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The aim of this study was to innovatively utilise the BERTopic model for topic modelling in order to comprehensively identify and understand the factors contributing to bed falls.
Retrospective study.
The study collected 241 reports of bed fall accidents recorded by nurses from Peking University Third Hospital Nursing Department from 2014 to 2024. Among them, 102 reports met the inclusion and exclusion criteria.
This study follows the Minimum Information for Medical AI Reporting (MINIMAR). It collected patient bed fall reports from Peking University Third Hospital between 2014 and June 2024, preprocessed the texts, utilised the BERTopic library in Python for topic modelling, and manually aggregated secondary topics by combining visualisation results and professional knowledge.
We utilised cluster bar charts to visually display the distribution of the 22 secondary topics and further consolidated them into five core topics through the use of a topic distribution diagram and a topic similarity matrix diagram. These topics were related to patient factors, ward equipment and surroundings factors, medication risk factors, caregiver factors, and nursing practice factors. The study highlights the environment's specificity in bed falls, especially bedside safety and patient-bed rail interaction.
The innovation of this study lies in the successful utilisation of BERTopic technology to identify topics of risk factors for bed falls through alternative data sources, providing a scientific basis for formulating preventive measures. The findings aim to optimise nursing processes, improve ward environments and enhance educational training, ultimately reducing patient bed falls and enhancing medical safety, nursing quality and patient experience.
This study not only helps nurses identify risk factors for patient bed falls, but also provides important guidance for developing effective prevention strategies.
No patient or public contribution applied.
The treatment of chronic wounds in the Aged is often difficult. Masquelet technique is used for the treatment of infected large segmental bone defects as it provides an adequate blood supply for bone and soft tissue reconstruction. In this study, a two-stage wound management strategy was used, consisting of covering the initial wound with bone cement and skin grafting under induced membranes. From September 2020 to September 2022, 20 Aged patients with chronic refractory wounds of the lower extremities with exposed bone or tendons were recruited in the Department of Wound Repair Surgery of the Second Affiliated Hospital of Wenzhou Medical University. Each patient was reconstructed according to a two-stage process. In the first stage, while treating the patient's underlying disease, several debridements were first performed on the wound; subsequently, the Masquelet technique was applied to seal the wound with antibiotic bone cement. Four to 6 weeks later, the second stage was initiated—after confirming the sufficient formation of wound induced membranes, the bone cement was removed, and free skin grafts were finally used to cover the chronic refractory wounds on the extremities. The area of the defects ranged from 4.5 × 3.0 cm to 15.0 × 6.0 cm, and all soft tissue defects were associated with tendon or bone exposure. After the surgery, patients attended regular outpatient visits and were followed up by telephone and video to observe the healing of the wounds and whether there were any complications in the donor site. The Lower Extremity Function Scale (LEFS) score was used to evaluate the functional recovery of the lower extremities. We found that all implants survived without necrosis or infection. All 20 cases were followed up regularly after surgery for 3 to 12 months, with a mean of 7.6 months. In the first stage, Induced Membranes induction was performed 1–4 times, with an average of (1.3 ± 0.7) times, and in the second stage, free skin grafting was performed on the induction membrane, and all 20 cases of skin grafting survived without necrosis or infection; the appearance and texture of the skin in the grafted area were satisfactory, and the postoperative LEFS score was (69.83 ± 10.82). Finally, our strategy for the management of chronic refractory wounds in the Aged can achieve satisfactory clinical results, reduce surgical risk, be simple and reliable, and be an effective addition to the repair modality.
To explore the relationship between nurses' decision-making styles and missed care across different stages of the nursing process (assessment and evaluation, planning, implementation) in oncology care settings.
A cross-sectional study was conducted among oncology nurses from three hospitals using convenience sampling. Data were collected through a sociodemographic questionnaire, the Oncology Missed Nursing Care Self-Rating Scale (OMNCS) and the General Decision-Making Style Scale (GDMS). Mann–Whitney U tests and binary logistic regression were employed to analyse the associations between different decision-making styles and missed care.
