Physicians’ preferences for financial and non-financial incentives significantly influence their job satisfaction and career choices. A comprehensive understanding of these preferences can aid in the optimisation of incentive policies. While prior studies have examined these preferences using discrete choice experiments (DCEs), the effects of intrinsic motivations, such as altruism and job satisfaction, on incentive responsiveness remain poorly understood. Understanding this heterogeneity is essential for designing incentive policies that are effective and tailored to the healthcare context in China. This study aimed to assess how physicians’ altruism and job satisfaction shape their preferences for financial and non-financial incentives.

This study employed a DCE methodology and surveyed 886 physicians from urban tertiary hospitals. The DCE design was based on a comprehensive literature review and focus group interviews, assessing physicians’ preferences regarding attributes such as work environment, workload, career development opportunities and career identity. Mixed logit models were used to estimate the willingness to pay for each attribute and analyse heterogeneity across subgroups based on levels of altruism and job satisfaction.

Financial incentives were the most important factor for physicians, followed by attributes such as work atmosphere and workload. On average, physicians expressed a willingness to sacrifice 4859.035 ¥ for an improved work atmosphere and 4335.008 ¥ in exchange for reduced workload. Subgroup analysis showed that physicians with low- and medium-altruism prioritised improvements related to working conditions, while those with high-altruism placed greater emphasis on intrinsic career development and career identity. Furthermore, physicians reporting low-job satisfaction demonstrated heightened sensitivity to both financial and non-financial incentives, whereas those with high-job satisfaction showed weaker preference for financial incentives and greater preference for improvements in work atmosphere (β=1.002) and work environment (β=0.876).

The findings highlight the need to align incentive policies with physicians’ intrinsic motivations and current job satisfaction. Financial incentives remain a key driver of job preferences. Non-financial factors, including improvements in the work atmosphere, work environment, workload, career development and professional identity, also play an important role in supporting physicians’ job satisfaction and retention. Considering differences in altruism and job satisfaction can help healthcare institutions and policymakers develop more targeted and context-specific incentive strategies.

Robotic rehabilitation on locomotion is a new approach in amyotrophic lateral sclerosis (ALS) and previous studies showed its feasibility. In this study, we aim to evaluate safety, patient’s experience and efficacy of a gait training programme with the Atalante exoskeleton, compared with usual care, on walking ability, functional capacity and other symptoms associated with ALS.

EXALS is a monocentric, prospective, interventional, open trial. 20 slowly progressing patients with gait deficits will be recruited. The study is conducted in three phases, each lasting 6 weeks, following the ABA procedure. Phase B represents the intervention phase, during which patients practise their gait training at a rhythm of three sessions/week, as an add-on to usual care. In the two phases A, patients receive usual care with no additional treatment. An evaluation is planned before, in the middle and at the end of each phase. The primary outcome of the study is safety and tolerability of the Atalante exoskeleton. Secondary outcomes include: participants’ subjective impact and experience, attitude and motivation, efficacy and interactivity of the exoskeleton, walking ability, functional capacity, spasticity, balance, postural stability, lower limb muscle strength, quality of life, pain, fatigue, anxiety and depression. Statistical analyses will include descriptive methods for all variables and adverse events. Quantitative outcomes are analysed using repeated-measures ANOVA (analysis of variance) across the seven visits, with post hoc tests applied when appropriate. Nominal outcomes are evaluated using Cochran’s Q test with McNemar pairwise comparisons when significant. Associations between variables are examined using Spearman correlation coefficients. Missing data will be replaced using linear interpolation, and sensitivity analyses will be planned. Qualitative interview data are analysed using thematic analysis.

This study was approved by the French ethics committee CPP Nord-Ouest I (no. 23.02378.000201). Participant data are anonymised and securely stored in the laboratory’s database, accessible only to the research team. Results will be disseminated through peer-reviewed journals and conferences.

NCT06199284.

Glaucoma is an optic neuropathy caused by the gradual degeneration of retinal ganglion cells. This study aimed to investigate the knowledge, attitude and practice (KAP) towards glaucoma among ophthalmic inpatients.

A web-based questionnaire.

Local hospital.

Ophthalmic inpatients (n=1238).

The primary outcome was the patients’ KAP.

