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The aim of this study is to explore whether subjective cognitive decline and frailty were related to each other and whether nutrition mediated their association.
From January 2025 to May 2025, a total of 194 middle-aged and elderly MHD patients were selected by convenience sampling method. Cross-sectional data on patients' subjective cognitive decline, nutrition, and frailty were collected using questionnaires. Data were analysed using SPSS 27.0 and PROCESS macros.
The frailty score of middle-aged and elderly MHD patients was 4.00 (range 3.00 to 9.00), and 69 (35.57%) were identified as frailty. Spearman correlation analysis showed that subjective cognitive decline (SCD) was positively correlated with frailty. Nutrition was positively associated with SCD and frailty. When controlling for covariates, nutrition was observed to mediate a relationship between SCD and frailty. The intermediate effect value accounted for 31.29% of the total effect.
Nutrition plays a partial mediating role in the relationship between SCD and frailty in middle-aged and elderly MHD patients in this cross-sectional study with a one-way correlational model. The negative effects of SCD on frailty can be mitigated by improving nutritional status. Considering the bidirectional interaction among SCD, nutrition and frailty, this mediating pathway needs to be further verified by longitudinal studies.
Our findings indicate that nutrition plays a mediating role in the association between SCD and frailty. Routine screening for SCD and nutritional status could be considered in clinical practice to detect those at elevated risk of frailty at an early stage. Targeted nutritional and cognitive interventions may help alleviate frailty progression, reduce adverse clinical outcomes, and enhance self-management ability and quality of life, thus supporting the establishment of comprehensive strategies for frailty prevention and management in haemodialysis settings.
This article follows the STROBE guidelines for the reporting of cross-sectional studies.
No patient or public contribution.
by Fangqing Liu
BackgroundTranscutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique that activates vagal afferents projecting to prefrontal–limbic circuits implicated in attention, memory, and emotion regulation. Preliminary studies suggest that taVNS may enhance cognitive performance; however, the evidence remains fragmented across domains and populations.
ObjectivesThis systematic review and meta-analysis aim to (1) quantify the overall effects of taVNS on cognitive functions, (2) examine its efficacy across clinical and non-clinical populations, and (3) identify moderators influencing variability in outcomes, including stimulation parameters, participant characteristics, and study design features.
MethodsFollowing PRISMA-P guidelines, this protocol will be prospectively registered with PROSPERO. Six databases (PubMed, EMBASE, PsycINFO, Web of Science, CENTRAL, and Scopus) and major trial registries will be systematically searched. Eligible studies include randomised controlled trials assessing validated cognitive outcomes following taVNS compared with sham or active controls. Effect sizes will be calculated as Hedges’ g and pooled using random-effects models. Heterogeneity will be evaluated with I² and τ statistics; moderator and meta-regression analyses will explore dose–response and population effects. Risk of bias will be assessed with RoB 2 for randomised trials and ROBINS-I for non-randomised studies, and the certainty of evidence will be rated using GRADE separately by study design.
Expected Results and ConclusionsThis review will provide the first quantitative meta-analytic synthesis of taVNS-induced cognitive modulation across executive, attentional, affective, and learning domains in both clinical and healthy populations, complementing recent narrative syntheses by offering pooled effect size estimates, formal heterogeneity assessment, and a GRADE-rated evidence hierarchy. By delineating domain-specific efficacy and optimal stimulation parameters, the findings aim to inform future clinical applications and the development of standardized neuromodulation protocols.
Despite the rapid increase in the proportion of unmarried women in the Chinese population, little is known about their sexual and reproductive health (SRH) and well-being. The aim of this survey is to collect data on SRH knowledge and needs, past care-seeking experiences, fertility goals and attitudes towards fertility technology among unmarried women in four megacities in China where singlehood is prominent among women of reproductive age.
This multi-centre cross-sectional survey, Survey of Unmarried women on Reproductive health and Fertility (SURF), aims to recruit 6000 eligible women, with 1500 from each study site. Eligibility criteria include: (1) women; (2) aged 25–40 years; (3) currently unmarried (never married, divorced or widowed); and (4) reside in Beijing, Shanghai, Shenzhen or Guangzhou metropolitan areas. Quota sampling is used to ensure the age strata in the final sample correspond to the age distribution from the latest Chinese census. Data are currently being collected through referral recruitment and a self-administered questionnaire available on the mobile devices and computers of participants.