Missed care was commonly reported across all dimensions, with the highest prevalence observed in the planning stage. The rational decision-making style was dominant, with significantly higher scores in the non-omission group. It was negatively associated with missed care during the implementation stage (OR = 0.460, 95% CI 0.251–0.844; p = 0.012). The intuitive-impulsive decision-making style showed a protective effect in all dimensions (OR = 0.254–0.337, 95% CI 0.128–0.501, 0.172–0.661; p < 0.01). In contrast, the dependent and avoidant styles both significantly increased the risk of missed care during the assessment and evaluation stage.
Nurses' decision-making styles play a crucial role in the occurrence of missed care, with different styles exerting varying influences across stages of the nursing process. Therefore, nursing managers should recognise the role of these styles in nursing quality and tailor interventions to support nurses with dependent or avoidant decision-making styles. Moreover, using simulated training or decision support systems to transition between rational and intuitive approaches offers a promising strategy to reduce stage-specific missed care, enhance oncology nursing quality and improve patient safety.
Identifying high-risk stages for missed care, incorporating assessments of nurses' decision-making styles and implementing personalised interventions provide a new management pathway to reduce missed care and enhance patient safety.
What problem did the study address?: This study provides new evidence that nurses' decision-making styles are significantly associated with missed care, with this relationship varying across different stages of the nursing process. What were the main findings?: The rational style was the most common decision-making style among oncology nurses, with the non-omission group scoring significantly higher than the omission group. The intuitive-impulsive style consistently showed a protective effect across all stages. In contrast, both dependent and avoidant styles increased the risk of missed care during the assessment and evaluation stage. Where and on whom will the research have an impact?: This study informs the development of targeted interventions for nursing management. Immediate priorities include implementing structured tools and training during high-risk care stages, while long-term strategies should focus on simulation-based training and fostering a supportive culture to enhance decision-making skills and reduce missed care.
The STROBE checklist.
This is a cross-sectional study to investigate the relationship between nurses' decision-making styles and missed care at specific stages of the nursing process. In the design phase, the research team collected data on oncology nurses' general information, missed care status and decision-making styles by reviewing relevant literature. During the research process, the nurses participated in data collection, providing key primary data for the study. This cooperation ensured the smooth execution of the research and contributed to obtaining effective results.
by Yuanyuan Ren, Jing Sun
BackgroundLarge Language Models (LLMs) highlight their potential in supporting patient education and self-management. Their performance in responses to orthodontic questions has yet to be explored.
ObjectivesThis study aims to compare the quality, empathy, readability, and satisfaction of responses from LLMs and search engines on common orthodontic questions.
MethodsForty-five common orthodontic questions (six categories) and a prompt were developed, and a self-designed multidimensional evaluation questionnaire was constructed. Questions were presented to 5 LLMs and 3 search engines on December,22,2024. The primary outcomes were the median expert-rated scores of LLMs versus search engine responses on quality, empathy, readability, and satisfaction, using 5- or 10-point Likert scales.
ResultsLLMs scored significantly higher than search engines in quality (4.00 vs. 3.50, p Conclusions
In this cross-sectional study, the LLMs, particularly GPT-4o, outperformed search engines. These results indicate the potential of LLMs as supplementary tools for orthodontic patient education and self-management.
Both varicose veins (VV) and iliac vein compression syndrome (IVCS) can cause skin damage and functional impairment in the lower extremities, and these issues often coexist. However, the question of whether IVCS exacerbates VV progression and leads to differences in the surgical outcomes of therapy for VV remains unanswered. Therefore, no high-level evidence-based medical data is available to support the concomitant use of iliac vein stenting in patients with VV and severe IVCS, and treatment protocols vary significantly among different centres. This study will investigate the effects of concomitant iliac vein stenting on post-procedure varices recurrence and quality of life (QoL) on the basis of a prospective, multicentre, randomised controlled trial with the goal of providing a foundation for the standardised treatment of patients with VV and IVCS.
