XRD) and energy-dispersive spectroscopy (EDS). The coatings exhibited a dense, low-porosity microstructure composed of partially molten Ni particles and fine WC and W₂C carbides embedded in a cobalt-based matrix, with locally nanocrystalline features. XRD analysis confirmed WC and W₂C as the dominant phases, with weak reflections indicating the possible formation of the η-phase (Co₆W₆C). Mechanical and tribological performance, evaluated by instrumented indentation and scratch testing, showed that Ni addition significantly enhances crack resistance, wear resistance, and coating–substrate adhesion. The results demonstrate that Ni-modified WC–Co coatings deposited by HVOF enable effective microstructural design, leading to improved durability and performance, which makes them promising candidates for advanced coating applications.

Article
Public Health and Healthcare
Public Health and Health Services

Iryna Makhnevych

,

Yauhen Statsenko

Abstract: emotional distress and diminished quality of life (QoL), yet the indirect pathways linking PI to QoL through distress remain largely untested in breast cancer. Methods: This exploratory secondary analysis used a publicly available longitudinal dataset of 40 women with non-metastatic breast cancer assessed at baseline and 2-month follow-up. Bootstrapped mediation (5,000 resamples, BCa CIs) tested whether depression, anxiety, and stress (DASS-21) statistically mediated the association between PI (AAQ-II) and QoL (WHOQOL-BREF) across 27 models. Hierarchical regressions, Kruskal–Wallis tests, and extended correlations supplemented the analysis. Results: At follow-up, all nine cross-sectional indirect effects were significant (all 95% BCa CIs excluding zero), with distress accounting for 33–51% of the total association between PI and QoL. The largest indirect effects were observed for depression on psychological QoL (indirect = −0.845, p < .001) and anxiety on physical QoL (indirect = −0.739, p < .001). No indirect effects were significant at baseline or for change scores (all p > .05). Concurrent PI independently predicted psychological QoL (ΔR² = .094, p = .002), general QoL (ΔR² = .084, p = .015), and anxiety (ΔR² = .122, p = .004) in hierarchical regressions. Anxiety severity was associated with impairment across all five QoL domains (all p_adj < .05). Conclusions: These preliminary findings suggest that emotional distress may partially account for the association between PI and QoL in breast cancer, consistent with predictions from the ACT model. However, the small sample size and cross-sectional nature of the follow-up indirect effects preclude causal inference. Replication in adequately powered prospective designs is essential.

Case Report
Medicine and Pharmacology
Urology and Nephrology

Mario Bonomini

,

Valeria Vezzani

,

Michele Rossini

,

Lorenzo Di Liberato

,

Liborio Stuppia

,

Valentina Gatta

Abstract: Background and Clinical Significance: Autosomal dominant tubulointerstitial kidney disease caused by mutation in uromodulin gene (ADTKD-UMOD) is a rare kidney disorder characterized by progressive tubulointerstitial damage and slowly progressive loss of renal function. ADTKD is often under-recognized in the clinical setting. In fact, diagnosis of ADTKD-UMOD can be challenging due to its nonspecific symptoms, being confirmed by genetic testing only. Case presentation: We report the case of a 42-years-old male patient referred for evaluation of renal dysfunction, incidentally discovered in routine laboratory checks. He had no significant medical history and no known familiarity for kidney disease or gout. Physical examination was unremarkable. Renal dysfunction was confirmed, with serum creatinine 1.44 mg/dl and eGFR 59.5 ml/min/1.73 m2. Urinalysis was within physiological limits, with proteinuria of 75 mg/day. Uric acid was mildly elevated (7.5 mg/dl) without gout history. Other laboratory findings including autoantibodies were in normal range. Patient underwent kidney biopsy, which however was not diagnostic showing mild focal tubular atrophy and interstitial fibrosis without glomeruli involvement. Immunofluorescence staining was negative for complement and immunoglobulins. Based on above nonspecific findings, the patient was suspected of a possible diagnosis of ADTKD. Genetic investigation using a clinical exome next-generation sequencing approach identified a novel heterozygous missense variant in the UMOD gene (c.409T>C; p.Cys137Arg). Patient is in regular clinical-laboratory monitoring. After one year, his overall health is good, renal function stable with no proteinuria, uric acid mildly increased without gout attacks. Conclusions: Increased clinical awareness is crucial for detecting ADTKD-UMOD. Genetic testing can help to solve clinical diagnostic challenges in patients with unexplained decreased kidney function.