SURF has been approved by the Biomedical Ethics Committee of Peking University (institutional review board (IRB) number: IRB00001052-24040). Each participant receives comprehensive information about the objectives, procedure and data handling of the survey before proceeding to the questionnaire. Participants are also provided with the contact information of the principal investigator in case they have questions regarding the survey. Written informed consent is obtained before data collection starts. Participation is anonymous and no personal identifiers are collected. Findings from this survey will be disseminated through peer-reviewed journals and at scientific conferences.
To assess whether a simple echocardiographic grading system reflecting the severity and stage of myocardial injury can stratify long-term mortality risk among patients with first-time ST-segment elevation myocardial infarction (STEMI).
Multicentre prospective registry-based cohort study.
Eight hospitals in China.
Consecutive patients with first-time STEMI between June 2016 and June 2024 who survived to hospital discharge and underwent echocardiography were included. A total of 2708 patients were enrolled and followed up for a median of 5.5 years (IQR: 5.3–6.4).
The primary outcome was long-term all-cause mortality.
Patients were stratified into four grades: 1392 (51.4%) were classified as Grade 1; 905 (33.4%) as Grade 2; 350 (12.9%) as Grade 3; and 61 (2.3%) as Grade 4. During follow-up, long-term all-cause mortality increased stepwise across increasing echocardiographic grades. In multivariable Cox regression analysis, the baseline grading remained an independent predictor of long-term mortality after adjustment (adjusted HR for Grade 4 vs Grade 1: 3.35, 95% CI 1.34 to 8.38, p
Patient grade from the echocardiographic grading system was associated with long-term mortality after first-time STEMI, with the highest risk observed in patients classified as Grade 4. As a simple and objective classification, this grading system may provide a practical way to describe and communicate infarct severity among clinicians and others involved in patient care, as the term ‘myocardial infarction’ alone may inadequately reflect disease severity.
Obesity is a global chronic metabolic disorder associated with significant comorbidities and healthcare burdens. Nutrient-stimulated hormone (NuSH)-based therapies have markedly advanced the pharmacological treatment for obesity. However, heterogeneity in treatment responses, high discontinuation rates, post-cessation weight regain and concerns regarding long-term safety still remain unresolved. To address these challenges, we initiated the Hongkou Advanced Research on Metabolism and Obesity iNtervention studY (HARMONY), a real-world, prospective observational cohort designed to comprehensively monitor the metabolic responses and clinical outcomes of adults with overweight or obesity undergoing various weight management interventions, with particular attention to the application of NuSH therapy.
The HARMONY study is a prospective, observational cohort study to be conducted at Shanghai Fourth People’s Hospital, Hongkou district, Shanghai, China. The study will enrol approximately 1500 overweight and obese participants over a 5-year period. Data collection will occur at baseline, week 4, week 12, week 24 and annually thereafter, including anthropometric measures, clinical evaluations, metabolic assessments and treatment outcomes. The primary endpoint is the percentage change in body weight at week 12 and week 24, while secondary endpoints include glucose metabolism, lipid profiles, liver and intrapancreatic fat deposition and safety outcomes such as adverse events. The cohort will be followed longitudinally to assess the long-term impact of weight management interventions.
Ethical approval for the study has been granted by the Medical Ethics Committee of Shanghai Fourth People’s Hospital (No. 2025036–001). Study findings will be disseminated through peer-reviewed publications and academic conferences, with reporting in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
ChiCTR2500113384.