Multivariable logistic regression analysis showed that rural residence (OR=0.488, 95% CI 0.313 to 0.762, p=0.002), college education or above (OR=4.996, 95% CI 2.942 to 8.483, p

Ophthalmic inpatients might have moderate knowledge and attitude, but a proactive practice towards glaucoma. A history of glaucoma, previous glaucoma surgery, education level, residency and alcohol consumption were potentially associated with knowledge and attitudes towards glaucoma among ophthalmic inpatients.

To evaluate the performance of Ghana’s environmental surveillance (ES) system for poliovirus (PV) detection from 2018 to 2022 using standardised indicators developed by the WHO and the US Centers for Disease Control and Prevention.

A retrospective performance evaluation using 10 key indicators benchmarked against global targets for PV surveillance.

Seven regions across Ghana, participating in the national ES programme implemented under the Global Polio Eradication Initiative.

Wastewater sampling was conducted at designated ES sites, supported by field collection teams and laboratory personnel responsible for sample acquisition, processing and reporting of PV detection results.

Detection rates of PV and non-polio enteroviruses (NPEVs), timeliness of sample collection and reporting, data quality and system stability.

A total of 738 wastewater samples were collected. The system demonstrated high sensitivity, detecting circulating vaccine-derived PV type 2 in 51 (6.9%) of samples, Sabin PV types 1 and 3 in 61 (9.5%) and 114 (17.8%), respectively, and NPEVs in 491 (66.5%) of samples. Over 80% of samples met the recommended 21-day collection-to-reporting time frame. Data quality exceeded the ≥80% threshold, and workflows remained stable throughout the evaluation period.

Ghana’s ES system for PV was found to be flexible, stable and effective in generating high-quality data for early detection and public health response. These findings underscore the system’s critical role in supporting polio eradication efforts and highlight its potential as a model for surveillance in similar settings.

NHS Health Checks (NHSHCs) provide individuals with cardiovascular disease (CVD) risk scores alongside advice and signposting to behaviour change support. A particular problem is that the support people receive is often poorly delivered, absent or not tailored to the needs of people in deprived communities, which risks exacerbating health inequalities. Improving this support is critical if NHSHCs are to achieve their goals of prevention and equity.

To explore needs and preferences for behaviour change support among adults in deprived areas, using a digital prototype presenting CVD risk information and signposting to services.

A longitudinal qualitative study involving focus groups and semi-structured follow-up interviews.

Adults from minoritised ethnic groups eligible for NHSHCs, recruited online and through a community centre, with both methods targeting high-deprivation areas.

Participants were first shown the digital prototype in focus groups to generate discussion. Follow-up interviews captured more in-depth reflections on needs for behaviour change support. Data were analysed using reflexive thematic analysis.

We conducted four focus groups and 20 follow-up interviews with 23 adults, predominantly of South Asian ethnicity living in areas of high deprivation. We developed three themes: (1) Trusted information to counter confusion and misinformation; (2) Support that makes change feel possible and meaningful, through culturally and personally relevant advice that addresses unhelpful beliefs about risk reduction and behaviour change and (3) Ensuring access to inclusive, socially connected environments that feel supportive and conducive to action.

For minoritised ethnic adults in deprived areas, NHSHC support should build on everyday practices and foster positive perceptions of services. Alongside service-level changes, policy action is needed to remove structural barriers (eg, cost, safety) that limit people’s ability to act on advice. Such changes could enhance the programme’s contribution to reducing inequalities in CVD prevention.

Acute kidney injury (AKI) is a significant challenge in hospital settings, and accurately differentiating between intrinsic and prerenal AKI is crucial for effective management. The fractional excretion of urea (FEUN) has been proposed as a potential biomarker for this purpose, offering an alternative to traditional markers such as fractional excretion of sodium. This study aimed to assess the diagnostic accuracy of FEUN for differentiating intrinsic from prerenal AKI in hospitalised patients.

We conducted a systematic review and bivariate random effects meta-analysis of diagnostic accuracy studies. The study followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

PubMed, Embase and Cochrane databases were searched from inception to 1 November 2023.

We included observational studies that focused on patient with AKI and reported FEUN data sufficient to reconstruct a complete 2x2 contingency table (true positives, true negatives, false positives and false negatives) for evaluating its diagnostic accuracy.