This prospective, multicentre, randomised controlled trial will enrol 160 patients with VV and severe IVCS. All patients will be randomly divided into either the VV endovenous thermal ablation (ETA) alone group or the VV ETA combined with iliac vein stenting (ETAS) group. Baseline data will be collected and follow-up will be conducted at 1, 6, 12 and 36 months after the procedure. The primary outcome is post-procedure VV recurrence (as assessed by clinical and ultrasound examination). Secondary outcomes include QoL scores (according to the Aberdeen Varicose Vein Questionnaire, the Chronic Lower Limb Venous Insufficiency Questionnaire, the European Quality of Life Five-Dimensions, and the Venous Clinical Severity Score) and the incidence of post-procedure complications. Bleeding complications resulting from anticoagulation therapy and stent-related complications (such as restenosis and deep vein thrombosis) will also be recorded for patients in the ETAS group.
This study has been approved by the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (approval number: XJTU1AF2024LSYY-075). Written informed consent has been obtained from all participants. The final results of this study will be published in a peer-reviewed journal and presented at national or international conferences.
This protocol was registered on chictr.org.cn prior to enrolment, which began on 19 June 2024 (Registration ID: ChiCTR2400085815).
Smart home technology, as an emerging innovation, holds significant potential to support proactive health by enabling accurate prediction and intelligent warning of health issues. This study aims to explore older adults' perceptions of adopting smart home technology to promote proactive health.
An exploratory qualitative study.
Focus groups and one-on-one interviews were held with 20 older adults recruited from a retirement activity center, a nursing home, and the geriatrics department of a tertiary hospital in China between June and October 2024. The interview transcripts were analysed using thematic analysis and further examined through the framework of the Technology Acceptance Model.
The analysis identified four themes: (1) The need for care is the primary determinant for older adults' consideration of adopting smart home technology. When care is needed, factors such as self-care ability, care from children and the caregiving capabilities of smart home technology play a crucial role in their decision-making process. (2) Older adults expect smart home technology to deliver essential healthcare services, including health monitoring and counselling, emergency assistance and emotional support. (3) Individual differences, interplay with life experiences, significantly influence older adults' willingness to adopt smart home technology. (4) The perceived effectiveness of technology, age-friendly design, potential technical malfunctions and privacy concerns are also critical factors affecting adoption decisions. All themes were also matched to perceived usefulness, perceived ease of use and attitude in the Technology Acceptance Model.
This study provides valuable insights into older adults' perspectives on adopting smart home technology and serves as a reference for its development in geriatric health management. To enhance the applicability of these technologies, nurses should collaborate with developers, integrating their expertise in elderly care and daily living needs.
The findings offer guidance for advancing smart home technology to better address the health needs of older adults. By integrating these technologies into practice, nurses can more effectively respond to the unique health conditions of older adults, optimise nursing workflows and enhance the overall quality of care. Ultimately, this ensures that older adults remain the primary beneficiaries of technological advancements in healthcare.
The study adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.
Limited patient and public involvement was incorporated, focusing on feedback on data analysis.
To develop an instrument for assessing competence in emerging infectious disease prevention among health and care workers in long-term care institutions and evaluate its psychometric properties.
A cross-sectional, descriptive design utilising both qualitative and quantitative methods was employed.
Based on scale development guidelines, the scale was developed in two phases, namely the scale development phase and scale testing phase, with the staff of long-term care institutions as the study population and their workplaces as the sampling unit.
The scale comprises 27 items across three dimensions: 14 items pertaining to professional role performance, 7 items addressing workplace resources, and 6 items focusing on soft skills in communication and collaboration. Content analysis was conducted via a focus group discussion; content validity analysis was carried out via expert reviews; item analysis was performed via a pilot study; and construct validity and reliability were ensured via factor analysis and internal consistency testing, respectively. The total variance explained by the three factors of the 27-item scale was 64.8%, demonstrating acceptable validity and reliability with a Cronbach's α value of 0.97.
This scale demonstrates excellent reliability and validity, making it suitable for clinical practice and research. In practice, this instrument could also assist managers in adjusting policies to adapt to dynamic situations and enhance the quality of care in long-term care institutions. Nonetheless, further research is warranted to refine the scale and enhance its generalisability.