Article
Physical Sciences
Theoretical Physics

Ahmed M. Ismail

,

Samira E. Mohamed

Abstract: This research answers the knowledge gap regarding the explanation of the quantum jump of the electron. This scientific paper aims to complete Einstein’s research regarding general relativity and attempt to link general relativity to quantum laws.

Article
Computer Science and Mathematics
Analysis

K. Mahesh Krishna

Abstract: Massera and Schaffer [Ann. Math. (2), 1958] established a breakthrough upper bound for the Clarkson angle between two nonzero vectors in a normed linear space. Maligranda [Am. Math. Mon., 2006] improved Massera-Schaffer upper bound for the Clarkson angle. Pecaric and Rajic [Math. Inequal. Appl., 2007] extended Maligranda's inequality to finitely many nonzero vectors. We derive a finite field version of Massera-Schaffer-Maligranda-Pecaric-Rajic inequality.

Article
Engineering
Civil Engineering

Sonjoy Paul Avi

Abstract: The construction industry remains one of the largest contributors to global carbon emissions, with ordinary Portland cement (OPC) production accounting for a significant share due to high energy consumption and carbon intensive clinker manufacturing processes. As infrastructure development accelerates worldwide, particularly in rapidly urbanizing regions, the demand for sustainable construction materials has become urgent. In recent decades, alternative cementitious materials (ACMs), including fly ash, ground granulated blast furnace slag (GGBS), silica fume, and rice husk ash, have gained attention as partial replacements for OPC in concrete mixes. This research paper investigates the geotechnical and environmental impacts associated with the use of alternative cementitious materials in concrete, emphasizing real world construction conditions and performance requirements. The study evaluates the influence of ACMs on parameters such as soil–structure interaction, compressive and long term strength development, durability under aggressive environmental exposure, permeability characteristics, and resistance to chemical attack. Environmental performance indicators including carbon footprint reduction, energy savings, industrial waste utilization, and lifecycle sustainability are also assessed. Experimental findings and recent literature indicate that ACM based concrete exhibits reduced permeability, enhanced resistance to sulfate and chloride ingress, and improved long term mechanical performance compared to conventional OPC concrete. These contribute to improved geotechnical behavior in foundations exposed to adverse soil conditions. Furthermore, adopting alternative cementitious materials can reduce greenhouse gas emissions while supporting circular economy principles. The study concludes that integrating ACMs into concrete production is an approach for construction without compromising geotechnical performance or structural reliability.

Article
Computer Science and Mathematics
Software

Alexandros Pino

,

Dimitrios Vrailas

,

Georgios Kouroupetroglou

Abstract: This study quantitatively evaluates the performance of a non-invasive hybrid brain–computer interface (BCI) compared to a conventional mouse in pointing (point-and-click) tasks. A commercial wearable BCI (Brainfingers), based on electromyography (EMG) and electrooculography (EOG) signals with low-level electroencephalography (EEG) components, was assessed against a Microsoft Optical Mouse using ISO/TS 9241-411-based one-dimensional (1D) and two-dimensional (2D) target acquisition tasks. Pointer coordinates were recorded and analyzed using Fitts’ law metrics. A total of 48 non-disabled participants completed the experiments. The results reveal significant performance differences between the two input devices. The BCI device exhibits substantially lower performance than the mouse across the reported Fitts’ law measures. Mean throughput was 0.35 bits/s for the BCI and 6.03 bits/s for the mouse in the 1D tests, and 0.43 bits/s for the BCI and 5.17 bits/s for the mouse in the 2D tests. Despite the BCI’s low performance and although the present experiments involved non-disabled participants, the findings, considered alongside prior literature on Brainfingers and non-invasive BCIs for computer access, suggest that the device may still have assistive technology value for users with severe motor impairments.

