Despite the minimally invasive nature of video-assisted thoracoscopic surgery (VATS), moderate-to-severe postoperative pain remains frequent and impairs recovery. Intravenous lidocaine possesses multimodal analgesic, antihyperalgesic and anti-inflammatory properties that may improve pain control and functional outcomes, but robust evidence in thoracic surgery is lacking. Moreover, its potential to attenuate neuropathic pain, a key component of chronic post-thoracic pain syndromes, has not been adequately investigated. This trial will determine whether continuous perioperative intravenous lidocaine infusion improves recovery, reduces acute pain intensity and prevents the development of neuropathic pain after VATS.

This single-centre, randomised, double-blind, placebo-controlled trial will enrol 84 adult patients undergoing elective VATS. Participants will be randomised (1:1) to receive either intravenous lidocaine (bolus 1 mg/kg at induction followed by continuous infusion at 1.5 mg/kg/hour intraoperatively and postoperatively for 24 hours) or matched normal saline postoperatively, with identical intraoperative management in both groups. The primary outcome is the incidence of moderate-to-severe movement-evoked pain at 24 hours postoperatively. Secondary outcomes include pain at 48 and 72 hours, opioid consumption, pulmonary complications, sleep quality, quality of recovery, neurocognitive outcomes and chronic neuropathic pain at 3 months. Analyses will follow the intention-to-treat principle.

The study protocol was approved by the Institutional Review Board of Tongji Hospital (Reference No. TJ-IRB202509102) and registered in the Chinese Clinical Trial Registry (ChiCTR2500111163). Written informed consent will be obtained from all participants. Results will be submitted to peer-reviewed journals and academic conferences.

ChiCTR2500111163.

Postoperative sleep disturbance (PSD) is a common complication following major surgery, occurring in 15%–72% of patients. PSD poses a significant threat to both postoperative recovery and long-term outcome, leading to elevated risks of cognitive decline, pain sensitivity and cardiovascular events in patients. The current pharmacological treatments for PSD are typically reactive, administered only after symptoms have manifested, highlighting a critical unmet need for effective prophylactic strategies during the perioperative period. Recently, an increasing number of studies have demonstrated the effect of esketamine on preventing PSD, but their findings are inconsistent. This protocol outlines a systematic review and meta-analysis to examine the effect of perioperative esketamine on the prevention of PSD.

A comprehensive search will be conducted in MEDLINE (via Ovid), EMBASE (via Ovid), the Cochrane Central Register of Controlled Trials (via Ovid), PubMed and Web of Science by two authors independently. The search terms will comprise indexed and free-text terms to encompass the concepts of esketamine and PSD. The primary outcome is the incidence of PSD at postoperative days 1, 3 and 7. Two authors will independently conduct study screening, data extraction and risk of bias assessment with the Cochrane Collaboration’s tool. RevMan V.5.4.1 and Stata V.17.0 software will be used to conduct the statistical analysis. Subgroup analysis, sensitivity analysis and assessment of publication bias will be performed to verify the strength of our conclusions. Finally, the Grading of Recommendations Assessment, Development and Evaluation approach will be used to recommend evidence quality.

Ethical approval is not required for this study. The findings will be presented at national or international conferences and submitted to a peer-reviewed journal.

CRD420251232636.

Osteoporosis (OP) is a systemic skeletal disorder that increases fragility and susceptibility to fractures. Despite the availability of teriparatide for the treatment of patients with acute fractures with better efficacy, its long-term daily injection and high cost limit its broader use among a wider patient population, especially for those living in low- and middle-income countries. This study aims to evaluate the efficacy of a novel sequential treatment with teriparatide daily for 6 months followed by denosumab every 6 months for another 18 months, in comparison with denosumab monotherapy every 6 months for 24 months, in reducing the risk of fractures in patients with newly diagnosed osteoporotic fractures. The study will also explore the possible difference between two sequential treatments (shifting to denosumab treatment at 6 or 12 months) in their effect on increasing bone mineral density (BMD).