The scale is a psychometrically robust tool tailored for the evaluation of competence in emerging infectious disease prevention in long-term care institutions. It assesses the role performance, workplace resources, and soft skills of health and care workers in these institutions, which are crucial for guiding educational interventions and shaping policies to enhance disease prevention, ultimately improving care quality.
No patient or public contribution.
To identify and synthesise the available evidence of nurses' perceptions and experiences of providing bereavement care.
Systematic literature review of qualitative studies with meta-synthesis of findings.
We searched six databases, PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, and PsyINFO. Initial search in October 2023, and updated in December 2024.
The systematic review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Two reviewers independently conducted study selection and data extraction, and quality appraisal was assessed using the Critical Appraisal Skills Program tool for qualitative research. Data synthesis was conducted using thematic analysis.
A total of thirteen studies were included, revealing nine sub-themes and three descriptive themes: challenges in bereavement care, coping strategies, and multifaceted job requirements. Six sub-themes were graded as high confidence and the other three were moderate confidence.
Bereavement care is a personalised, long-term and complex process, presenting nurses with unique challenges and requirements that must be measured through the authentic experiences of this group. Educational and practice policies should focus on nurse-centred strategies. Through this meta-synthesis, we can demonstrate to healthcare administrators how to enhance nurses' bereavement care practice experiences and meet their needs, thereby advancing future palliative care development and fostering professional fulfilment.
This systematic review synthesises evidence concerning nurses' experiences of providing bereavement care, revealing the multidimensional challenges, coping strategies, and professional demands encountered in practice. The findings offer significant implications for nursing education, clinical practice, and health policy development. Currently, research on nurses delivering bereavement support remains insufficient; further investigation into this group could help bridge gaps between grief counselling theory and practice while highlighting the identified societal issues they face.
Not applicable.
PROSPERO: CRD42024590469
Circadian rhythm disturbance is associated with neurologic, metabolic, cardiovascular and immune disorders. As the most reliable biomarker of endogenous circadian rhythms, melatonin regulates the sleep-wake cycle and promotes sleep. Studies have demonstrated that saliva and plasma melatonin levels show strong correlations in non-surgical populations. However, the relationship between salivary and plasma melatonin measurements in patients undergoing surgery is unknown. This study will analyse the correlation between the peak concentrations of salivary and blood melatonin in perioperative patients.
In this prospective study, 102 patients scheduled for thoracic or neurosurgical procedures are being enrolled. The primary outcome of this study is to analyse the correlation between the peak concentrations of salivary and plasma melatonin (measured at 04:00 on the first postoperative day) in patients.
The study protocol has been approved by the Medical Ethics Committee of Peking University Third Hospital (M2023009). The results of the study will be published in peer-reviewed international journals.
The study has been registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) with identifier ChiCTR2300070470. The latest version of the trial protocol was approved in October 2023.
Pressure injuries remain a significant concern in military hospital settings, leading to increased morbidity and healthcare costs. Understanding the interplay of multiple risk factors is critical for effective prevention. To identify key risk factors and their combined effects on pressure injury development among inpatients in multi-centre military hospitals using factor analysis. A cross-sectional study was conducted involving 4876 inpatients across multiple military hospitals. Data were collected on 15 potential risk factors, including incontinence, care dependency, mobility limitations, comorbidities, medication use, nutritional status, and demographics. Factor analysis with principal component analysis and varimax rotation was applied, and maximum canonical correlation coefficients were calculated to evaluate the predictive contribution of single and combined factors. Single-factor analysis identified incontinence as the strongest predictor (MaxCanonicalCorr = 0.50126), followed by care dependency (0.31982) and bedridden status (0.30061). Two-factor analysis revealed incontinence combined with care dependency as the highest-performing model (MaxCanonicalCorr = 0.50867). Three-factor models incorporating incontinence, health conditions, and care dependency achieved the greatest predictive capacity (MaxCanonicalCorr = 0.5157), demonstrating that multi-factor interactions enhance risk prediction beyond single-factor effects. Incontinence is the primary modifiable risk factor for pressure injury in military hospital inpatients. Integrating continence management with assessments of functional status and comorbidities can improve early identification of high-risk patients and guide targeted preventive strategies.
