This study aimed to investigate the impacts of chronic diseases such as hypertension, dyslipidaemia and diabetes on personal and household income among ageing Chinese adults. The primary hypothesis was that these chronic diseases have differential effects on the socioeconomic status of individuals and households, with gender and age influencing these relationships.

Prospective cohort study using double/debiased machine learning (DDML) techniques to analyse data from the China Health and Retirement Longitudinal Study (CHARLS).

Nationally representative sample of ageing Chinese adults, with data collected from multiple regions across China. The sample represents a variety of both urban and rural settings.

A total of 69 457 participants entered the study, with 69 457 completing it. The sample included both male and female participants, with the majority being of Han Chinese ethnicity. Participants were selected based on the presence of hypertension, dyslipidaemia and diabetes, and exclusion criteria included: no information on age (n=4307), no information on gender (n=12), no information on medical insurance (n=177).

The primary outcome measures, as outlined in the study protocol, were the associations between three chronic diseases (hypertension, dyslipidaemia and diabetes) and personal income (LPI) as well as household income (LHI). These associations were measured using the DDML method, which provided both overall measurements and gender-specific subgroup analyses. There were no significant deviations between the planned and actual outcome measures, and all outcomes were assessed as originally intended.

Dyslipidaemia was positively associated with LPI (coefficient=0.078, 95% CI 0.052 to 0.105) but negatively associated with LHI (coefficient=–0.049, 95% CI –0.084 to –0.015). Diabetes showed stronger positive effects on LPI (coefficient=0.093, 95% CI 0.052 to 0.135) and negative effects on LHI (coefficient=–0.094, 95% CI –0.147 to –0.041). Gender-specific analyses revealed that dyslipidaemia had a stronger association with LPI in males (95% CI 0.080 to 0.163) compared with females (95% CI 0.007 to 0.075). For diabetes, males experienced larger increases in LPI (95% CI 0.053 to 0.190) compared with females (95% CI 0.015 to 0.117). Additionally, reductions in LHI were more pronounced in females with diabetes (95% CI –0.187 to –0.043).

Chronic diseases, particularly dyslipidaemia and diabetes, significantly affect the socioeconomic status of ageing Chinese adults, with distinct gender-specific impacts. These findings highlight the importance of targeted interventions to address the income disparities linked to chronic diseases. Further research is needed to explore the long-term effects of disease management on socioeconomic outcomes.

Prospective, observational, community-based cohort study using 2011–2018 CHARLS data from 28 provinces in mainland China, with the registration number IRB00001052-11015, following ethical approval from the Biomedical Ethics Committee of Peking University.

Previous meta-analysis only focused on the safety and effectiveness of vagus nerve stimulation (VNS) in upper extremities motor function in stroke patients. The aim of this study was to systematically evaluate the efficacy and safety of VNS for more comprehensive functional rehabilitation in stroke patients.

This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The study protocol was registered in PROSPERO (CRD42024552624) and included randomised controlled trials (RCTs) investigating VNS-assisted rehabilitation in patients with stroke.

Searches were conducted in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database, covering the period up to October 2025.

We included studies in which the intervention group received VNS, while the control group received either sham stimulation or conventional rehabilitation alone. Studies were required to report efficacy outcomes (such as upper extremity motor function and swallowing function) as well as safety outcomes.

Two researchers independently performed literature screening, data extraction and quality assessment. A meta-analysis was conducted using RevMan V.5.4 (The Cochrane Collaboration, London, United Kingdom) and STATA V.18.0(StataCorp LLC, College Station, TX, USA), using the standardised mean difference (SMD) for continuous outcomes and applying a random-effects model. To explore potential sources of heterogeneity, sensitivity and subgroup analyses were performed, while publication bias was assessed using funnel plots and Egger's test.

Overall, 18 RCTs involving 954 participants were included in this study. This meta-analysis indicated that VNS could improve Fugl-Meyer Assessment of Upper Extremity (SMD=0.89, 95% CI 0.59 to 1.20, I²=64%, pI²=81%, p=0.005), Motor Activity Log (SMD=0.44, 95% CI 0.18 to 0.70, I²=0%, p=0.0008), swallowing function (SMD=0.62, 95% CI 0.12 to 1.11, I²=0%, p=0.01), extensor carpi radialis muscle strength (SMD=1.07, 95% CI 0.67 to 1.47, I²=0%, pI²=48%, p≤0.0006), Modified Barthel Index (SMD=0.95, 95% CI 0.48 to 1.42, I²=75%, pI²=0%, p=0.00009) in stroke patients compared with the control group. Quality assessment using the Cochrane Risk of Bias tool indicated that most studies had a low risk of bias. Publication bias was low, as indicated by symmetric funnel plots and Egger's test results (p>0.05 for all key outcomes). According to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, five outcomes (eg, swallowing function) were rated as high quality, while two (WMFT and spasticity) were rated as low quality. Sensitivity analysis confirmed that no single study significantly influenced the pooled results. Subgroup analysis identified stimulation modality, treatment duration, region and age as the main sources of heterogeneity in this study.

The evidence supporting the use of VNS to improve function in stroke patients demonstrates reasonable reliability, a satisfactory degree of consistency and applicability, and suggests a potentially favourable clinical impact.

