Scaling and root planing (SRP) combined with adjunctive antibiotic therapy is widely adopted in the management of periodontitis in patients with type 2 diabetes mellitus (T2DM), with the aims of ameliorating glycaemic control, alleviating local inflammation and facilitating periodontal tissue regeneration. As a topically administered adjunctive antibiotic for periodontal treatment, minocycline hydrochloride (MH) ointment has shown favourable clinical efficacy in systemically healthy patients with periodontitis. However, robust evidence supporting its clinical efficacy and potential glycaemic-improving effects in patients with periodontitis complicated by T2DM remains limited. The present study is designed to test the null hypothesis that no significant differences in clinical outcomes exist between SRP combined with MH and SRP alone in the management of periodontitis among patients with T2DM, with its primary objective to investigate whether MH as an SRP adjunct confers superior clinical benefits to SRP alone.

We will conduct a randomised, single-blind, placebo-controlled clinical trial. 56 patients with T2DM-associated stage III/IV periodontitis will be recruited from the Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China. Eligible participants will be randomised into two groups: the experimental group will undergo SRP combined with topically administered MH ointment and the control group will undergo SRP with a matched placebo. The primary outcomes will include probing depth (PD) changes at periodontal pocket sites with a baseline PD ≥6 mm at 6 months post-baseline, with a specific focus on the percentage of such sites with PD reduced to ≤5 mm. The secondary outcomes will comprise PD changes at pocket sites with a baseline PD ≥5 mm at 6 months post-baseline, as well as clinical attachment loss, the plaque index, bleeding index, the levels of IL-1β, IL-17, calprotectin and insulin levels in gingival crevicular fluid and serum, complete blood count, blood biochemistry, including glycated haemoglobin levels, and the composition of subgingival plaques at baseline, and 2 and 6 months post-baseline.

This study was approved by the Ethics Committee of Peking University School and Hospital of Stomatology (PKUSSIRB-2024102139b). Results will be published in a peer-reviewed scientific journal.

ChiCTR2400092305.

V.3.1 (date: 6 January 2026).

Total knee arthroplasty (TKA) is a common and effective procedure for end-stage knee osteoarthritis, yet patients frequently encounter a complex and dynamic symptom experience during the initial period that can significantly impact their rehabilitation and quality of life. This study aimed to explore the symptom experience of patients within 6 weeks after TKA.

A longitudinal qualitative study using semi-structured interviews.

This study was conducted in an orthopaedics department of a tertiary general hospital in China.

Interviews were conducted with 16 patients at 3–5 days postoperatively, 14 patients at 2 weeks postoperatively and 10 patients at 6 weeks postoperatively.

Data were collected between July 2024 and November 2024. A purposive sampling method was used to recruit patients. Data were analysed using directed content analysis, with data collection and analysis performed concurrently.

Three themes and nine subthemes were identified: (1) symptom perception, including perceived complexity of symptoms, self-identity conflict due to functional limitations, activation of negative emotions and psychological adaptation and interaction and amplification effects among symptoms; (2) symptom evaluation, characterised by the dynamic cognitive reframing of symptom meaning, self-blame tendency and internalisation of responsibility and interference from social and medical information; (3) symptom coping, involving dynamic evolution of active coping strategies and self-efficacy reinforcement, temporal characteristics of passive coping patterns and rehabilitation barriers.

The symptom experience of patients who had TKA is complex and dynamic. Healthcare providers should implement tailored interventions based on patients’ symptom experiences at different stages to facilitate symptom management, alleviate distress and negative emotions and improve quality of life.

A good limb position (GLP) plays an important role in the rehabilitation process of patients who have had a stroke with hemiplegia. However, there remains a lack of effective assessment tools for clinical nurses to evaluate their GLP management practices.

This study aimed to develop and test the psychometric properties of the Good Limb Position Management Scale for Stroke Patients with Hemiplegia by Nurses (GLPMSSPHN).

A quantitative and cross-sectional design.

89 hospitals in 16 cities of China.

A total of 516 participants completed the questionnaire and were finally used for the analyses.