Two reviewers extracted data, assessed risk of bias with Quality Assessment of Diagnostic Accuracy Studies-2 and graded certainty of evidence using the GRADE approach. Pooled sensitivity, specificity, positive and negative likelihood ratios, and the area under the summary receiver operating characteristic curve (SROC) were calculated; heterogeneity was measured with I². A prespecified subgroup restricted to patients receiving diuretics served as a sensitivity analysis.

12 studies involving 1240 patients were included, with an overall occurrence rate of intrinsic AKI of 38.8%. FEUN had a pooled sensitivity of 0.74 (95% CI 0.60 to 0.84) and specificity of 0.78 (95% CI 0.66 to 0.87), with positive predictive value and negative predictive value of 0.76 (95% CI 0.68 to 0.83) and 0.74 (95% CI 0.66 to 0.81), respectively. The SROC curve showed a pooled diagnostic accuracy of 0.83. Heterogeneity was substantial (I²>90%) for sensitivity and specificity. In a diuretic-only subgroup (six studies) specificity rose to0.87 and heterogeneity declined (I²=56%). Overall certainty of evidence was low owing to inconsistency.

FEUN is a biomarker with moderate diagnostic accuracy for differentiating between intrinsic and prerenal AKI in hospitalised patients. Its application could enhance AKI management; however, the high heterogeneity observed in our study highlights the need for further research to evaluate its utility across diverse patient populations and clinical settings.

CRD42024496083.

Treatment failure remains a major challenge in tuberculosis (TB) management. Rapid and objective assessment of treatment response is essential, as existing tools have limited accuracy and slow turnaround times. The PATHFAST TB LAM Ag assay (PATHFAST-LAM), an automated chemiluminescent enzyme immunoassay, was developed to quantify lipoarabinomannan (LAM) in sputum within 1 hour. Previous studies have shown a strong correlation between sputum LAM concentration and culture-based bacterial load. However, its clinical utility for predicting poor outcomes during treatment has not been prospectively evaluated.

We will conduct a prospective longitudinal study enrolling newly diagnosed, bacteriologically confirmed patients with pulmonary TB at Rhodes Chest Clinic and Mbagathi County Referral Hospital in Nairobi, Kenya. We will follow participants throughout the 6-month treatment course, attempting to collect sputum weekly during weeks 1–4, biweekly during weeks 5–12 and monthly during months 3–6. We will measure LAM concentrations at these time points using the PATHFAST-LAM assay. The primary outcome is to assess whether changes in sputum LAM concentration during the intensive phase (baseline to week 4 and/or week 8) predict a composite poor outcome, defined as positive sputum culture at month 6, treatment failure, death during treatment or relapse within 3 months after treatment completion. The primary endpoint is the area under the curve from the receiver operating characteristic analysis, representing the predictive performance of changes in sputum LAM concentration for the composite poor outcome. We will identify the optimal cut-off value for LAM change and estimate sensitivity and specificity with 95% CIs using 2x2 tables. We will apply an adaptive design that allows sample-size re-estimation after interim analysis.

The study was approved by the Kenya Medical Research Institute (KEMRI/SERU/CRDR/124/5241) and Nagasaki University (250619327). Findings will be disseminated through peer-reviewed publications and scientific meetings.

NCT07157904.

Transcranial magnetic stimulation (TMS) and upper extremity manipulation training have demonstrated clinical effectiveness in stroke rehabilitation. Post-stroke, the affected cerebral cortex often shows reduced excitability, which can limit the optimal outcomes of conventional manual training. To address this, we developed a new upper limb training method integrating TMS with active sensory training (AST) to enhance the fine motor ability in the upper limbs following stroke, potentially improving overall rehabilitation efficacy. However, the clinical effectiveness of this approach remains unclear. Importantly, we demonstrated the efficacy of the new rehabilitation strategy by using TMS in conjunction with AST in patients experiencing upper limb motor dysfunction after stroke.