This study is designed as a multicentre, open-label, randomised controlled trial among 2478 patients with newly diagnosed osteoporotic fractures from 58 hospitals across China. Participants will be randomly assigned in a 10:10:1 ratio to three treatment groups: 24 months of denosumab monotherapy, early sequential treatment (teriparatide for 6 months followed by denosumab for 18 months) and late sequential treatment (teriparatide for 12 months followed by denosumab for 12 months). The primary outcome is the incidence of vertebral fractures over 24 months of treatment. Secondary outcomes include changes in BMD at the lumbar spine, total hip and femoral neck, changes in bone turnover markers (β-carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 N-terminal propeptide), treatment adherence and cost-effectiveness. Follow-up assessments are scheduled at 3, 6, 9, 12, 18 and 24 months post-randomisation for primary and secondary outcomes, and biannually afterwards for the primary outcome.

The study protocol has been registered on ClinicalTrials.gov and has received ethical approval from the Peking Union Medical College Hospital Medical Science Research Ethics Committee (1-22PJ939). The findings will be disseminated through peer-reviewed scientific journals.

NCT05866029.

Adhesive capsulitis of the shoulder is a common shoulder disease. With the ageing population, the incidence of adhesive capsulitis has been rising year by year, posing a significant threat to the quality of life of middle-aged and elderly individuals. As one of the main means of treating adhesive capsulitis, manipulation under anaesthesia (MUA) can achieve good clinical results while maintaining high economic benefits. The purpose of this study is to investigate the prognostic factors and the longitudinal recovery trajectory of patients, so as to provide a basis for the precise treatment of MUA.

The study is a longitudinal prospective cohort study with a 12-month follow-up. A trajectory analysis model (latent growth curve modelling) will be used to observe the recovery changes of adhesive capsulitis patients. Linear mixed-effects models will be employed to analyse the prognostic factors of adhesive capsulitis.

Ethical approval was obtained from the Institutional Review Board of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (approval number: 2025-1707-047-02), following ethical guidelines and standard reporting practices. The research findings will be disseminated through presentations at both regional and global medical conferences.

ChiCTR2500100645.

Individuals with incomplete spinal cord injury (iSCI) often experience impaired balance control and turning-while-walking ability, which increase the risk of falls and limit their community mobility. While overground exoskeleton training has shown promise in improving gait and balance, evidence from randomised controlled trials (RCTs) on ambulation of individuals with iSCI remains limited. This protocol outlines a cluster RCT investigating the effectiveness of overground exoskeleton-assisted gait training compared with conventional training and usual care in improving turning-while-walking performence, balance control, and functional mobility in individuals with iSCI.

This multicentre, cluster RCT will compare 12-week interventions across three groups: (1) overground exoskeleton training group, (2) conventional training group and (3) usual care group. Participants with ambulatory iSCI will be recruited from three centres in Hong Kong SAR and mainland China. Primary outcomes include turning duration and number of steps during a 2-m turning-while-walking test. Secondary outcomes include static and dynamic balance, sensorimotor integration, gait performance, muscle strength, spasticity, quality of life, self-efficacy and fall incidence. Assessments will be conducted at baseline, mid-intervention, postintervention and at the 1-month follow-up.

This study has received approval from the Research Ethics Committees of Hong Kong Metropolitan University, the Affiliated BenQ Hospital of Nanjing Medical University, and Changzhou Sunshine Rehabilitation Hospital. Written informed consent will be obtained from all participants before enrolment. Study findings will be shared through peer-reviewed publications, conference presentations and summaries available to participants upon request.

NCT06971510.

To investigate the associations of oxidative balance score (OBS) with all-cause mortality, cardiovascular mortality and cardiovascular disease (CVD) incidence in two large, population-based cohorts.

Cohort study and cross-sectional study were used.

The US National Health and Nutrition Examination Survey (NHANES) and the UK Biobank.