An initial scale was developed based on the Capability, Opportunity and Motivation-Behaviour model combined with a comprehensive literature review, semi-structured interviews, Delphi expert consultations and a pilot test. A field survey was then performed using the initial scale to test the reliability and validity of the scale. Reliability analysis was conducted by calculating Cronbach’s α coefficients and test–retest reliability. The results of exploratory factor analysis and confirmatory factor analysis were used as the validity index to further verify the model structure of the scale and develop a formal scale.

The GLPMSSPHN was formulated with 4 dimensions and 35 items. Exploratory factor analysis extracted four factors, with a cumulative variance contribution rate of 81.842%, and confirmatory factor analysis indicated that the scale had good construct validity. The Cronbach’s α coefficient of the scale was 0.978, and the test–retest reliability was 0.863.

The GLPMSSPHN has ideal reliability and validity and provides a valid and reliable tool for clinical nurses to identify and assess the management level of GLP in patients who have had a stroke with hemiplegia.

Semirigid thoracoscopy plays an important role in the diagnosis of pleural diseases. However, its diagnostic performance remains unsatisfactory particularly in terms of the negative likelihood ratio. Therefore, more effective supplementary diagnostic tools are required. Probe-based confocal laser endomicroscopy (pCLE), which allows live tissue imaging at the cellular level, can discriminate between malignant and benign pleura during medical thoracoscopy. However, the clinical relevance of pCLE in pleural disease remains unclear. This protocol describes a randomised controlled trial that evaluates the additional diagnostic value of pCLE in diagnosing pleural diseases using semirigid thoracoscopy.

This study is a multicentre, parallel-group, randomised controlled trial that will be conducted at ten sites in China. A total of 158 adult patients with undiagnosed exudative pleural effusions will be enrolled and randomly allocated (1:1) to undergo either a conventional pleural biopsy (control group) or a pCLE-guided pleural biopsy (intervention group) via semirigid thoracoscopy. In the intervention group, a pCLE system will be applied during thoracoscopy to identify suspicious pleural areas for targeted biopsy. The primary outcome is the diagnostic yield of the procedure in patients with unknown causes of pleural effusion. Secondary outcomes include negative likelihood ratio, diagnostic sensitivity in specific diseases, procedural time, rate of adequate specimens for achieving molecular diagnosis and complications.

Ethics approval was obtained from the China-Japan Friendship Hospital Ethics Committee (2025-KY-018). Written informed consent will be obtained from all the participants. The findings will be disseminated through journal publications and conference presentations.

NCT06741839.

Atosiban may confer therapeutic benefits to specific subpopulations in assisted reproductive technology. The Phase I Atosiban study indicated potential improvements in live birth rates among women with previous implantation failure undergoing frozen-thawed blastocyst transfer who exhibited abnormal uterine contractions, although these findings did not reach statistical significance. Therefore, further investigations are warranted to thoroughly elucidate the efficacy of atosiban and to evaluate whether uterine contractions can serve as a reliable biomarker for its targeted application.

This is a single-centre, randomised, triple-blind, placebo-controlled trial aiming to enrol 792 infertile women aged 20–40 years with a history of at least one previous embryo implantation failure and abnormal uterine contractions prior to single blastocyst-stage embryo transfer. Eligible participants will be randomly assigned in a 1:1 ratio to receive either intravenous atosiban or a placebo before embryo transfer. The primary outcome is live birth rate, with secondary outcomes encompassing various pregnancy and perinatal parameters. Randomisation will be stratified by age and transfer type. Intention-to-treat analysis will be performed using generalised linear models. The trial will be monitored by an independent data and safety monitoring committee, including one interim analysis.

This study has been approved by the Institutional Ethics Committee of Northwest Women’s and Children’s Hospital (No. 2025-058-02). Written informed consent will be obtained from all participants. The study results will be disseminated at scientific conferences and published in peer-reviewed journals.

NCT07185230.

Postoperative pulmonary complications affect approximately 40% of individuals undergoing lung cancer surgery. A number of clinical trials and meta-analyses have shown that postoperative telehabilitation may reduce the incidence of postoperative adverse events while reducing transport time and outpatient costs and improving patient motivation. However, optimal telehabilitation strategies remain undetermined. The primary objective of this protocol is thus to compare the effects of different telehabilitation methods used after pulmonary surgery in patients with lung cancer by conducting a network meta-analysis.