This study aimed to identify potential categories of rotation stress among nurses undergoing standardised training and to explore the relevant factors associated with each profile.
Cross-sectional study.
Data were collected in November 2024 from three hospitals in Zunyi City, Guizhou Province, China.
Nurses undergoing standardised training were recruited for this study.
Convenience sampling method was used to recruit standardised training nurses in November 2024 from three hospitals in Zunyi City, Guizhou Province. The survey instruments used included demographic characteristics questionnaire, the Nursing Job Rotation Stress Scale and the Maslach Burnout Inventory. Latent profile analysis method was used to analyse rotation stress characteristics of nurses during standardised training. Additionally, logistic regression was performed to identify the factors influencing different characteristics.
A total of 493 nurses completed the questionnaires, of which 453 were valid, resulting in a validity rate of 91.88%. Rotation stress was classified into two profiles: ‘Low Emotional Response–Stress Adaptation Group’ (21.5%) and ‘High Emotional Response–Stress Distress Group’ (78.5%). Univariate analysis showed that highest degree (2=11.389, p=0.001), monthly night shifts (2=33.913, p2=20.858, p2=12.319, p2=35.754, p2=15.357, p=0.002) significantly influenced the two subgroups. Multivariable regression analysis revealed significant associations of monthly night shifts, pretraining work experience, training duration and burnout level (p
Nurses undergoing standardised training exhibit two distinct rotation stress profiles. Monthly night shifts, pretraining work experience, training duration and burnout are significant factors. Nursing managers should implement targeted interventions such as mindfulness, laughter therapy and emotional freedom techniques to mitigate stress and thereby enhance the quality of standardised training.
First-degree relatives of colorectal cancer (CRC) patients have a twofold to fourfold increased risk of CRC. Tailored communication interventions have shown efficacy in improving their risk awareness and screening participation. While computer-based tailoring systems offer convenience, they often overlook the integration of healthcare professionals’ verbal input, potentially limiting effectiveness and long-term impact. To address this gap, we developed ScreenTalk, an intelligent voice-interactive tailored communication system that employs intelligent speech interaction to automate the tailoring process, enhance message credibility and improve scalability within CRC screening workflows.
This study is a two-arm, cluster-randomised controlled trial with a hybrid type I design involving 314 participants across three tertiary general hospitals in Guangzhou, China. Participants in both groups will receive usual care. Additionally, the intervention group will receive a 1-month tailored intelligent voice-interactive intervention, whereas the control group will receive unrelated health education to control for attention. Screening uptake (primary outcomes) and health beliefs (secondary outcomes) are measured at baseline and at 3 months, 6 months, 9 months and 12 month post the intervention. Implementation outcomes including reach, implementation, adoption and maintenance will be assessed through questionnaire, qualitative interviews and tailored system record.
The trial has been approved by the Ethics Committee of the Sun Yat-sen University (IRB No. L2024SYSU-HL-054). Information on the purpose and process of this study will be provided to the participants before recruitment, and written signatures will be collected from all participants to ensure their voluntary participation and protection of their rights and privacy.
NCT06710860 on ClinicalTrials.gov. Registered 26 November 2024. Date and version: 3.0, 14 July 2025.
Atrial fibrillation (AF) constitutes a growing public health challenge. Consequently, the exploration of modifiable risk factors is essential for advancing AF prevention and management. While obstructive sleep apnoea is established as a risk factor for AF recurrence following catheter ablation, and its treatment with continuous positive airway pressure therapy reduces recurrence rates, the influence of non-sleep apnoea-related sleep indicators remains unclear. This systematic review aims to elucidate the association between these non-sleep apnoea-related sleep indicators and AF recurrence to inform optimised management strategies.