This single-centre, single-blind, sham stimulation, randomised controlled clinical trial investigated the efficacy of AST combined with TMS in patients with stroke and upper limb motor dysfunction post-stroke (1–24 months post-onset) at Brunnstrom stages III–V. Upper limb motor function was evaluated before and 2 weeks after the intervention. The primary outcome was the Action Research Arm Test result, and the secondary indicators included results on the Fugl–Meyer Assessment Upper Extremity Scale, Modified Barthel Index, Semmes–Weinstein Monofilament, Erasmus MC revised Nottingham Sensory Assessment Scale, Embodied Sense of Self Scale (stroke version), functional near-infrared spectroscopy and neuroelectrophysiology. Between-group differences were analysed using independent t-tests, and within-group differences were examined with paired t-tests, with statistical significance set at p

This study was approved by the Ethics Committee of the Second Rehabilitation Hospital of Shanghai for ethical application (Approval number: 2024-34-01). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals and presentations at local and international conferences.

ChiCTR2500097067.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by impairments in social interaction, communication and the presence of repetitive behaviours. Recent advancements in brain-computer interface (BCI) technologies have demonstrated potential benefits in enhancing cognitive, social and communication skills in individuals with ASD. However, the effectiveness of BCI-based interventions in ASD rehabilitation remains inconsistent across studies. Therefore, this protocol outlines a systematic review and meta-analysis to synthesise the evidence on the effectiveness of BCI-based interventions for ASD rehabilitation.

We will conduct a comprehensive literature search across multiple databases, including MEDLINE Ovid, Embase Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), Conference Proceedings Citation Index-Science (CPCI-S), Science Citation Index Expanded (SCI-EXPANDED) and so on, to identify relevant studies published from inception to the present. The search will be supplemented by screening the reference lists of included studies and relevant systematic reviews. Two independent reviewers will screen the titles, abstracts and full texts of identified studies for eligibility based on predefined criteria. Data extraction will be performed using a standardised form, and the risk of bias (RoB) will be assessed using the Cochrane RoB tool. Heterogeneity will be evaluated using the I² statistic, and a random-effects or fixed-effects model will be selected for meta-analysis based on the degree of heterogeneity. Subgroup analyses will be conducted to explore potential sources of heterogeneity, including participant age, ASD severity, type of BCI intervention and duration of the intervention. The review will be conducted from January 2026 to April 2026.

Ethical approval is not required for this study, as it does not involve the collection of primary data from individual patients. Findings will be disseminated through peer-reviewed publication and conference presentations.

CRD420251010496.

Age-standardised incidence rates of myocarditis have been widely reported; this metric primarily provides a cross-sectional view of risk based on a fixed standard population and does not capture the effects of population ageing. Lifetime risk represents the probability of developing myocarditis over an individual’s lifespan and incorporates both demographic ageing and competing mortality, thereby offering a complementary perspective that reflects the burden experienced in real-world populations. This study aimed to estimate the global lifetime risk of myocarditis.

This was a systematic analysis using publicly available aggregated data from Global Burden of Disease Study 2021.

The study included 204 countries and territories from 1990 to 2021.

We used deidentified data from the general population to measure the lifetime risk of developing myocarditis.

The primary outcome was the estimated lifetime risk of developing myocarditis at the global, regional and national levels. Secondary outcomes included long-term trends in lifetime risk using the average annual percentage change (AAPC), variation in lifetime risk by age and sex, differences across Sociodemographic Index (SDI) levels assessed with concentration indices, and future risk estimated using an Autoregressive Integrated Moving Average (ARIMA) model.

The global lifetime risk of developing myocarditis increased from 1.33% (95% CI 1.32% to 1.33%) in 1990 to 1.50% (95% CI 1.49% to 1.50%) in 2021 (AAPC: 0.388%, 95% CI 0.314% to 0.462%). High and high-middle SDI countries had the greatest risks. In 2021, risk was higher in males (1.59%, 95% CI 1.59% to 1.60%) than in females (1.40%, 95% CI 1.39% to 1.40%). People over 40 years, especially older women, had higher lifetime risks. Forecasts based on the ARIMA model suggest that the risk will continue to rise through 2050.

From 1990 to 2021, the global lifetime risk of developing myocarditis has shown an upward trend. It is crucial to enhance early detection and diagnostic capabilities in primary care settings.

This study assessed the global burden of glaucoma using data from the Global Burden of Disease (GBD) 2021 study. The analysis of epidemiological trends aimed to inform future public health prevention strategies.