by Yuzhong Feng, Jiazhen Cui, Xuan Huang, Yupeng Li, Haolong Dong, Xianghua Xiong, Gang Liu, Qingyang Wang, Huipeng Chen
Uricase-based drugs excel at treating refractory hyperuricemia and tumor lysis syndrome by directly degrading uric acid but are limited by immunogenicity. Here, we engineered RAW264.7 macrophages with ectopic co-expression of Aspergillus flavus uricase and murine urate anion transporter 1 (URAT1), forming a “transport-degradation” system: URAT1 actively transports uric acid into cells for intracellular degradation. Recombinant lentiviral vectors carrying target genes were transfected into RAW264.7 cells, followed by puromycin screening. In vitro assays showed that the engineered macrophages nearly completely degraded uric acid (from 556.0 ± 37.0 μmol/L to 0.7 ± 0.6 μmol/L) at 72 h. URAT1 inhibition with benzbromarone abolished uric acid degradation in URAT1-expressing cells. In both acute dietary-induced and chronic genetic hyperuricemic mouse models, RAW-afUri-URAT1 exerted robust and sustained uric acid-lowering activity, maintaining serum uric acid at 77.14 ± 37.48 μmol/L on day 16 in yeast extract gavaged mice and normalizing serum uric acid to 76.2 ± 15.9 μmol/L in liver uricase conditional knockout mice, both significantly superior to the rebound levels observed in mice treated with Rasburicase (143.19 ± 38.21 μmol/L and 142.4 ± 17.4 μmol/L, respectively; P
by Yuzhen Sun, Ziguang Zhou, Yu Mao, Niu Liu, Yanfeng Li, Weiyuan Fang
BackgroundPsoriasis, a chronic inflammatory skin disease affecting 2–3% of the global population, is driven by dysregulated immune responses. Despite advancements in biologic therapies, treatment challenges persist due to high recurrence rates. This study aimed to identify immune-related hub genes and elucidate their clinical implications in psoriasis pathogenesis and therapy.
MethodsMultiple microarray datasets from psoriasis patients (GSE30999, GSE106992, GSE14905, GSE78097, and GSE117468) were obtained to identify immune-key genes by differential gene analysis and Weighted Gene Co-expression Network Analysis (WGCNA). Subsequently, immune-related hub genes were identified using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and Protein-Protein Interaction (PPI) networks, with further validation through Gene Set Enrichment Analysis (GSEA) and Receiver Operating Characteristic (ROC) curves to assess exploratory within-sample discrimination. Pearson correlation analysis evaluated the relationship between hub genes, skin lesion severity, and treatment outcomes. The study also conducted immune infiltration by using the Cell-type Identification by Estimating Relative Subsets Of RNA Transcripts (CIBERSORT) algorithm and identified potential therapeutic targets by the Drug-Gene Interaction Database (DGIdb).
ResultsThirty-one immune-related key genes were identified, and six hub genes (CLEC7A, CXCL1, IRF1, S100A12, S100A8, S100A9) were validated as central players in immune signaling pathways. These genes exhibited within-sample discrimination (AUC > 0.9) and correlated with disease severity and biological therapy efficacy. Immune infiltration analysis revealed increased activated memory CD4+ T cells and M1 macrophages in lesional skin, which was strongly associated with hub gene expression. Additionally, drug-gene interaction analysis identified potential therapeutic agents targeting these genes.
ConclusionThis study identified six immune-related hub genes that were closely linked to the severity of psoriasis, the effectiveness of biological treatments, and infiltrated activated memory CD4+ T cells and M1 macrophages. Our findings elucidate a novel immune-related hub gene network in psoriasis and provide potential targets for the development and application of biologics.
To examine the risk of severe cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD) across different time periods following COPD exacerbations and the incidence rate of cardiopulmonary events in a real-world setting in China.
Retrospective cohort study.
Regional electronic health records database from Yinzhou District of Ningbo City, China.
A total of 14 713 patients aged ≥40 years with a first COPD diagnosis between 1 January 2014 and 1 March 2022.
The risk of severe CV events (ie, hospitalisation and a primary or secondary discharge code for acute coronary syndrome, heart failure decompensation, cerebral ischaemia, arrhythmia and CV-related death) during different exposed time periods following a COPD exacerbation, the incidence rate of overall cardiopulmonary events (ie, severe exacerbation of COPD, all-cause mortality, inpatient CV events, inpatient ischaemic stroke and inpatient tachyarrhythmia/atrial fibrillation) and the incidence rate stratified by COPD exacerbation history.
We included a total of 14 713 patients. During a median (IQR) follow-up of 2.8 (4.0) years, 20.1% experienced severe CV events. Compared with the unexposed period, the risk of severe CV events was the highest in the first 10 days following a COPD exacerbation (adjusted HR 10.00, 95% CI 8.16 to 12.25). The risk of severe CV events decreased over time but remained significantly elevated up to 90 days post exacerbation. We found that 32.7% of COPD patients experienced cardiopulmonary events, with a crude incidence rate of 9.38 (95% CI 9.09 to 9.69) per 100 person-years.