A comprehensive search will be performed in databases, including PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database and Wanfang Data, covering publications from database inception to 27 August 2024. Study selection will be performed independently by two reviewers using predefined eligibility criteria, with the screening process documented in a referred Reporting Items for Systematic Review and Meta-Analysis-compliant flow diagram. Data will be extracted using standardised forms and risk of bias of included studies will be assessed with the Risk Of Bias In Non-randomised Studies-of Interventions tool. Non-sleep apnoea-related sleep indicators, including sleep duration, sleep quality, sleep latency, sleep efficiency, REM (Rapid Eye Movement)/NREM (Non-Rapid Eye Movement), etc, serve as exposure factors. The primary outcome is defined as AF recurrence, whereas the secondary outcome comprises quality of life measures among AF patients. Should sufficient data be available, a meta-analysis will be performed using appropriate statistical methods; otherwise, a narrative synthesis will be conducted.
This study uses publicly available data, so ethical approval is not required. The findings will be disseminated through peer-reviewed journals and scholarly platforms to inform clinical practice and future research.
CRD42024607124.
Flexible ureteroscopy has advanced modern stone management; however, lower pole renal stones remain a challenge due to suboptimal ureteroscope deflection and navigation using conventional flexible and navigable suction ureteral access sheaths (FANS). The SCULPT trial is designed to assess whether the novel steerable FANS—which enables active controlled deflection—can improve the success rate of lower pole access during flexible ureteroscopy.
This multicentre, prospective, single-blinded, randomised controlled superiority trial will recruit 400 adult patients (aged 18–75 years) with solitary lower pole renal stones ≤2 cm diagnosed by CT from 20 high-volume urological centres in China. Participants will be randomised 1:1 to undergo flexible ureteroscopy with either steerable or conventional FANS. The primary outcome is the success rate of navigating into the lower pole calyx (defined as successful direct stone visualisation, laser lithotripsy and aspiration without adjunct use). Secondary outcomes include immediate and 1 month stone-free rates, operative time, complication profiles (graded by Clavien–Dindo), instrument damage rates, quality-of-life assessments and cost analysis. Statistical analysis will be performed using appropriate tests for continuous and categorical data, with their significance set by prespecified superiority margins.
The study protocol has been designed in accordance with the Declaration of Helsinki and ICH-GCP guidelines. Ethical approval was centrally granted by the Institutional Review Board of The First Affiliated Hospital of Guangzhou Medical University and adopted by all participating centres following local feasibility review. The trial results will be disseminated via peer-reviewed publication and presentation at international conferences.
by Xiyuan Zhu, Hongtao Dang, Xiaoyuan Jin, Xun Li
Surface defect detection of organic jujubes is critical for quality assessment. However, conventional machine vision lacks adaptability to polymorphic defects, while deep learning methods face a trade-off—deep architectures are computationally intensive and unsuitable for edge deployment, whereas lightweight models struggle to represent subtle defects. To address this, we propose Ju-LiteMobileAtt, a high-precision lightweight network based on MobileNetV2, featuring two key innovations: First, the Efficient Residual Coordinate Attention Module (EfficientRCAM) integrates spatial encoding and channel interaction for multi-scale feature capture; Second, the Cascaded Residual Coordinate Attention Module (CascadedRCAM) refines features while preserving efficiency. Experiments on the Jujube12000 dataset show Ju-LiteMobileAtt improves accuracy by 1.72% over baseline while significantly reducing parameters, enabling effective real-time edge-based jujube defect detection.
by Bing Wu, Pengli Wei, Jiaxiang Deng, Yuanyuan Rui
BackgroundThe atherogenic index of plasma (AIP) is a recognized marker of atherosclerosis and cardiovascular disease (CVD). However, the association between AIP and the risk of acute kidney injury (AKI) in critically ill patients with sepsis has not yet been investigated.
MethodsThe data used in this study were derived from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The clinical outcome was the occurrence of AKI. Logistic regression was used to assess the association between AIP and the risk of AKI in sepsis patients. Restricted cubic spline (RCS) analysis was applied to explore potential non-linear relationships. Threshold analysis confirmed a turning point at this value. Subgroup analyses evaluated the consistency of the association across different strata. Mediation analysis was performed to explore potential intermediate variables.