Retrospective cross-sectional study.

None.

Analysis of 1990–2021 GBD data on glaucoma prevalence, disability-adjusted life years (DALYs), age-standardised prevalence rates (ASPR), and age-standardised DALY rates (ASDR). Estimated annual percentage changes (EAPC) were calculated, Joinpoint regression identified trend changes, and Autoregressive Integrated Moving Average (ARIMA) modelling projected the burden for the year 2050.

Globally, the number of prevalent glaucoma cases increased from 4 072 106.59 (95% uncertainty interval (UI) 3 489 888.7 to 4 752 867.3) in 1990 to 7 587 672.9 (95% UI 6 522 906 to 8 917 725.4) in 2021. Concurrently, DALYs increased from 467 600.4 (95% UI 323 490.5 to 648 641.6) in 1990 to 759 900.2 (95% UI 530 942.9 to 1 049 127.2) in 2021. In contrast, the ASPR and ASDR declined to 90.1 per 100 000 population (95% UI 77.8 to 105.5) and 9.1 per 100 000 population (95% UI 6.3 to 12.5) in 2021, respectively. During the COVID-19 pandemic period (2019–2021), the slowest growth rates in crude case numbers and overall disease burden were observed, accompanied by the most pronounced decline in annual percentage change of ASPR. The highest estimates for both case counts and DALYs were identified in the 70–74 age group, with males demonstrating higher prevalence rates than females. Furthermore, regions with lower Sociodemographic Index (SDI) values bore a disproportionately higher burden of glaucoma.

These findings underscore the need to strengthen early screening and treatment of glaucoma, particularly in ageing populations, male groups and low SDI regions. We urge cautious interpretation of COVID-19 related data and vigilance against potential post-pandemic surges in burden. Critical strategies include enhanced screening and intervention for high-risk groups, targeted prevention measures and integration of ophthalmic care into public health emergency frameworks to alleviate the disease burden.

The objective of this scoping review is to map out what has been published in the scientific literature on the relationship between climate change-related events and how these overlap with associated changes in resource availability, transactional sex and HIV incidence and prevalence, within fishing communities in the Lake Victoria basin. This objective is informed by the fact that climate change and the associated natural resource strains in the Lake Victoria region have exacerbated existing inequities within fishing communities. Vulnerable populations, especially women, engage in strategies such as transactional sex to cope with the uncertainty of natural resource-dependent livelihoods. This practice greatly increases women’s risk of contracting HIV in this region, with prevalence rates four to five times the national averages. This scoping review will thus show how the existing empirical literature reports on climate change, transformation in natural resources and livelihoods, and transactional sex and HIV in the Lake Victoria region.

Studies that meet the following inclusion criteria will be included: align with at least two of the major concepts of interest, including climate change, transactional sex, HIV/AIDS, Lake Victoria Basin and/or empirical studies; are published in English and after 2012; and focus on the Lake Victoria basin. The scoping review will be guided by the JBI Manual for Evidence Synthesis: Scoping Reviews, supported by the standard principles of Arksey and O’Malley. The specific search strategies to be implemented were developed with guidance from an experienced research librarian to align with the inclusion criteria. The search will be conducted in relevant global databases, with two reviewers screening the results and extracting relevant data points. Finally, results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews flow diagram, and summarised in figures, tables and text.

The scoping review is designed to comprehensively scope the existing literature and document the coverage of linkages between transactional sex, HIV/AIDS and sustainable livelihoods in the context of climate change with a view to informing health systems responses to human health specific to the HIV epidemic.

The proposed scoping review is registered with the Open Science Foundation (OSF), registration number:https://doi.org/10.17605/OSF.IO/9DTW4.

To explore the chain-mediating role of academic buoyancy and academic burnout between self-directed learning ability (SDLA) and learning engagement in undergraduate nursing students.

A cross-sectional survey.

This study was conducted in December 2024, involving 239 nursing undergraduates from a university in Daqing city, Heilongjiang province.

Independent samples t-tests and analysis of variance were employed to examine the relationships between undergraduate nursing students’ characteristics and learning engagement. Pearson correlation analysis was used to analyse the correlations among the variables. Based on self-determination theory, the chain-mediating effects of academic buoyancy and academic burnout between self-directed learning ability and learning engagement were tested using Model 6 of the SPSS PROCESS macro (V.3.5), with bootstrap samples set to 5000.