This study is the largest retrospective cohort study investigating CV and cardiopulmonary events among patients with COPD in China. Our findings highlight an elevated risk of CV events closer to the time of COPD exacerbations and show that nearly one-third of COPD patients experience cardiopulmonary events.
Domestic sex trafficking is a major health and human rights concern associated with profound social, physical and psychological harms, including complex trauma. People who are being/have been sex trafficked often present to emergency departments (EDs) with unmet health needs and in contexts shaped by coercion, control and fear of authority. ED encounters represent an important setting for identifying sex trafficking, building trust, making referrals to specialised resources and facilitating an exit out of sex trafficking. This scoping review will explore the care experiences and processes for sex trafficked persons in EDs by synthesising existing evidence on the barriers and facilitators to providing high quality, equitable and effective emergency care. This review represents the first phase of a multi-stage study to develop quality indicators (QIs) for ED clinicians providing care for people experiencing domestic sex trafficking in Canada.
This scoping review will follow Arksey and O’Malley’s framework, as updated by Levac and colleagues, which consists of: (1) identifying a research question(s); (2) identifying relevant literature; (3) selecting studies; (4) charting/extracting data; (5) collating, summarising and reporting results; and (6) consulting with community partners. Five databases will be systematically searched to find scholarly, empirical studies describing emergency care experiences and processes for people being sex trafficked. Data will be extracted using a standardised charting tool developed by the lead author and research team.
Research Ethics Board (REB) approval is not required for this study as it involves an analysis of published literature only. Findings will be synthesised into a set of candidate QIs to be disseminated.
Parenting concerns, stemming from cancer's projected impact on children, are a common and significant source of emotional distress for parents. A quantitative synthesis of existing data is critically absent, and the role of modulating factors (e.g., male sex, single parenthood, and the number of children) remains unclear.
This meta-analysis aims to quantify the association between parenting concerns and emotional distress in cancer patients, examining male sex, single parenthood, and number of children as key moderators.
This systematic review and meta-analysis followed PRISMA guidelines. Searches (PubMed, Embase, PsycINFO, Airiti Library; inception-November 2025) identified observational studies of adult cancer patients with minor children. Data on parenting concerns, anxiety, and depression were extracted and appraised using a modified JBI Checklist. Correlations were synthesized. Meta-regression addressed the quantitative void, examining male sex, single parenthood, and number of children as key moderators. Publication bias and sensitivity were assessed.
We included 12 studies (N = 3895). Our meta-analysis found significant positive associations (r = 0.50, p < 0.001) between parenting concerns and both anxiety and depression. Meta-regression, controlling for time since diagnosis, identified male sex, single parenthood, and fewer children as significant moderators for anxiety (p < 0.001), with similar trends for depression.
This meta-analysis highlights parenting concerns linked to distress in cancer patients, with fathers, single parents, and those with fewer children particularly vulnerable. Routine assessment and tailored, family-centered psychosocial interventions are urgently needed.
This systematic review was registered with the International Prospective Register of Systematic Reviews and Meta-analysis (PROSPERO; Registration No. CRD42024592899).
Accelerated population aging has driven substantial growth in demand for palliative care services. Such services can effectively enhance the living quality for end-of-life patients through multidimensional interventions. Currently, China lacks a localised experience-oriented quality assessment scale for palliative care, resulting in gaps in service quality supervision. To develop a self-reported measurement for palliative care services, with the foundation in the Senses Framework.
This study developed a scale by extracting core contributors of palliative care experiences through 14 patients and 16 families' narratives. To refine and improve the scale, a total of 19 experts were invited to participate in a two-round Delphi expert consultation. Additionally, an empirical research was conducted, with 380 valid samples from two independent cohorts collected to complete the full psychometric testing of the scale.
The final Palliative Care Experience Scale (PCES) comprises two dimensions: sense of security and belonging, and sense of purpose and significance, with a total of 13 items. The total variance includes 79.26% that is explained by these two factors. Confirmatory factor analysis confirmed a stable factor structure for the PCES. The scale exhibited good reliability, with a total Cronbach' α of 0.937, McDonald' ω of 0.952, and Spearman-Brown corrected split-half reliability of 0.897. Cronbach's α for both dimensions exceeded 0.88. The scale's SEM was 1.50 and MDC95 was 4.16, offering a validated threshold to identify real changes in patients' palliative care experience.