Article
Biology and Life Sciences
Immunology and Microbiology

Paloma Napoleao-Pego

,

Guilherme C. Lechuga

,

Joao P.R.S. Carvalho

,

Flavio R. da Silva

,

Karine Rangel

,

Mariana S. Freitas

,

Jessica A. Waterman

,

Arnaldo Maldonado-Junior

,

Carlos Graeff-Teixeira

,

Salvatore G. De-Simone

Abstract:

Angiostrongyliasis, the primary cause of eosinophilic meningitis, represents an emerging disease caused by Angiostrongylus cantonensis larvae, inadvertently transmitted to humans. The diagnosis of human angiostrongyliasis relies on epidemiological features, clinical symptoms, medical history, and laboratory findings, notably hyper eosinophilia in blood and cerebrospinal fluid. Consequently, accurate diagnosis is challenging and prone to confusion with other parasitic diseases. The quest for an early, rapid, and specific diagnostic test for angiostrongyliasis persists, driven by the imperative for enhanced test specificity. Material and Methods: This study focused on the mapping of IgM epitopes within galectin-1 (Gal-1) and galectin-2 (Gal-2) proteins derived from A. cantonensis. The specificity of the epitopes was assessed using database homology analysis. After selecting specific epitopes, researchers chemically synthesized 12 individual MAPs4 peptides and one chimeric polypeptide that is 58 amino acids long. The effectiveness of these synthesized peptides was subsequently evaluated using ELISA. Results: A total of twelve unique IgM epitopes were discovered; four were linked to Gal-1, while eight linked to Gal-2. An ELISA-peptide method confirmed the twelve epitopes, and then the chimeric polypeptide was employed as an antigen to coat ELISA plates. This setup was evaluated with patients' sera to diagnose strongyloidiasis in vitro. Conclusions: This study provides a comprehensive representation of the IgM epitopes of Gal-1 and Gal-2 from A. cantonensis. ELISA data utilizing chimeric the polypeptide demonstrate that the selected sequences hold promise for the development of a specific immunological assay tailored for the acute diagnosis of angiostrongyliasis infections.

Brief Report
Biology and Life Sciences
Virology

Hideki Kakeya

Abstract: Submissions of sequences consistent with SARS-CoV-2 BA.3.2, a newly observed saltation variant, have increased in GISAID since November 2025. Saltation events are often prioritized for monitoring due to extensive divergence. Using 12-category nucleotide substitution spectra and principal component analysis, we show that BA.3.2 has a mutation-spectrum profile distinct from BA.1 and BA.2.86, lacking pronounced transversion enrichment while retaining spike-focused substitution enrichment. Unlike BA.1, BA.3.2 shows no clear enrichment of basic residue-introducing substitutions in spike.

Article
Medicine and Pharmacology
Transplantation

Mikołaj Basza

,

Wojciech Bojanowicz

,

Fryderyk Zawadzki

,

Dagmara Galle

,

Mateusz Soliński

,

Weronika Kowalczyk

,

Łukasz Kołtowski

,

Marek Ochman

Abstract: Background: Lung transplantation (LTx) remains the final therapeutic option for patients with end-stage and irreversible respiratory failure. The most common complication after LTx is chronic lung allograft dysfunction (CLAD), which affects long-term outcomes. However, CLAD may be partially reversible, especially after early detection of the cause. For this reason, systematic monitoring of transplanted lung function, including spirom-etry values, is so important. In these cases, the usage of modern technologies and tele-medicine can be extremely useful and allow for early response to possible decreases of spirometry values. Objective: The aim of our study is to evaluate the feasibility and clinical usefulness of spirometry telemonitoring in lung transplant patients. Methods: This retrospective study compared lung transplant recipients, where the first group of patients was subjected to spirometry telemonitoring (N=21), the second group was monitored with standard home spirometry (N=23), and the control group underwent routine follow-ups only in the transplant center (N=32). Results: The mean number of emergency visits was found to be lower in the telemoni-toring vs routine care group (1.24 vs 2.34, P=.05). Additionally, the mean duration of all visits was higher in the routine care group (10.0 days) in comparison to the telemonitoring group (5.8 days, P< .001) and to the standard home spirometry group (8.7 days, P=0.03). Conclusions: Spirometry telemonitoring using digital devices is not only feasible in lung transplant recipients, but it may provide substantial clinical benefits in this group of patients. It makes it possible to react faster in the event of abnormalities, which results in a reduction in the number of emergency visits and their duration.