A total of 239 undergraduate nursing students were included in the analysis, of whom 84.94% were female. The sample comprised students from all academic years, including first-year (27.62%), second-year (33.47%), third-year (17.57%) and final-year students (21.34%). Most participants selected nursing as a voluntary major choice (62.34%), and 43.51% were from urban areas. The 239 undergraduate nursing students scored 72.26±10.26 on SDLA, 14.90±2.64 on academic buoyancy, 53.75±9.33 on academic burnout and 50.81±7.64 on learning engagement. SDLA and academic buoyancy were positively correlated with learning engagement (all p

SDLA is associated with higher learning engagement among nursing students through academic buoyancy and reduced academic burnout. These findings highlight the importance of developing SDLA and clarify the mediating roles of academic buoyancy and burnout in this relationship, providing valuable insights for enhancing learning engagement in nursing education.

This scoping review addresses the underexplored issue of abuse of people with mental illnesses by healthcare professionals. We mapped the existing literature to establish the nature, prevalence, contributing factors and experiences of this abuse.

Scoping review based on the Joanna Briggs Institute framework.

We searched MEDLINE, CINAHL Complete, PsycINFO, ProQuest, Web of Science, Cochrane Central Register of Controlled Trials and Ichushi-Web during the period from 3 July to 22 August 2024. Eligible studies reported abuse of people with mental illnesses by healthcare professionals, with no restrictions on year or language.

Two reviewers independently extracted data from the selected articles. The data were synthesised to examine prevalence, associated factors and experiences of people with mental illnesses.

Of 5793 records, 61 met the inclusion criteria, with 32 from the USA and Japan (16 from each). Abuse types reported across 17 countries included physical, psychological, sexual and economic abuse, neglect and human rights violations. Histories of physical and sexual abuse were frequently reported as possible contributing factors to further abuse. Recommendations for prevention were identified at multiple levels, including individual care, organisational and institutional systems, and broader policy and society.

This review mapped the literature on abuse by healthcare professionals in mental health services and identified critical research gaps, including a lack of methodologically robust studies. Further research is needed to build an evidence base for prevention strategies and to establish institutional safeguards.

To summarise the symptom clusters (SCs), assessment tools and their evolution at different stages of postsurgical chemotherapy in oesophageal cancer patients, providing reference for future research design and precise symptom management.

A systematic search and literature review were conducted according to the Joanna Briggs Institute Scoping Review Methodology framework and PRISMA extension for scoping reviews (PRISMA-ScR) guidelines.

Databases searched include PubMed, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science, Embase, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wanfang, VIP Chinese Journal and China Biomedical Literature Database. The search covered the period from database inception to 30 November 2024, and references were traced backward.

Patients aged ≥18 years with postsurgical oesophageal cancer undergoing adjuvant chemotherapy; studies focusing on SCs before, during or after chemotherapy; original quantitative research; published in Chinese or English. Exclusion criteria included neoadjuvant or palliative chemotherapy, reviews, conference abstracts and inaccessible full-text articles.

Two independent reviewers screened, extracted and cross-checked the data. Content analysis was employed to summarise the SCs, assessment tools and phase-related changes.

A total of 11 studies were included (8 in Chinese, 3 in English). Twelve SCs were identified, with gastrointestinal-related, eating-related and physical function-related clusters being the most common. Eleven assessment tools were used, with MD Anderson Symptom Inventory-Gastrointestinal Cancer Module and its Chinese version being the most frequently applied. Difficulty eating was the most prominent SC before chemotherapy, gastrointestinal symptoms were the most severe during chemotherapy and psychological-physical symptoms dominated in the postchemotherapy phase.

The composition of SCs in oesophageal cancer chemotherapy evolves dynamically across different stages. However, the existing evidence is mainly derived from small sample cross-sectional studies, with high heterogeneity in tools and methods. Standardised assessment criteria and longitudinal validation are needed to develop stage-specific, evidence-based interventions that can be widely applied.