This study developed an assessment scale of palliative care quality based on the Senses Framework, uniquely centred on patient experiences. Validated through robust methodologies, this scale fills a gap in the evaluation of experiential dimensions of palliative care in China, providing a scientific and feasible measurement tool for the continuous improvement of services.
This study addresses the critical gap of a culturally adapted, patient experience-centred tool for evaluating palliative care service quality in China. Its core finding is the successful development and full psychometric validation of the 13-item Palliative Care Experience Scale (PCES). This research provides a reliable tool for palliative care clinical practice and academic research to capture patients' care experience, offers clinicians and administrators a practical instrument to identify service gaps and guide quality improvement, and delivers foundational reference data for policymakers to advance patient-centred palliative care development in China.
We adhered to the relevant EQUATOR reporting guidelines. The development and validation process followed the COSMIN framework for patient-reported outcome measures.
Patients receiving palliative care and familes played an integral role in designing and conducting this study. In Phase I, qualitative data from semi-structured interviews with 14 patients and 16 families helped define core thematic constructs and develop the initial item pool, which ensured the scale's content validity were based on their real-life experiences. In Phase III, we recruited a new, independent cohort of participants to complete the psychometric testing of the scale, providing key data for its validation.
by Hongtao Li, Li Xu, Longxin An, Xiaojing Li, Linjing Zhang, Jun Liu, Kaili Zhai, Xuecheng Sun, Naibo Feng
PurposeTo evaluate whether posterior column screws penetrate the posterior cortical surface of the acetabulum when assessed using obturator oblique radiographic imaging.
MethodsComputed tomography (CT) scans were performed on the right acetabulum of 50 healthy adults to measure the angle (α) between the posterior wall of the acetabulum and the sagittal plane at the level of the femoral head’s maximal diameter. In addition, five cadaveric pelvises were subjected to C-arm fluoroscopic imaging. A 6 cm long, 1.5 mm Kirschner wire was positioned along the posterior surface of the acetabular posterior column, aligned with the greater sciatic notch, and imaged in both the 45° and α-degree obturator oblique views. The radiographic line visualized from the Kirschner wire in the obturator oblique view was defined as the posterior iliac line, and its anatomical relationship with the posterior surface of the posterior column was analyzed. Subsequently, a 2.5 mm Kirschner wire was inserted into the posterior column at the standard entry point for screw placement using an electric drill, with the wire tip intentionally positioned between the posterior iliac line and the posterior rim in the 45° obturator oblique view. The trajectory of the wire was assessed under both 45° and α-degree obturator oblique views to determine its relation to the osseous corridor.
ResultsThe measured angle between the posterior surface of the acetabular posterior column and the sagittal plane was (60.2 ± 2.5)°. In the 45° obturator oblique view, the posterior iliac line corresponded with the outer edge of the iliac crest superiorly and the outer edge of the ischium inferiorly, while the posterior wall was projected posterior to the midpoint of the posterior iliac line. In the α° obturator oblique view, the posterior iliac line maintained this alignment but intersected centrally with the posterior acetabular wall. The 2.5 mm Kirschner wire remained within the osseous corridor under the 45° view but potentially extended beyond it under the α° view.
ConclusionWhen the posterior column screw is visualized posterior to the posterior iliac line in the 45° obturator oblique view, further assessment using a α° view is necessary. If the screw appears anterior to the posterior iliac line in the α° view, it indicates that the posterior cortical surface has not been breached.
Cardiac resynchronisation therapy (CRT) is a cornerstone device-based treatment for patients with heart failure with ventricular dyssynchrony. However, approximately 30–40% of recipients fail to achieve clinical response. Despite extensive research, validated prediction tools grounded in high-level evidence and readily applicable in clinical practice remain lacking. This study protocol describes the development and real-world validation of a simplified clinical scoring model for CRT response derived from systematic review and meta-analysis.
This study will develop a CRT response prediction model via meta-analysis and preliminarily validates it in a single-centre retrospective cohort. Initially, systematic searches of multiple databases up to 31 January 2026 and meta-analysis will synthesise effect estimates for candidate predictors, creating an evidence-based foundation that conceptually functions as a ‘training dataset’. Predictor selection and prioritisation will be guided by study frequency, effect magnitude and clinical accessibility, with factor weights derived directly from pooled random-effects meta-analytic estimates. Log relative risks will be converted to integer scores to establish a series of nested prediction models. Model performance will then be comprehensively assessed in an independent ‘validation dataset’ comprising a single-centre cohort from Xinjiang Medical University, evaluating discrimination (area under the receiver operating characteristic curve), calibration (calibration plots and Hosmer-Lemeshow test) and clinical utility (decision curve analysis). The final scoring system will be identified through comparative model evaluation guided by parsimony principles.