A total of 33 566 adults from NHANES (1998–2018) and 55 760 adults from the UK Biobank were included.

All-cause mortality, cardiovascular mortality and CVD. Mortality outcomes were ascertained through national death registries. Prevalent CVD was identified in NHANES through questionnaire, and incident CVD events were identified in the UK Biobank using linked hospital admission and death registry data.

Higher OBS was consistently associated with lower all-cause and cardiovascular mortality in both cohorts. In NHANES, participants in the highest OBS quartile (Q4) had a 39% lower risk of all-cause mortality (adjusted HR: 0.61, 95% CI 0.52 to 0.72) and a 45% lower risk of cardiovascular mortality (adjusted HR: 0.55, 95% CI 0.41 to 0.74) compared with those in Q1. Similarly, in the UK Biobank, Q4 was associated with an 18% lower risk of all-cause mortality (adjusted HR: 0.82, 95% CI 0.74 to 0.91) and a 41% lower risk of cardiovascular mortality (adjusted HR: 0.59, 95% CI 0.4 to 0.87). In NHANES, Q4 was associated with lower odds of prevalent CVD (adjusted OR: 0.56, 95% CI 0.46 to 0.67), whereas in the UK Biobank, Q4 was associated with a 19% lower risk of incident CVD during follow-up (adjusted HR: 0.81, 95% CI 0.74 to 0.9). Subgroup analyses in NHANES indicated heterogeneity by ethnicity and socioeconomic status, whereas associations in the UK Biobank followed an L-shaped pattern with a flattening of estimated risk at moderate OBS levels.

Higher OBS was associated with more favourable mortality and cardiovascular outcomes. These findings indicate that OBS is a composite indicator associated with cardiovascular health at the population level.

The Circle of Security-Parenting (COS-P) group intervention has demonstrated efficacy in reducing maternal perinatal mental health difficulty (PMHD) symptoms in some contexts. The Circle of Security Intervention (COSI) study, a multisite, individually randomised, single-blind, parallel-arm controlled trial, was conducted in England to assess the clinical effectiveness of COS-P in reducing perinatal psychopathology, parenting and infant development, as well as its acceptability among the National Health Service (NHS) participants and staff. The main aim of this work is to estimate the cost-utility of COS-P plus treatment as usual (TAU) relative to TAU among mothers and birthing parents receiving NHS perinatal mental health services (PMHS) in England.

A within-trial economic evaluation was performed comparing COS-P plus TAU with TAU alone, using data from the COSI trial, which employed a 2:1 randomisation ratio. Analyses were conducted from both NHS and personal social services (PSS) and societal perspectives. A 12-month time horizon was used, consistent with the final trial follow-up.

Secondary care NHS perinatal health services across multiple centres in England.

A total of 371 mothers and birthing parents with PMHD were randomised and had complete economic outcome data; 248 received COS-P plus TAU and 123 received TAU alone. Participants were eligible if they were receiving NHS PMHS; exclusion criteria were defined in the trial protocol.

Participants in the intervention arm received the COS-P group programme in addition to TAU. The control group received TAU alone.

The primary economic outcome was quality-adjusted life years (QALYs) over 12 months, derived from the 5-level EuroQol five-dimensional (EQ-5D-5L) questionnaire - responses. Costs were estimated from NHS and PSS as well as societal perspectives, including healthcare utilisation and productivity losses due to work absence.

Compared with TAU, COS-P was associated with higher costs from both NHS and PSS (£180.58; 95% CI –£1075 to £1436) and societal (£72.94; 95% CI –£1473 to £1619) perspectives. COS-P was marginally less effective in terms of QALYs (–0.01; 95% CI –0.06 to 0.05). Probabilistic sensitivity analyses indicated substantial uncertainty around cost and effectiveness estimates.

On average, COS-P was associated with higher costs and did not demonstrate improvements in health-related quality of life compared with TAU alone. Given the uncertainty surrounding the estimates, further research is warranted to explore potential longer term economic and clinical impacts of COS-P in perinatal mental health settings.