Two researchers will independently search six databases (PubMed, the Cochrane Library, Embase, Web of Science, Medline and the Chinese National Knowledge Infrastructure (CNKI)) and two clinical trial registries (ClinicalTrials.gov and WHO ICTRP). The time range will be from database inception to March 2026. EndNote X V.21 will be used for screening based on predetermined inclusion criteria. All Chinese and English randomised controlled trials examining the effects of telehabilitation on lung function after lung cancer surgery will be included. The primary outcome measures will be forced vital capacity (FVC), forced expiratory volume over 1 s (FEV₁), FEV₁/FVC and 6 min walking test. The secondary outcome measures will be the incidence of adverse events, intervention completion rate, incidence of postoperative pulmonary complications and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) score. Risk of bias assessment will be performed using the Cochrane Risk of Bias V.2 (RoB V.2.0) tool, while certainty of evidence will be evaluated using the Grading of Recommendations Assessment and Evaluation (GRADE). Stata V.18.0 (StataCorp, College Station, Texas) and R (V.4.1.2) will be used to conduct traditional pairwise meta-analysis and network meta-analysis.

Ethical approval is not required for this study. The results will be submitted to a peer-reviewed journal or conference.

CRD420251275899.

Tanzania carries a dual burden of communicable and non-communicable diseases while remaining vulnerable to emerging pandemics of public health concern. Since its independence in 1961, Tanzania has implemented successive health reforms aimed at expanding access and moving towards universal health coverage (UHC). Despite notable progress, inequities in access, quality and financial protection persist. This review examined how policy evolution (1961–2025) addressed or reinforced inequities and the lessons for building resilience and equity in UHC.

We conducted a scoping review of national health policies, strategies, legislation and the related literature (1961–2025), following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligible sources included government reports, strategic plans, evaluation reports and peer-reviewed or grey literature. Data were analysed using the Walt and Gilson Policy Triangle and mapped against the WHO Health Systems Building Blocks.

Out of 10 435 records identified, 60 documents met the inclusion criteria. Policy evolution reflected five broad reform episodes, ranging from postindependence centralisation to primary healthcare, structural adjustment and cost-sharing, sector-wide reforms and recent UHC-focused financing strategies. Reforms shifted from politically driven, top-down policies to participatory and evidence-informed approaches. Mapping showed progressive but uneven gains across service delivery, workforce, financing, governance, medicines and information systems. Six thematic shifts towards UHC were identified: fragmented to pooled financing, routine delivery to resilient systems, paper to digital systems, workforce numbers to distribution and skills-mix, state-only to mixed providers and expansion to effective coverage.

Tanzania’s reform trajectory illustrates adaptive progress, but persistent inequities in financing, workforce distribution and service access remain. Achieving equitable and resilient UHC will require stronger domestic financing, governance and primary care, with transferable lessons for other low- and middle-income countries.

To investigate the impact of non-pharmaceutical interventions (NPIs) on COVID-19 transmission in different pandemic stages across 12 Asian countries.

This was an ecological study of publicly available data. This study used the Stringency Index from the Oxford COVID-19 Government Response Tracker (OxCGRT) as a composite measure of implementation strictness of non-pharmaceutical interventions.

Data were obtained from Our World in Data and OxCGRT (January 2021 to September 2022).

12 countries were included in the study: Azerbaijan, Turkey, Bahrain, Israel, Lebanon, Japan, South Korea, Singapore, Malaysia, Thailand, Cambodia, and Indonesia.

The instantaneous reproduction number (Rt). Rt is defined as the expected number of secondary infections occurring at time t, divided by the number of infected individuals, each scaled by their relative infectiousness at time t (an individual’s relative infectiousness is based on the generation interval and time).

Three different pandemic development patterns were identified: Cluster 1 countries (marked by distinct fluctuation), Cluster 2 countries (characterised by smaller fluctuation) and Cluster 3 countries (featuring a peak between July and September). An increase in the Stringency Index was associated with a significant decrease in Rt during warmer seasons in both Cluster 1 and 2 (both p values

This study demonstrates that the effectiveness of NPIs varies with seasonal changes and pandemic patterns. Therefore, to improve the efficiency of public health responses, policymakers should tailor NPI strategies based on seasonal variations and local socio-structural factors. The findings provide new insights for future research on the impact of NPI implementation during pandemics, which plays a critical role in pandemic management.