Article
Public Health and Healthcare
Nursing

Gustavo Gonçalves dos Santos

,

Mónica Alexandra Pinho da Silva

,

Maria João Jacinto Guerra

,

Júlia Maria das Neves Carvalho

,

Ana Cristina Ribeiro da Fonseca Dias

,

Maria Luísa Santos Bettencourt

,

Cely de Oliveira

,

Bruna Feichas Renó

,

Eneida Tramontina Cerqueira

,

Katucha Rocha de Almeida Farias

Abstract: Background/Objectives: Maternal mortality remains an important indicator of health inequities, reflecting social, regional, and racial inequalities, as well as the responsiveness of health systems. This study aimed to analyze and compare maternal mortality between Brazil and Portugal from 2020 to 2023. Methods: This is a binational ecological and observational study based on secondary data from official records of live births and maternal deaths in both countries. Maternal mortality rates were calculated per 100,000 live births and stratified by sociodemographic and regional variables. Poisson regression models offset by the logarithm of live births were used to estimate adjusted incidence ratios (IRR) and 95% confidence intervals. Analyses were conducted using R and Stata software. Results: Brazil presented rates between 55 and 62 per 100,000 live births, while Portugal maintained lower values, ranging from 8 to 20 per 100,000. In Brazil, higher risks were observed among Black and Indigenous women, residents of the North and Northeast regions, and in age groups above 30 years. Direct and indirect causes showed similar proportions, with an increase in indirect causes during the pandemic. In Portugal, mortality showed low magnitude, but annual fluctuation was attributed to the small number of events and the limitation of microdata. Conclusions: The study highlights strong structural and racial inequalities in Brazilian maternal mortality, contrasting with the lower magnitude and greater stability observed in Portugal. This reinforces the need for intersectoral actions, strengthening the obstetric network, and continuous surveillance to reduce preventable deaths and promote equity in maternal care.

Review
Physical Sciences
Optics and Photonics

Léa Chaccour

Abstract: Vertical-External-Cavity Surface-Emitting Lasers (VECSELs) have gained significant attention over the past two decades due to their versatility in a wide range of photonic applications. This review focuses on VECSEL configurations for dual-wavelength emission, highlighting their use in high-resolution spectroscopy, terahertz (THz) generation, and advanced optical communication. We explore recent developments in VECSEL designs, including systems utilizing birefringent crystals for polarization-based frequency separation and configurations with dual VECSEL chips or dual gain regions within a single cavity. These two-wavelength VECSELs enable diverse operation modes, including narrow-linewidth, pulsed, multimode, and frequency-converted emission, with high-brightness output, excellent beam quality, and tunable wavelengths. Additionally, the review discusses advancements in dual-frequency VECSELs, with applications in LIDAR systems for environmental monitoring, highly stable optical clocks, and fiber sensors. We examine improvements in cavity design, semiconductor structures, and power stabilization, which have enhanced frequency stability and spectral purity, making VECSELs suitable for precision metrology and sensing applications.

Article
Computer Science and Mathematics
Computer Vision and Graphics

Donald Martin

,

Blake Bowman

Abstract: Incomplete 3D point clouds present a significant challenge in diverse applications due to sensor limitations and occlusions. Existing methods often struggle to balance local detail accuracy and global structural integrity, frequently yielding artifacts or distortions due to reliance on symmetric Chamfer Distance or unguided contrastive losses. We propose Dual-Constraint Contrastive Completion (DCCC), an end-to-end framework integrating asymmetric weighted Chamfer distance with multi-granularity contrastive learning. DCCC utilizes an encoder-decoder backbone with Mamba layers for efficient feature extraction. Central is the Asymmetric Contrastive Chamfer Loss (ACCL), decoupling local precision and global integrity objectives into distinct contrastive components, optimized via dynamic asymmetric weighting. A Self-Supervised Structural Guidance (SSG) module further learns coarse structural priors directly from incomplete inputs, reducing annotation reliance and improving robustness. Extensive experiments on benchmark datasets demonstrate DCCC's superior performance. DCCC achieves best-in-class results across critical metrics, significantly enhancing structural completeness and fine-grained accuracy in diverse settings, including real-world scenarios and high sparsity.