ResultsAmong 1,874 sepsis patients, higher AIP levels were associated with increased AKI incidence. Logistic regression showed a significant association between AIP and AKI in unadjusted and partially adjusted models, but the association was no longer significant after full adjustment. RCS analysis revealed a nonlinear relationship with a peak AKI risk at AIP = 1.333. Threshold analysis confirmed a turning point at this value. Subgroup analyses showed consistent associations, while nonlinear effects were more evident in specific groups. Mediation analysis suggested that SOFA score, creatinine, WBC count, and respiratory rate partially mediated the AIP-AKI relationship.
ConclusionAIP was nonlinearly associated with AKI in sepsis, with a clear threshold effect. This relationship was partially mediated by SOFA score, creatinine, WBC, and respiratory rate. AIP may serve as a useful marker for AKI risk assessment.
Dexamethasone is commonly used to prevent postoperative nausea and vomiting (PONV). However, PONV is an unresolved complex problem; even with preoperative dexamethasone administration, 14.0%–26.3% of patients undergoing minimally invasive endoscopic procedures still experience PONV within 24 hours postoperatively. Compared with dexamethasone, dexamethasone palmitate has a long-lasting anti-inflammatory effect, two to five times that of traditional water-soluble dexamethasone, with fewer adverse events. This trial aims to assess the efficacy and safety of preoperative dexamethasone palmitate administration on postoperative PONV.
The INDEX trial is a multicentre, open-label, randomised, positive-controlled trial. A total of 588 patients will be recruited from three centres in China. Eligible patients are adults (aged 18–65 years) who undergo elective minimally invasive endoscopic surgery (laparoscopic or thoracoscopic surgery) under general anaesthesia. Eligible patients will be randomly assigned (1:1) to the dexamethasone palmitate or dexamethasone group. Patients in the dexamethasone palmitate group will receive intravenous injection of 8 mg of dexamethasone palmitate (containing 5 mg of dexamethasone), and those in the dexamethasone group will receive 5 mg of dexamethasone after anaesthesia induction and before surgical incision. The primary endpoint will be the incidence of PONV within the first 24 hours postoperatively. Secondary outcomes will include the incidence of PONV, postoperative nausea, postoperative vomiting, number of vomiting or retching episodes, severity of PONV, participant satisfaction, use of rescue antiemetic drugs and quality of postoperative recovery. The safety of participants will be monitored. A primary analysis will be conducted to evaluate between-group differences in the incidence of PONV in the intention-to-treat population and within the first 24 hours postoperatively. We will also perform a sensitivity analysis to evaluate the effect of missing values in the outcome parameters on the results. There is no plan to conduct an interim analysis.
Ethical approval was obtained from the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (KY 2025-041-02-01). The results will be disseminated in open-access publications and plain-language summaries.
by Huawei Wu, Xiaolong Ding, Gui Liu, Xiaoyuan Zhu, Hualiang Wang
Aiming at the extreme loading conditions of an backhoe loader under dynamic and uncertain environments, this paper proposes a structural optimization method based on EDEM-ADAMS for a compact multi-functional excavating transporter device. The D-H coordinate kinematic analysis model of the backhoe loader is constructed, and the forward kinematic solution is obtained. Using the multi-body dynamics software ADAMS and enhanced discrete element software, a virtual prototype model and a discrete element material model are established. Through the coupled simulation method of EDEM-ADAMS, the load distribution of two working modes, forward digging and side digging, is analyzed, and the extreme working conditions of the boom are determined. Finally, topology optimization of the boom under extreme working conditions is performed to strengthen the local structure. The results show that after optimization, the boom’s mass is reduced by 14.32 kg (13.80%), the maximum stress is reduced by 26.12%, and the total deformation is reduced by 29.11%. Compared to existing optimization methods, the equivalent stress and total deformation of the proposed optimized model are reduced by 18.76% and 22.27%, respectively. These improvements not only achieve weight reduction but also significantly enhance the structural strength and safety. The optimized design has significant implications for the structural optimization of similar backhoe loader under extreme working conditions.
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