To systematically review qualitative studies on the self-management experiences and needs of patients with chronic obstructive pulmonary disease (COPD) and to provide evidence for developing needs-based self-management intervention strategies.

A systematic review and meta-aggregation of qualitative studies conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

PubMed, Cochrane Library, Web of Science, Scopus, CINAHL, Embase, CNKI, Wanfang Database, VIP Database and CBM were searched from database inception to March 2025 for qualitative studies on COPD self-management experiences and needs.

Qualitative studies involving adults (≥18 years) with a confirmed diagnosis of COPD that reported patients’ real feelings, experiences and needs during the self-management process in any setting (hospital, community or home). Studies were excluded if the full text could not be obtained or data were incomplete, if they were duplicate publications or if they were not published in Chinese or English.

Two reviewers independently screened titles, abstracts and full texts, extracted data using a standardised form and assessed methodological quality using the 2016 Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Findings (participants’ quotations and authors’ interpretive statements) were synthesised using a JBI meta-aggregation approach to develop categories and overarching synthesised findings.

15 qualitative studies were included, comprising 251 patients with COPD. A total of 52 findings were identified, grouped into 13 categories and synthesised into 4 overarching findings: (1) physical symptom burden strongly shapes psychological well-being during COPD self-management; (2) patients face multiple and interrelated barriers to effective self-management; (3) some patients develop active coping strategies and self-management resources; and (4) patients express multidimensional and continuing support needs.

Patients with COPD experience substantial physical and psychological distress and face multiple challenges in the self-management process. Healthcare professionals should prioritise patients’ lived experiences, establish comprehensive and coordinated support systems and develop diversified, needs-based intervention strategies to address patients’ multidimensional needs, thereby enhancing self-management capacity and improving quality of life.

CRD42024607051.

Pain experienced during functional activities, referred to as movement-evoked pain (MEP), is a common and disabling symptom in individuals with knee osteoarthritis (KOA). Unlike pain at rest, MEP may better reflect the real-life burden of KOA and is increasingly recognised as a core outcome in musculoskeletal pain trials. However, its clinical utility remains limited by a lack of evidence on its measurement properties. This study aims to evaluate the test-retest reliability and validity of MEP assessments during functional tasks in individuals with KOA.

This study includes two components: (1) a test-retest reliability assessment conducted over two sessions separated by approximately 7 days and (2) a cross-sectional analysis of convergent validity. We will recruit 62 participants with symptomatic KOA from the local communities. MEP will be assessed using an 11-point Numeric Rating Scale during five standardised functional tasks: 30-Second Chair Stand Test, One-Step Stair Climb Test, 40m Fast-Paced Walk Test, Timed Up and Go Test and Six-Minute Walk Test. Test-retest reliability will be evaluated using intraclass correlation coefficients (ICC_3,1). Convergent validity will be assessed separately for each functional task by calculating correlation coefficients between MEP ratings and the pain subscale of the Knee injury and Osteoarthritis Outcome Score.

This study was approved by the Ethics Committee from Shanghai University of Sport (Ref: 102772025RT193). The study protocol was registered on the Open Science Framework (10.17605/OSF.IO/B9N7G). The findings will be disseminated through presentations at national and international scientific conferences and submitted for publication in a peer-reviewed journal.

Stroke is the leading cause of death and disability among adults in China, with a growing disease burden. Data from the China Stroke Prevention and Treatment Report 2023 show that the incidence rate of stroke in China is approximately 246.8 per 100 000 population, with over 2 million new cases annually. Among surviving patients, 60%–70% experience varying degrees of hand dysfunction after discharge, and only 10%–20% can recover to near-normal levels. As the most refined and core motor function of the human body, hand function recovery essentially reflects motor cortical neuroplasticity (synaptic remodelling and cortical reorganisation). Its recovery directly affects the independence of activities of daily living (ADLs) such as eating, dressing and personal hygiene, markedly reducing quality of life and increasing family care burden and social medical costs.