SRCTN18308962.

Hand dysfunction following stroke, especially during the flaccid paralysis phase, significantly impairs patients’ motor abilities and daily functioning. Electroacupuncture (EA) is widely used in post-stroke rehabilitation; however, inconsistent clinical outcomes and lack of standardised treatment parameters have limited its broader adoption.

This protocol describes a randomised controlled trial designed to determine optimal EA parameters for post-stroke hand dysfunction using an orthogonal experimental design.

This protocol presents a single-centre, randomised controlled trial design with 10 arms. A total of 110 patients with post-stroke hand dysfunction will be randomly assigned to nine electroacupuncture groups or one sham acupuncture group in equal proportions. Participants will receive 12 treatment sessions over 2 weeks. The EA groups are designed based on a four-factor, three-level orthogonal design to systematically evaluate the main effects of acupoint selection, stimulation frequency, needle thickness and treatment duration. The primary outcome is the effective response rate, defined as reduction in the Chinese Stroke Scale (CSS) score at 2 weeks. Secondary outcomes include assessments with the Modified Lindmark Rating Scale, range of motion measures, Modified Barthel Index and hand motor subscores of the CSS. As this is a trial protocol, results are not yet available. Statistical analyses will be conducted after completion of recruitment and follow-up according to the prespecified analysis plan. Safety and adverse events will be monitored throughout the study.

This trial is designed to address the current lack of evidence-based standardisation of EA parameters for post-stroke hand dysfunction. By systematically evaluating key treatment components using an orthogonal experimental design, the study aims to identify optimal EA strategies and provide a methodological framework to improve consistency, reproducibility and clinical effectiveness in post-stroke hand rehabilitation.

This manuscript describes a study protocol and does not report any data from participants at this stage. Ethical approval for the planned trial was obtained from the Medical Ethics Committee of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (Approval No. TYLL2024(K)072). Written informed consent will be obtained from all participants prior to enrolment. The results of the study will be disseminated through peer-reviewed journals and academic conferences.

ITMCTR2024000819.

Postoperative acute pain following video-assisted thoracoscopic surgery (VATS) impedes patient rehabilitation. While multimodal analgesia effectively mitigates postoperative acute pain and facilitates the postoperative rehabilitation process, the efficacy of preventive precision multimodal analgesia (PPMA) remains uncertain. This study designs a PPMA strategy targeting incisional pain, inflammatory pain and visceral pain in VATS. It aims to investigate the impact of the PPMA strategy on the postoperative acute pain process and rehabilitation outcomes.

This multicentre, single-blinded, randomised controlled trial will enrol adult patients scheduled for elective thoracoscopic lobectomy or segmentectomy. A total of 1372 participants will be recruited and randomly allocated in a 1:1 ratio to either the preventive precision multimodal analgesia group (PPMA Group) or the conventional multimodal analgesia group (CMA Group). Patients in the PPMA Group will receive a regimen consisting of local anaesthetic infiltration of surgical incision (for incisional pain), intravenous injection of oxycodone (for visceral pain) and parecoxib sodium (for inflammatory pain) before surgery initiation. Patients in the CMA Group will receive the same regimen after specimen isolation. This trial will be conducted across 13 medical centres in China from 2023 to 2026. The primary outcome is the duration of postoperative acute pain. Secondary outcomes include postoperative analgesic consumption, postoperative pain scores, intraoperative haemodynamic parameters and the Indexes of Consciousness (IoC₁ and IoC₂), as well as intraoperative arterial blood gas and ventilation parameters, intraoperative dosages of general anaesthesia, inflammatory markers at predefined time points, postoperative rehabilitation process and perioperative adverse events and complications.

This study has been approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University (Linyanshen[2023]-NO.012-003-Revised Vision 1). The results will be published in a peer-reviewed journal.

Chinese Clinical Trial Registry (ChiCTR2300072176).