This meta-analysis exclusively uses published, de-identified data and therefore does not require ethical approval. The validation cohort employs retrospectively anonymised patient data in strict adherence to the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the Institutional Review Board of the First Affiliated Hospital of Xinjiang Medical University (Approval No.: K202403-48-2503A-Y1). As this constitutes a retrospective analysis of existing data, individual informed consent will be waived. Comprehensive measures to protect participant privacy and ensure data integrity will be implemented throughout all research procedures. The findings will be presented at academic gatherings or published in scholarly, peer-reviewed journals.
CRD42024572313
Mucosal melanoma (MM) carries a high risk of postoperative relapse and poorer survival than cutaneous disease. Prospective data from China support adjuvant temozolomide–cisplatin (TMZ/DDP) in resected MM, while radiotherapy (RT) may augment antitumour immunity and synergise with programmed death 1 (PD-1) inhibitor. We therefore designed an adjuvant regimen combining short-course RT (SCRT) with chemotherapy and PD-1 inhibitor after curative-intent resection.
This investigator-initiated, single-arm, prospective, phase II study at Fudan University Shanghai Cancer Centre enrols adults (≥18 years) with histologically confirmed MM after R0/R1 resection, Eastern Cooperative Oncology Group (ECOG) performance status 0–1 and M0 disease. Patients receive six 3-week cycles of systemic therapy: pucotenlimab 200 mg IV on day 1; TMZ 200 mg/m² orally on days 1–5 and DDP 25 mg/m² IV on days 1–3. (SCRT; 25 Gy in five fractions) is delivered after the first two cycles of systemic therapy, followed by four additional cycles of systemic therapy without RT. The primary endpoint is 1-year recurrence-free survival (RFS). Secondary endpoints include locoregional RFS, distant metastasis-free survival, overall survival and safety (CTCAE V.5.0). The planned sample size is 47 (44 evaluable), providing 80% power (one-sided α of 0.10) to detect an improvement in 1-year RFS from 55% to 70%. Time-to-event endpoints will be estimated using Kaplan–Meier methods with 95% CIs.
The protocol was approved by the Ethics Committee of Fudan University Shanghai Cancer Centre (approval number: 2407300-5), and all participants will provide written informed consent. Findings will be disseminated in peer-reviewed journals and at scientific conferences.
ChiCTR2400093001.
Haemorrhoidal disease affects 25–40% of adults worldwide and constitutes a primary reason for outpatient colorectal consultations. Surgical management is essential for grade III–IV or treatment-refractory cases. Numerous procedures have emerged, including Milligan-Morgan open haemorrhoidectomy, Ferguson closed haemorrhoidectomy, stapled haemorrhoidopexy, Doppler-guided haemorrhoidal artery ligation, transanal haemorrhoidal dearterialisation and laser haemorrhoidoplasty. However, randomised controlled trials and conventional meta-analyses report conflicting results on efficacy, postoperative pain, recurrence rates and complications such as bleeding, stenosis and incontinence. Although network meta-analyses exist, an updated synthesis is needed because outcomes and follow-up vary across trials. This protocol aims to determine the most effective and safest haemorrhoid interventions (office-based and operative) through systematic review and network meta-analysis, providing evidence-based guidance for clinical practice and guideline development.
The Cochrane Library, Web of Science, MEDLINE, Embase, China National Knowledge Infrastructure, VIP, SinoMed and Wanfang databases will be searched from inception to January 2025, limited to English or Chinese publications. Randomised controlled trials evaluating haemorrhoid interventions/procedures for haemorrhoidal disease will be included, with outcomes encompassing cure rate, recurrence, complications, postoperative pain, wound-healing time, anal function and operative duration. Risk of bias will be assessed using RoB 2. Pairwise meta-analyses will be conducted in RevMan; network meta-analysis will employ Bayesian frameworks in GeMTC or R, incorporating consistency evaluation, node-splitting and surface under the cumulative ranking curve for treatment ranking. Subgroup analyses (haemorrhoid grade, follow-up duration), sensitivity analyses and publication bias assessments will be performed. Evidence certainty will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Confidence in Network Meta-Analysis (CINeMA) framework.