Currently, clinical rehabilitation interventions for patients who had a stroke are mostly concentrated during hospitalisation, focusing on acute-phase stability and basic function recovery. However, postdischarge rehabilitation follow-up coverage is fewer than 40%, and community rehabilitation resources are disparately distributed, leaving most patients facing the dilemma of ‘interrupted rehabilitation after discharge’. Additionally, existing studies mostly focus on short-term follow-up (3–6 months) and lack systematic investigation of the long-term trajectory of hand function recovery (6 months to 1 year), key turning points and influencing factors—especially the regulatory role of multidisciplinary intervention on neuroplasticity. The integrated ‘hospital-community-family’ multidisciplinary collaborative management model remains underdeveloped.

This study aims to describe the dynamic trajectory of hand function and overall rehabilitation outcomes in patients who had a stroke at 6 months and 1 year postdischarge, analyse the key influencing factors of hand function recovery (with a focus on the regulatory role of multidisciplinary collaborative intervention on motor cortical neuroplasticity), verify the effectiveness of the multidisciplinary collaborative management model on complications and rehabilitation satisfaction, and ultimately construct a continuous rehabilitation management model adapted to the current status of primary medical care in China.

A single-centre, prospective cohort study design will be used. A total of 120 patients who had a stroke with hand dysfunction discharged from the Department of Rehabilitation Medicine, The Second People’s Hospital of Hefei Guangde Road Campus between February 2026 and February 2027 will be enrolled. A multidisciplinary team (MDT) consisting of rehabilitation physicians, rehabilitation therapists, community doctors/nurses and family caregivers will be established to implement a three-stage intervention: discharge connection, community intervention and online support (incorporating neuroplasticity initiation, enhancement and maintenance strategies).

Hand function (primary outcome) will be assessed using the Fugl-Meyer Assessment for Hand (FMA-Hand) at baseline (1–3 days predischarge, T0), 3 months postdischarge (T1), 6 months postdischarge (T2) and 12 months postdischarge (T3). Secondary outcomes include overall motor function (FMA Total Score, FMA-Total) and ADL (Modified Barthel Index). Influencing factor data will be collected using structured questionnaires, and neuroplasticity will be indirectly evaluated using transcranial magnetic stimulation-derived motor evoked potentials.

SPSS V.26.0 software will be used for statistical analyses. Quantitative data will be expressed as (x±s) or (M (IQR)) depending on normality; categorical data will be presented as (n (%)). Repeated measures analysis of variance will compare functional changes across time points, and multiple linear regression will identify independent influencing factors of hand function recovery.

Patients will show progressive hand function recovery within 1 year after discharge, with the fastest recovery at 3–6 months and stabilisation from 6 to 12 months. Younger age, higher baseline function, better rehabilitation adherence and active multidisciplinary intervention are associated with greater neuroplasticity and better hand function recovery. The MDT model may reduce complications and improve rehabilitation satisfaction and ADL.

The results of this study will fill the data gap in long-term postdischarge rehabilitation trajectories of patients who had a stroke, clarify the regulatory role of multidisciplinary collaborative intervention on motor cortical neuroplasticity and provide scientific evidence and practical references for optimising postdischarge rehabilitation follow-up programmes and improving the primary rehabilitation service system.

This study was approved by the Biomedical Research Ethics Committee of The Second People’s Hospital of Hefei (No. 2024-KY-089). Written informed consent was obtained from all participants. The results will be published in peer-reviewed journals and disseminated to participants and community health institutions.

ChiCTR2600119007.

To explore patients’ experiences of discharge readiness following acute pancreatitis (AP) and to identify perceived barriers and facilitators influencing readiness for discharge during the transition from hospital to home.

A descriptive qualitative study guided by Meleis’ Transitions Theory.

Emergency and gastroenterology wards of Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

16 patients with AP were recruited; all 16 eligible patients approached agreed to participate (100% response rate).

Data were collected between December 2024 and January 2025 through semistructured in-depth interviews. Data were analysed using Elo and Kyngäs’s three-step qualitative content analysis framework, integrating conventional and directed content analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.

Patterns of response reflected variability in patients’ psychological adaptation during the transition process, including cognitive-emotional responses and relational interactions. Factors influencing discharge readiness were identified across three theoretical domains. Nature of Transitions captured the dynamics of self-management, including awareness, engagement and behavioural evolution. Transition Conditions reflected the complexity of socioecological determinants, including age and life stage, health literacy, financial resources and occupational and cultural influences. Nursing Therapeutics highlighted the discordance between professional support and patient needs, particularly in relation to information provision, dietary management and care continuity.