Accurate estimates of the burden of vaccine-preventable community-acquired pneumonia (CAP) hospitalisations both overall and due to the most frequent and vaccine-preventable pathogens are needed to inform the use of respiratory vaccines in adults.

This was a prospective, population-based CAP surveillance study at three hospitals in Germany. All patients admitted with clinically suspected CAP were tested for Streptococcus pneumoniae using urine antigen tests and for respiratory syncytial virus (RSV), influenza virus and SARS-CoV-2 using multiplex PCR from nasopharyngeal swabs. Incidence rate calculations for all-cause CAP were based on eligible patients, regardless of enrolment status.

Individuals admitted to study hospitals within the surveillance period with suspected or confirmed diagnosis of pneumonia who provided informed consent.

Radiologically confirmed (RAD) CAP.

Active surveillance between 1 January 2021 and 30 June 2023 identified at the three study sites 4319 adults with RAD-CAP that met eligibility criteria, of which 1479 (34.2%) were enrolled and included in the analysis for pathogen distribution. The main reason for non-enrolment was the inability to provide informed consent. Incidence estimates were based on 1254 study-eligible individuals admitted at the largest study site. SARS-CoV-2, S. pneumoniae, RSV or influenza were identified in 36.5%, 9.1%, 3.7% and 1.8% of patients with RAD-CAP, respectively. Serotypes included in the 20-valent pneumococcal conjugate vaccine were detected in 6.9% of RAD-CAP and 76.0% of pneumococcal CAP. The overall adjusted annual incidence of all-cause RAD-CAP over the study period was 490/100 000 (95% CI 461 to 521). The incidence of pneumococcal and RSV-related RAD-CAP increased 8.6-fold and 10.0-fold over the study period, resulting in an incidence of 60/100 000 (95% CI 45 to 75) and 30/100 000 (95% CI 19 to 41) in 2022/2023, respectively, while SARS-CoV-2 related RAD-CAP declined by 70% to 97/100 000 (95% CI 78 to 116).

Active pneumonia surveillance reported a high burden of RAD-CAP hospitalisations in Germany, especially among older adults. The resurgence of CAP due to RSV, S. pneumoniae or influenza, alongside maintained activity of SARS-CoV-2, was associated with an overall increase of RAD-CAP among adults.

Mentoring has been identified as a promising strategy for implementing and sustaining evidence-based practice (EBP) in healthcare organisation. However, no appropriate tools were specifically developed or cross-culturally adapted into Chinese context to assess nurse’s perceived EBP mentoring, impeding comprehensive evaluation of the effects of mentoring intervention studies. This study aimed to cross-cultural adapt the Evidence-Based Practice Mentoring (EBPM) scale into Mainland China and evaluate its psychometric properties, including validity and reliability.

A comprehensive translation and adaptation process was adopted to achieve the Chinese version of the EBPM (C-EBPM) scale. It consists of four steps: (1) trilateral translation procedure, (2) cognitive interview, (3) psychometric testing and (4) cross-time confirmatory factor analysis (CFA).

This study was conducted in four 3A-level hospitals located in Shaanxi and Zhejiang provinces, China, during two different data collection periods.

A total of 598 registered nurses participated in this study.

After two rounds of the trilateral translation procedure, a 9-item version of the C-EBPM scale was generated. Ten registered nurses participated in cognitive interview understood the meaning of all items but the response options. All items had significant critical ratio values (t=15.866~20.584, p²/df=65.681/27 0.950, Tucker-Lewis Index=0.966 > 0.950, and standardised root mean square residual=0.026 0.70) and average variance extracted was 0.60 (>0.50).

The 9-item C-EBPM scale demonstrated robust reliability and validity and is suitable for assessing EBP mentoring among nurses.

To develop and validate a mortality-risk prediction model for patients with advanced splenomegaly-subtype schistosomiasis, enabling accurate prognosis assessment and informed resource allocation.

Retrospective, population-based cohort study using clinical data from a single-centre registry.