The implantable cardioverter defibrillator (ICD) is a cardiac device recommended for use to prevent the occurrence of sudden cardiac death (SCD) in post-myocardial infarction (MI) patients with reduced left ventricular ejection fraction (LVEF). The evidence informing this guidance comes from landmark trials that are now more than 20 years old. The risk-benefit profile of ICD for the contemporary target population may have changed substantially since then, which raises the question of whether there is evidence for sparing patients a procedure associated with potentially severe complications and high healthcare costs. A main part of the PRevention Of sudden cardiac death aFter myocardial Infarction by Defibrillator implantation (PROFID) project is the PROFID EHRA trial, which is supported by the European Heart Rhythm Association. PROFID EHRA is a European Union-funded, prospective, randomised, multi-centre, non-inferiority study designed to compare optimal medical therapy (OMT) alone to ICD with OMT, for post-MI patients with reduced LVEF. The study also describes economic evaluation methods to quantify the cost and health implications of using OMT alone in place of ICD implantation plus OMT in this group of patients.

The economic evaluation has been designed to conduct a pre-trial cost-effectiveness analysis (CEA) prior to the availability of trial data, followed by a within-trial cost-consequences analysis (CCA) and a long-term post-trial CEA, conducted from the National Health Service and Personal Social Service perspective in England. The pre-trial CEA uses simulation modelling informed by available evidence to assess the lifetime costs and quality-adjusted life years of OMT alone and ICD+OMT in post-MI patients with reduced LVEF at risk of SCD, as defined in the PROFID EHRA trial. The within-trial CCA is intended to summarise the health-related quality of life (HRQoL), healthcare resource use and associated costs observed during the PROFID EHRA trial follow-up period. The post-trial CEA updates the pre-trial model by incorporating contemporary evidence about the HRQoL and costs observed during the trial and the occurrence of those events and outcomes accruing during the trial follow-up period and projecting them into the expected lifetime of the patients. Sensitivity analyses are performed to assess the robustness of the CEA results with respect to both model assumptions and uncertainty in the value of the model input parameters. Finally, a value of information analysis will identify the key drivers of uncertainty surrounding the model conclusions regarding the optimal treatment strategy, establishing if further research may be required.

The PROFID EHRA trial, under legal sponsorship of Charité—Universitätsmedizin Berlin, Germany, received its first ethics approval by the Medicine Research Ethics Committee of the La Paz University Hospital in Madrid, Spain (reference number LHS-2019-0209). Before including patients, for all participating study centres, the required local, central and/or national ethical approval has to be obtained. As of the date 13 November 2025, at least one participating study centre in the following countries has received ethical approvals from relevant ethics committees: Austria, Belgium, Czech Republic, Denmark, France, Germany, Great Britain, Hungary, Israel, the Netherlands, Poland and Spain. Results will be shared with the general public through various media channels and additionally with healthcare professionals and the scientific community through scientific meetings, conferences and publications.

NCT05665608.

Human papillomavirus (HPV) vaccines have been introduced in the Chinese market since 2016. However, the HPV vaccine coverage is still remarkably low among adolescent girls in China. This study will employ discrete choice experiments (DCEs) to elicit the preferences of Chinese caregivers for HPV vaccine-related profile characteristics and service delivery methods for adolescent girls.

Two DCEs will be conducted with caregivers of girls aged 9–18 in China. The first DCE will focus on caregivers’ preferences regarding the HPV vaccine-related profile for girls aged 9–18, with potential attributes including level of protection against cervical cancer, level of protection against genital warts, risk of severe side effects, number of dose(s), place of manufacture, waiting time and cost for one dose. The second DCE will assess Chinese caregivers’ preferences for vaccination service delivery methods, with the potential attributes including source of recommendation, information channel, message framing, how to make an appointment, location for receiving the vaccine and incentives. A total of 300 participants will be recruited to complete the DCEs. We will summarise the key socio-demographic characteristics of participants and use latent class and mixed logit models to assess preferences and preference heterogeneity in HPV vaccination services.

Ethical approval was obtained from the Research and Ethics Committee at Nanjing Medical University. Findings from this study will be disseminated widely to relevant stakeholders via scheduled meetings, webinars, presentations at conferences and in peer-reviewed journal manuscripts.

This study aims to describe the characteristics of hospitalised COVID-19 patients in a tertiary care hospital close to an international airport in Japan and to compare these characteristics among different waves during the pandemic.