Building on Meleis’ Transitions Theory, this study provides an empirically grounded understanding of discharge readiness among patients with AP as a dynamic, multifactorial process. Our findings extend the theory by demonstrating that discharge readiness is shaped by the interaction between individual self-management, socioecological determinants, psychological adaptations and professional support. Addressing gaps in professional health information, personalised and structured dietary management and continuity of care is essential to enhance discharge readiness and support safe, sustainable recovery.

Chronic obstructive pulmonary disease (COPD) has an unpredictable clinical course, causing difficulties in short-term mortality prediction, overtreatment and delayed palliative care. Existing prediction models are limited and lack applicability to Chinese elderly patients with advanced COPD. Given the heavy disease burden and limited palliative care in China, we designed this multicentre cohort study to develop a 6-month mortality prediction model for elderly patients with advanced COPD to aid risk stratification, timely palliative care and efficient healthcare resource allocation.

Patient recruitment has been ongoing since May 2024 and will be completed by December 2026, with a 12-month follow-up to be completed by December 2027. Eligible patients are being enrolled, and multidimensional baseline data including demographic characteristics, clinical indicators, laboratory results, comprehensive geriatric assessment and COPD-specific prognostic factors are being systematically collected. All participants will receive 12 months of standardised follow-up (monthly for the first 6 months and quarterly thereafter) to monitor 6-month all-cause mortality (primary outcome), as well as survival duration, end-of-life healthcare utilisation and do-not-resuscitate status (secondary outcomes). After completion of data collection, we will employ multiple machine learning algorithms to develop and internally validate a 6-month mortality prediction model with pre-specified centres reserved for external validation. Model performance will be evaluated by discrimination and calibration and head-to-head comparisons with the Body Mass Index, Airflow Obstruction, Dyspnoea and Exercise Capacity (BODE) and Age, Dyspnoea and Airflow Obstruction (ADO) indices will be conducted to verify its clinical value. The findings will provide a China-specific prediction tool for elderly patients with advanced COPD to guide clinical intervention, palliative care referral and healthcare resource allocation.

This study was approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University (No. 2024-2662) and registered at ChiCTR2500100351. Informed consent is being obtained from all participants. Results will be published in peer-reviewed journals and presented at academic conferences.

ChiCTR2500100351.

Adolescent idiopathic scoliosis (AIS) requires long-term conservative management to prevent curve progression. While physiotherapeutic scoliosis-specific exercises, specifically the Schroth method, are considered the gold standard for conservative treatment, their clinical efficacy is often limited by accessibility barriers, high costs and suboptimal treatment adherence. This study aims to evaluate the efficacy of a novel artificial intelligence (AI)-based digital therapeutic system, which uses computer vision for remote, personalised posture analysis and adaptive exercise prescription compared with traditional outpatient Schroth therapy.

This parallel-group randomised controlled trial will be conducted at Guangzhou Women and Children’s Medical Center (Guangzhou, China). 300 adolescents aged 10–18 years with AIS who present with a Cobb angle between 10° and 30° and a Risser sign of 0–2 will be recruited and randomised in a 1:1 ratio into an intervention group and a control group. The intervention group will use a smartphone application to capture standardised bi-weekly images. These images will be processed by an AI algorithm to classify curve patterns and assign personalised exercise modules with adaptive dosing ranging from maintenance to high-intensity levels. The control group will receive standard outpatient Schroth care. The primary outcome is the absolute change in the major curve Cobb angle from baseline to 6 months. Secondary outcomes include the angle of trunk rotation, trunk appearance perception, Scoliosis Research Society-22 Revised (SRS-22r) quality-of-life scores and adherence rates. Statistical analysis will follow the intention-to-treat principle using linear mixed models to account for repeated measures.

Ethical approval has been obtained from the Medical Ethics Committee of Guangzhou Women and Children’s Medical Center (Guangzhou, China) (approval no. [2025]497A01). Written informed assent and consent will be obtained from participants and their legal guardians respectively. Results will be disseminated through peer-reviewed journals and international conferences.

ClinicalTrials.gov, NCT07341633.