Endemic regions of Hubei Province, China.

The study includes 628 patients with advanced splenomegaly-subtype schistosomiasis from the Hubei Provincial Advanced Schistosomiasis Registry between September 2014 and January 2015. The splenomegaly subtype is defined as splenomegaly extending below the umbilical line or with a transverse diameter exceeding the mid-abdominal line. We divided the study population into two cohorts. The derivation cohort included 452 patients selected from several counties within the registry. These patients had a confirmed diagnosis of advanced splenomegaly-subtype schistosomiasis. Only those with complete data were retained. The external validation cohort comprised 176 patients from geographically distinct counties in the same registry, and the same inclusion and exclusion criteria were applied. 10-fold cross-validation was employed to evaluate the model’s generalisation on the derivation cohort.

6-year all-cause mortality was the outcome measure. Baseline variables, included age, serum aspartate aminotransferase, albumin, splenectomy history and frequency of ascites ≥5 episodes were analysed using Cox proportional hazards regression. Model performance was assessed via C-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Five predictors were integrated into the mortality risk model. The C-statistic for predicting 6-year mortality was 0.79 (95% CI 0.74 to 0.83) in the derivation cohort, with robust validation in the external validation cohort (0.78, 95% CI 0.70 to 0.86). Simplified models using subsets of predictors showed slight reductions in discrimination (NRI and IDI). Patients with a frequency of ascites ≥5 episodes had significantly lower survival rates and should be given special attention in clinical practice.

The validated prediction model identifies high-risk patients using accessible clinical variables. The approach may optimise prognostication and prioritisation of healthcare resources for advanced schistosomiasis. The model’s performance remains to be confirmed in a prospectively enrolled cohort.

Soft robotic gloves (SRGs) integrated with brain-computer interfaces (BCIs) have demonstrated potential in facilitating motor recovery after stroke by enabling active, intention-driven rehabilitation. Emerging evidence suggests that incorporating vibrotactile stimulation (VTS) into SRG-BCI systems may further enhance sensorimotor feedback. The objective of this study is to evaluate the therapeutic efficacy and underlying neural mechanisms of BCI-driven, intention-based glove activation compared with automated glove-assisted training, with VTS applied identically in both groups.

This multicentre, single-blind, randomised controlled trial will involve 48 post-stroke patients within 1 week to 3 months after stroke onset, with stratification by time since stroke during randomisation. Participants will be randomly assigned to either the BCI-SRG group (n=24) or SRG group (n=24). Both groups will receive identical VTS. Patients in the BCI-SRG group will actively initiate movements of the SRG through motor imagery, while those in the SRG group will receive automated glove-assisted training without BCI control. The intervention will be administered 5 days per week for 4 weeks. The primary outcome measure is the Fugl-Meyer Assessment of Upper Extremity. Secondary outcome measures include Wolf Motor Function Test, International Classification of Functioning, Disability and Health Generic Set, Barthel Index, Modified Ashworth Scale, Semmes-Weinstein Monofilament Test, as well as event-related spectral perturbation and event-related desynchronisation. All assessments will be conducted at both baseline and post-intervention.

Ethics approval of this study protocol has been obtained from the Ethics Committee of the First Affiliated Hospital with Nanjing Medical University (2025-SR-508). The findings will be disseminated through peer-reviewed journals, conference presentations and communication with scientific, professional and general public audiences.

ChiCTR2500106951.

To investigate the trajectories of swallowing function recovery and associated influencing factors in adult patients following orotracheal extubation in the intensive care unit (ICU).

Prospective cohort study.

Emergency ICU of a tertiary hospital in Shenyang, China.

A total of 182 adult patients who underwent orotracheal intubation were enrolled between December 2023 and December 2024 using convenience sampling. Among them, 168 patients completed all follow-up assessments, with a loss-to-follow-up rate of 10.1%.