As only published data will be used, ethical approval is not required. Results will be disseminated via peer-reviewed publication and conference presentations.
CRD420251053697.
Periodontitis and chronic kidney disease (CKD) are inter-related conditions that can significantly impact patient health. This study aims to evaluate the efficacy of active non-surgical periodontal therapy (NSPT) combined with supportive periodontal care (SPC) in reducing tooth loss and improving masticatory function in patients with CKD and stage III periodontitis.
This randomised controlled trial will recruit 86 patients diagnosed with both stage III periodontitis and CKD. Participants will be randomly assigned at a 1:1 ratio to either an experimental group receiving active NSPT supplemented with SPC or a control group receiving oral hygiene instruction with scheduled periodontal monitoring. The intervention will last for 24 months, with assessments conducted at baseline and 3, 6, 12, 18 and 24 months. The primary outcome is the incidence of tooth loss due to periodontitis over the 2-year follow-up period. Secondary outcomes include the number of lost teeth, masticatory function, clinical periodontal parameters and oral health-related quality of life.
The study protocol and informed consent form were approved by the Institutional Ethics Committee of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (SH9H-2022-T404-1). Findings will be disseminated to participants and published in peer-reviewed journals.
ChiCTR2300068923.
China has the highest global burden of new cancer diagnoses and cancer-related mortality, with approximately 60%–85% of patients with advanced malignancies experiencing moderate-to-severe pain. Although the WHO’s analgesic ladder is widely implemented, approximately 20% of cancer-related pain remains refractory. This persistent pain is often further complicated by opioid-induced side effects and the risk of opioid use disorders. Methadone, a potent opioid with distinct pharmacokinetic and pharmacodynamic properties, has shown potential in managing refractory cancer pain; however, there is a lack of standardised and evidence-based protocols for methadone conversion, particularly in patients requiring high-dose opioids.
This multicentre, open-label randomised controlled trial will enrol 164 Chinese patients with cancer and oral morphine equivalent daily dose requirements of ≥300 mg. Participants will be randomised to receive either the 3 day switch (3DS) strategy or the National Comprehensive Cancer Network (NCCN)-recommended methadone conversion method. The primary endpoints include time to stable analgesia, methadone conversion efficiency and overall pain relief rate. Secondary endpoints will evaluate pain intensity, frequency of breakthrough pain, corrected QT interval changes, incidence of adverse events and health-related quality of life. This trial is designed to generate high-quality clinical evidence to inform methadone conversion strategies for patients with refractory cancer pain who are dependent on high-dose opioids. By addressing existing gaps in clinical practice and pharmacoeconomic decision-making, the study aims to support the development of standardised methadone protocols.
This study was approved by the Medical Ethics Committee of Zhejiang Cancer Hospital (approval number: IRB-2024-314(IIT)) on 3 April 2024 and registered with the Chinese Clinical Trial Registry (ChiCTR2400085332) on 5 June 2024. The outcomes will be disseminated through national and international presentations and peer-reviewed publications.
ChiCTR2400085332.
To identify body temperature dynamic patterns and develop a machine learning model for the early detection of nosocomial infections.
A retrospective and observational study of patients hospitalised in the haematology department of the Chinese People's Liberation Army General Hospital between January 2014 and December 2023.
A latent class trajectory model was used to discover patterns in patients' body temperatures over time. Machine learning models were then built to predict nosocomial infections and evaluated using standard metrics (AUROC, sensitivity, specificity). SHAP (SHapley Additive exPlanations) values were used to interpret the final model.
Among 6989 patients, we identified four distinct body temperature trajectories. Bloodstream infections were most common in patients exhibiting either a slow rise followed by a gradual decrease or a rapid rise followed by a quick decrease in body temperature. The XGBoost model showed excellent predictive performance (AUROC = 0.801), with balanced sensitivity (0.718) and specificity (0.701). The top five predictors of nosocomial infections were elevated procalcitonin, neutropenia, prolonged central venous catheter use and two specific temperature trajectories: ‘stable and relatively high’ and ‘a rapid rise followed by a quick decrease’.