Article
Physical Sciences
Mathematical Physics

George Davey

Abstract: We construct a fully self-contained covariant phase-space formulation of a complex scalar field theory whose canonical structure becomes stratified under a diffeomorphism-invariant local trigger condition. Beginning from a well-posed variational principle on a globally hyperbolic spacetime with boundary, we derive the presymplectic current, establish hypersurface independence through explicit boundary symplectic augmentation, and perform presymplectic reduction to obtain the physical phase space. We then construct integrable boundary charges and prove that their algebra is represented up to a cocycle determined by the boundary symplectic structure. A local invariant functional partitions spacetime into regular and dense strata. In the dense stratum, admissible variations are restricted, enlarging the presymplectic kernel and suppressing the boundary cocycle. The resulting theory exhibits a mathematically controlled transition in algebraic structure without modification of Euler-Lagrange dynamics. Quantization is shown to preserve consistency on both strata. The work provides a complete algebraic closure independent of prior physical interpretation.

Article
Public Health and Healthcare
Public Health and Health Services

Nguyen Ba Phuoc

,

Vu Tuan Anh

,

Nguyen Thi Ly

,

Nguyen Duc Son

,

Nguyen Thi Chin

,

Lam Thi Hanh

,

Trinh Thi My

,

Nguyen Thi Nhan

,

Le Van Mang

,

Nguyen Duc Thanh

+1 authors

Abstract: Objective: Patient safety culture (PSC) is a critical determinant of healthcare quality. This study aimed to assess the current status of PSC among healthcare workers at Kien An Hospital, Hai Phong, Vietnam, and identify associated factors. Methods: A cross-sectional survey was conducted using the 12dimension hospital survey on patient safety culture (HSOPSC). A total of 324 healthcare professionals (physicians, nurses, and allied healthcare staff) participated. Data were analyzed using descriptive statistics and multivariable logistic regression. Results: The overall positive response rate across the 12 HSOPSC dimensions was 81.5%. The highest positive response rate was observed in the “Teamwork within units” dimension (98.5%), whereas the lowest was in “Non-punitive response to error” dimension (55.6%). Statistical analysis of PSC revealed significant differences between physicians and nurses in two dimensions: “Feedback and communication about error” with OR = 1.92 (95% CI: 1.66–2.52; p < 0.05) and “Overall perceptions of patient safety.” With OR = 0.12 (95% CI: 0.16–0.89; p < 0.01). Conclusion: Healthcare workers at Kien An Hospital report a relatively high level of positive PSC per-ception. Interventions should prioritize improving the non-punitive response to error system to foster a culture of reporting and learning.

Article
Medicine and Pharmacology
Cardiac and Cardiovascular Systems

Enrico Paolini

,

Marco Tontodonato

,

Francesca Coraducci

,

Marco Moretti

,

Elli Soura

,

Christian Corinaldesi

,

Luca Piangerelli

,

Matteo Francioni

,

Marco Marini

Abstract: Background: Lipoprotein(a) [Lp(a)] is increasingly recognized as an independent and genetically determined cardiovascular risk factor. However, its clinical role in patients with established coronary artery disease (CAD), particularly in relation to premature disease onset, remains incompletely defined. This study aimed to evaluate the association between Lp(a) levels and early-onset CAD, as well as the relative contribution of Lp(a) compared with traditional cardiovascular risk factors. Methods: We conducted a retrospective observational study including 225 patients with established CAD admitted to a tertiary care center in 2023. Lp(a) levels were measured at admission. Patients were stratified according to revascularization strategy and age at first cardiovascular event (<50 vs. ≥50 years). Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess associations and determine predictive performance. Results: Thirty-eight patients (17%) experienced early-onset CAD. Patients with early events showed significantly higher Lp(a) levels compared with those with later events (median 42 [19–75] vs. 21 [10–66] mg/dL; p = 0.020), despite lower LDL and non-HDL cholesterol levels. In multivariate analysis, both Lp(a) (OR 2.835, 95% CI 1.226–6.556, p = 0.015) and smoking (OR 2.516, 95% CI 1.116–5.673, p = 0.026) were independently associated with early-onset CAD. Lp(a) showed modest discriminative ability (AUC 0.619), with a cut-off value of 23 mg/dL providing 74% sensitivity and 52% specificity, and a high negative predictive value (91%). Lp(a) levels did not differ across revascularization subgroups. Conclusions: Elevated Lp(a) levels are independently associated with premature CAD, even in patients with lower traditional lipid risk factors and intensive lipid-lowering therapy. Routine Lp(a) assessment may improve cardiovascular risk stratification, particularly in younger patients.

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