Swallowing function was assessed using the Standardised Swallowing Assessment (SSA) at 2, 4, 6, 8, 24 and 48 hours after extubation. Latent class growth modelling (LCGM) was used to identify distinct swallowing function trajectories. Unordered multinomial logistic regression was performed to examine factors associated with different trajectory classes.

Among the 168 patients who completed all six assessments, no significant differences in baseline characteristics were observed between patients who completed follow-up and those lost to follow-up (all p>0.05). LCGM identified three distinct swallowing function trajectories: a low-risk group (46.1%), characterised by consistently low SSA scores below the dysfunction threshold (26 points); a rapid recovery group (24.6%), in which SSA scores declined to below 26 points within 24 hours after extubation and a high-risk group (29.3%), characterised by persistently elevated SSA scores above 26 points. Multinomial logistic regression analysis showed that age ≤50 years, absence of spinal cord injury or rib fractures, APACHE II score

Distinct trajectories of swallowing function recovery were observed in adult ICU patients after orotracheal extubation. Several clinical factors were associated with more favourable recovery patterns. These findings may help improve the understanding of heterogeneity in postextubation swallowing function and inform future risk stratification and individualised management strategies.

Ethics approval and consent to participate in the trial were approved by the Institutional Research Ethics Committee of General Hospital of Northern Theatre, Shenyang, Liaoning province, PR China (Project Number: Y (2023)232). Written informed consent was obtained from all participants. All procedures were conducted in accordance with relevant guidelines and regulations and the Declaration of Helsinki.

Primary healthcare (PHC) workforce shortages remain a critical global and national challenge, threatening progress toward Universal Health Coverage. Limited research has examined career-stage-specific motivations and deterrents. This study explores how perceptions of PHC careers differ between final-year medical students and current PHC providers, offering insights for targeted recruitment and retention strategies.

We conducted semi-structured face-to-face and online interviews (November 2023 to December 2024) with final-year medical students and primary healthcare providers (PCPs) from Greater Bay Area institutions. Participants were purposively sampled to ensure diversity in key characteristics. Interviews continued until thematic saturation was reached. Data were analysed thematically using Braun and Clarke’s six-step framework.

Interviews with 17 PCPs and 13 students identified five themes: systemic and institutional factors, education and training, professional development, community perceptions and personal motivations and trade-offs. The analysis identified common barriers across the participant groups, including inadequate resources, fragmented health information systems, unstructured career pathways and inequitable pay-for-performance mechanisms. Career-stage differences were notable: students associated success with hospital-based specialisation and viewed PHC as a fallback option, influenced by limited PHC training exposure, unclear advancement pathways and prevailing stigma. In contrast, PCPs described professional fulfilment through developing niche expertise and fostering continuity of care, increasingly perceiving PHC as an innovative platform for specialised practice. PCPs with prior hospital experience described their transition from hospital settings as motivated by burnout and the pursuit of better work–life balance, an opportunity often overlooked in workforce planning.

Career-stage-specific recruitment strategies are essential to strengthen the PHC workforce. Policies that address early-career and mid-career needs, establish structured development pathways and enhance the societal value of PHC will be critical to building a resilient primary care system. Findings offer practical implications for health system reforms in China and other countries advancing toward Universal Health Coverage.

Atrial fibrillation (AF), with a prevalence of 1–2%, is the most common cardiac arrhythmia. AF is associated with a fivefold increased risk of cardioembolic events; approximately 20% of all strokes are caused by AF. Pulmonary vein isolation (PVI) has become the first-line treatment for AF. However, PVI cannot eliminate the residual stroke risk. Current guidelines recommend that anticoagulation be continued in this specific group of patients, regardless of the presence or absence of AF. In this large AF population post-PVI, who are considered to be in an earlier stage of AF, it is unknown whether left atrial appendage closure (LAAC) offers an alternative to direct oral anticoagulant (DOAC) therapy.