Retrospective observational study.

Tertiary care centre in Japan.

All patients diagnosed with COVID-19 who were hospitalised between January 2020 and April 2022 were included.

Clinical characteristics, characteristics of admission, treatments and outcomes were investigated and compared among six pandemic waves.

A total of 827 patients were included. The median age was 58.0 years. More than half of the patients (58.3%) had at least one comorbidity. The majority of patients (89.0%) were domestically infected patients admitted under the Infectious Diseases Law, while the remaining patients (11.0%) were those diagnosed during airport quarantine and admitted under the Quarantine Act. Hospital-acquired COVID-19 infection occurred in 7.0% of cases, and mainly during the sixth wave. Overall, some form of oxygen therapy, high-flow oxygen devices, invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation was provided in 46.3%, 10.4%, 4.5% and 1.5% of cases, respectively. Only 1.8% of patients were treated in the intensive care unit (ICU), and 59.5% of patients on IMV were managed in the non-ICU ward. The in-hospital mortality rate was 5.8%. Median age, percentages of some comorbidities, vaccination coverage, medications for COVID-19, types of supportive care and ICU admissions differed significantly among waves.

This study suggests that patient characteristics, vaccination coverage, standard of treatment and severity of illness changed across waves during the COVID-19 pandemic. Intensive care delivery in non-ICU wards was unavoidable due to limited ICU capacity, which may be a key consideration when preparing for future pandemics.

The Chinese neuroimmunological disease database (NIDBase) cohort was established to explore genetic and environmental risk factors, clinical features, multi-omics data and prognostic biomarkers. The aim is to enhance our understanding of central nervous system (CNS) demyelinating diseases. Additionally, the establishment of this cohort will address the critical issue of the lack of comprehensive genetic data and biological samples for precision diagnosis and treatment research related to neuroimmunological diseases in China.

56 hospitals in various regions of China were selected to participate in this study. The patients diagnosed with CNS demyelinating diseases were recruited, including clinically isolated syndrome (CIS), multiple sclerosis (MS), neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A).

At the time of patient enrolment, the clinical information is designated as baseline data. The collected baseline data include demographic information, disease history, clinical features of each demyelinating event, treatment records, standardised scales, questionnaire assessments and laboratory test results. Furthermore, biological samples, MRI and high-density electroencephalography (hd-EEG) data will be collected at baseline. All patients will be followed up at 3 months and 6 months and annually thereafter. As of December 2024, 3866 patients with CNS demyelinating diseases have been enrolled, including 84 CIS, 282 MOGAD, 1405 MS and 2095 NMOSD. Our findings indicate that CNS demyelinating diseases, particularly NMOSD, are more prevalent in women in China, with significant age differences observed among NMOSD patients compared with those with CIS, MS and MOGAD.

In future, all patients in our cohort will be followed up at 3 months and 6 months and then annually. By the end of December 2024, the database has been locked and is now being processed and analysed, while our data continue to be updated and expanded for further analysis. Both prospective and retrospective observations will be included in this study. Subsequent publications will emerge from this multicentre cohort, encompassing genomics, clinical cohort studies, hd-EEG biomarkers, imaging-based radiomics and electrical stimulation therapies.

NCT06443333.

Chemotherapy is the standard second-line treatment option for advanced biliary tract cancer (BTC), but its therapeutic efficacy is suboptimal. Disitamab vedotin (RC48) and lenvatinib have demonstrated promising efficacy in human epidermal growth factor receptor 2 (HER2)-positive BTC and other malignancies. In this study, we aim to evaluate the efficacy and safety of RC48 in combination with lenvatinib in second-line or above treatment for HER2-positive advanced BTC.

This is a single-centre, single-arm, open-label, exploratory phase II clinical study in patients with HER2-positive unresectable locally advanced or metastatic BTC who have failed prior therapy. 31 patients will be enrolled in this study to receive the combination of RC48 and lenvatinib. The primary study endpoint is objective response rate, and the secondary study endpoints are disease control rate, duration of response, progression-free survival and overall survival.

The study has received approval from the Medical Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (approval No. (2023)0367-01). Results will be disseminated through publication in peer-reviewed journals and through other appropriate media channels.

ChiCTR2300076406.