The XGBoost model effectively predicted nosocomial infections. Dynamic body temperature trajectories provided early, objective warning signs of infection. This predictive tool empowered nursing staff to proactively monitor nosocomial infection, allowing for timely, data-driven interventions in vulnerable hematologic patients.
The developed machine learning predictive tool can help clinical medical staff identify nosocomial infections as early as possible, facilitate personalised rehabilitation and health management plans, aligning with the philosophy of patient-centred precision nursing. Further, the four body temperature trajectory patterns identified provide nurses with objective, dynamic indicators for recognising potential infection subphenotypes, supporting a shift from experience-driven reactive care towards data-driven proactive nursing.
Previous studies suggested that body temperature could indicate the severity and prognosis of infections, but the pattern was unknown. In this study, we found that body temperature trajectories could signal infection subphenotypes, such as bloodstream infections being most common in patients with a slow rise followed by a gradual decrease in body temperature or with a rapid rise followed by a quick decrease. By integrating body temperature trajectories with key clinical biomarkers, the developed prediction model enables early and accurate identification of nosocomial infections in hematologic patients. The application of this tool may significantly shorten the time window between infection onset and intervention, potentially reducing infection-related complications, mortality and healthcare costs, thereby improving overall care quality and patient outcomes.
The study adhered to the relevant EQUATOR reporting guidelines, the TRIPOD Checklist for Prediction Model Development and Validation.
The research team included nursing staff and clinicians responsible for infection surveillance and control in the hospital, who contributed real-world insights into the definition of predictors, interpretation of temperature trajectories, clinical implications of the prediction model and preparation of the manuscript. Their expertise helped ensure that the study addressed relevant clinical questions and that the findings are interpretable and actionable in practice.
To systematically review published studies on the post stroke delirium risk prediction models; and to provide the evidence for developing and updating the clinically available prediction models.
Systematic review.
Systematically searched studies on 10 databases, which were conducted from inception to 9 January 2025. The studies of post-stroke delirium risk prediction models were included.
Extracted the data from the selected studies. The Prediction Model Risk of Bias Assessment Tool checklist was used to evaluate the risk of bias of the models. The meta-analysis of model performance and common predictors was performed by Revman 5.4 and Medcalc.
A total of 12 studies were included, and 21 risk prediction models for post-stroke delirium were constructed. The combined effect size of area under the receiver operating characteristic curve was 0.84. All studies were found to have a high risk of bias and good applicability. Meta-analysis showed: National Institutes of Health Stroke Scale score, age, neutrophil-to-lymphocyte ratio, neglect, visual impairment and atrial fibrillation were independent predictors of post-stroke delirium.
The included studies all found to have a high risk of bias; future studies should focus on adopting more scientifically rigorous study designs and following the standardised reporting guidelines to enhance extrapolation and facilitate its clinical application.
This review may promote clinical healthcare workers to develop and update clinically available prediction models, thereby establishing risk prediction models with strong clinical utility.
This study presents the first systematic evaluation of delirium risk prediction models in stroke patients, thereby facilitating the choice, use and develop of the clinical usable post stroke delirium risk prediction models.
This review adhered to the PRISMA guidelines.
No patient or public contribution.
RD42024620360 (PROSPERO According to JAN Guidelines).
This study aimed to systematically review Clinical Practice Guidelines (CPGs) for nutritional management of dementia and use evidence mapping to highlight research trends and identify gaps to inform future research.
A systematic review of guidelines using the PRISMA statement.
Systematically collect literature on dementia management CPGs from PubMed, Embase, Web of Science and guideline databases. Extract basic information, recommendations, methodological quality and reporting quality of the CPGs. Four researchers independently evaluated eligible CPGs using the AGREE II instrument and the RIGHT checklist. All recommendations from the CPGs were summarised and analysed, and evidence mapping bubble charts were created in Excel.
After excluding 5541 records, 10 CPGs were eventually proved eligible, 5 of which were of high quality and 5 of high quality. With 10 CPGs that combined 18 recommendations. The nutrition screening and assessment were summarised on the basis of the dementia recommendations for 4 major items, 7 items on nutritional interventions, 5 items on caring and 2 on education.
This review provides an evidence map and offers new perspectives on CPGs for nutritional management in dementia. However, there are improvements to the included CPGs, but most CPGs have a number of key recommendations that can help guide clinical practice.
The currently available guidelines on dementia nutritional management have room for methodological improvement.
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