The trial will be a prospective, randomised, multicentre non-inferiority study comparing two treatment strategies in AF patients after atrial ablation. Patients will be randomly assigned to either percutaneous LAAC (group A) or DOAC treatment (group B) in a 1:1 ratio; both sequential and concomitant planned ablation with or without LAAC are accepted. Randomisation will be conducted using web-based randomisation software. A total of 1012 participants (506 patients per group) will be enrolled. The primary effectiveness measure will be the occurrence of any of the specified events within 24 months after randomisation: stroke/transient ischaemic attack/systemic thromboembolism, cerebral haemorrhage, other major haemorrhages (Bleeding Academic Research Consortium ≥2), cardiovascular mortality and all-cause mortality.

The study was approved by the Ethical Review Board of Shanghai Chest Hospital, China (KS(Y)20287). Written informed consent will be obtained from all participants. The trial will follow the Declaration of Helsinki and Good Clinical Practice. Confidentiality will be maintained with anonymised, securely stored data. Findings will be disseminated through peer-reviewed publications and conferences.

ChiCTR2000036538.

Postoperative delirium (POD) is a common and serious complication after cardiac surgery, particularly in elderly patients, and is associated with adverse short- and long-term outcomes. Effective preventive strategies remain limited. Liraglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated potential neuroprotective, anti-inflammatory and metabolic benefits, which may reduce the incidence of POD.

This is a single-centre, randomised, double-blind, placebo-controlled trial in elderly patients undergoing elective cardiac surgery. Participants will be randomised in a 1:1 ratio to receive liraglutide or placebo from the day before surgery until postoperative day 3. A total of 260 patients are planned to be enrolled in this study. The primary endpoint is the incidence of POD within 7 days, assessed using the Confusion Assessment Method (CAM) or CAM-intensive care unit. Secondary outcomes include delirium severity, neurocognitive and psychological function, cardiac function, clinical outcomes, major adverse cardiovascular events within 1 year and perioperative biomarker changes. Exploratory outcomes include functional MRI in selected subgroups and additional biomarker analyses.

The protocol has been approved by the Medical Ethics Committee of Nanjing Drum Tower Hospital. Written informed consent will be obtained from all participants. Findings will be disseminated in peer-reviewed journals and academic conferences.

ChiCTR2500106943.

Ultrasound guidance improves the success rate and efficiency of radial arterial catheterisation (RAC). However, the procedure remains more challenging in obese patients, in whom excess subcutaneous tissue can impair anatomical visualisation. Additionally, frequent head shifts between the procedural site and ultrasound screen usually increase procedural complexity, prolong the procedural time and adversely affect both patient comfort and clinician performance. Smart glasses that project real-time ultrasound images directly into the clinician’s field of view offer a potential solution. The study aimed to evaluate whether the use of smart glasses improves the efficiency of ultrasound-guided RAC in obese patients.

In this prospective, single-centre, randomised controlled trial, a total of 176 eligible obese patients (body mass index ≥30 kg/m²) requiring RAC for perioperative monitoring will be enrolled. Participants will be randomly assigned in a 1:1 ratio to either the control group, receiving conventional ultrasound-guided RAC, or the smart-glasses group, undergoing ultrasound-guided RAC with real-time image display and needle-tracking assistance via smart glasses. The primary outcome is the first-attempt success rate. Secondary outcomes include the second-attempt success rate, time to successful catheterisation within the first and second attempts, overall procedural time, overall number of arterial catheterisation attempts; ultrasound scanning time, number of probe repositionings and needle redirections; incidence of RAC-related complications, and satisfaction scores of both patients and clinicians. Statistical analyses will be performed using Statistical Package for the Social Sciences (SPSS) and GraphPad Prism.

This study will be conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent will be obtained from all participants before enrolment. The study protocol has been reviewed and approved by the Medical Research Ethics Committee of the Second Affiliated Hospital of Anhui Medical University. This study has been prospectively registered at Chinese Clinical Trial Registry. Study results will be disseminated through presentations at scientific conferences and publication in peer-reviewed scientific journals.

ChiCTR2500108023.