Postoperative rehabilitation after anterior cruciate ligament reconstruction (ACLR) is crucial for functional recovery. Prehabilitation, performed before surgery, is considered to optimise the patient’s condition and improve postoperative outcomes. However, the evidence supporting the effectiveness of standardised prehabilitation protocols remains insufficient, particularly in comparison to conventional home rehabilitation programmes. This study aims to evaluate the impact of a 2-week standardised preoperative prehabilitation programme versus home rehabilitation training on perioperative functional outcomes and medium-term to long-term recovery in ACLR patients through a randomised controlled trial, providing evidence-based guidance for optimising rehabilitation pathways.

This study is a single-centre, prospective, assessor-blinded, randomised controlled trial. Eligible participants will be randomly assigned in a 1:1 ratio to the experimental group (receiving 2 weeks of standardised preoperative rehabilitation) or the control group (receiving 2 weeks of home-based rehabilitation training). Both groups will undergo 12 weeks of standardised rehabilitation postoperatively. The outcome measures include International Knee Documentation Committee Score (IKDC), Knee Injury and Osteoarthritis Outcome Score, Visual Analogue Scale, muscle strength, joint range of motion, anterior cruciate ligament-Return to Sport after Injury Index and Tegner score. The assessment time points are as follows: baseline (T0), 1–3 days preoperatively (T1), postoperative day 1 (T2), 30 days (T3), 90 days (T4), 180 days (T5) and 360 days (T6). All assessments will be performed at fixed time intervals within the same department of rehabilitation medicine, with the testing order randomised. The primary outcome (IKDC) will be analysed using a linear mixed model (LMM), including time, group and their interaction as fixed effects, with individuals as random effects. Secondary outcomes will be analysed using LMM, repeated measures analysis of variance or ² tests. Missing data will be handled using the multiple imputation method, under the assumption that data are missing completely at random and effect sizes will be evaluated using Cohen’s d (α=0.05).

This study has received approval from the Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University (Number: 2025012). All participants will provide written informed consent after reviewing documentation containing comprehensive details regarding the study procedures, risks and benefits, enabling informed decision-making about participation. The findings generated from this research will be disseminated via publication in an open-access, peer-reviewed journal and presented at relevant scientific conferences.

ChiCTR2500097293.

This study aimed to explore the mediating role of inspiratory muscle strength between abdominal obesity and lung function in young people.

Cross-sectional study.

This survey was conducted in Peking University Health Science Center, Beijing, China.

404 subjects aged 18 and older.

Forced expiratory volume in one second percent (FEV1%) predicted ≥80% was defined as the normal lung function.

A total of 404 subjects were included, with maximal inspiratory pressure of 65.27±29.55 cmH₂O. Among them, 61 subjects (15.10%) had central obesity, 106 subjects (26.24%) had a FEV1% predicted

This study highlighted the mediating role of inspiratory muscle strength between abdominal obesity and lung function.

Although a number of preclinical studies have demonstrated the therapeutic potential of puerarin for metabolic-associated fatty liver disease (MAFLD), there is a lack of high-quality clinical evidence. This study aims to evaluate the safety and efficacy of puerarin in patients with MAFLD in a randomised, controlled, crossover trial.

This study will use the randomised, double-blind, placebo-controlled crossover trial design. We plan to enrol 50 patients diagnosed with MAFLD, and they will be randomly assigned in a 1:1 ratio to receive either puerarin or placebo (maltodextrin) after a 2-week adaptation period. Participants in the two groups will receive the daily intervention of puerarin (180 mg/day) and placebo (180 mg/day) for 12 weeks, respectively. After a 4-week washout period, puerarin-treated and placebo-treated participants will cross over to receive the daily intervention of placebo and puerarin for 12 more weeks. The primary outcome measure will be defined as the changes in liver fat content, which will be assessed using MRI-proton density fat fraction before and after 12 weeks of puerarin or placebo supplement in patients with MAFLD. The secondary outcome measures include liver and kidney function changes, lipid metabolism indicators, blood glucose levels, iron metabolism parameters, blood routine, serum high-sensitivity C-reactive protein and anthropometric measurements. Additionally, alterations in gut microbiota composition and metabolic activity will be evaluated using 16S ribosomal RNA gene sequencing and liquid chromatography-mass spectrometry.

The study protocol has been approved by the ethics committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Approval Number 2024-1625-208-01). The findings will be published in international peer-reviewed journals and presented at relevant academic conferences.

The trial has been registered with the Chinese Clinical Trial Registry (ChiCTR2400094017).

Extensive progress has been made in improving pregnancy outcomes for in vitro fertilisation and embryo transfer (IVF-ET) patients through the use of electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS). However, a clear and suitable recommendation for the parameter selection scheme of EA/TEAS remains elusive.

To evaluate evidence-based conclusions of different EA/TEAS parameters on improvement of pregnancy outcomes in patients undergoing IVF-ET and evaluate other factors that may affect pregnancy outcomes.

This meta-analysis systematically searched eight databases from inception to 27 August 2024, focusing on randomised controlled trials (RCTs) that evaluated the effectiveness of EA/TEAS in improving IVF-ET outcomes, with the primary outcome defined as clinical pregnancy rate (CPR), and secondary outcomes including biochemical pregnancy rate (BPR) and live birth rate (LBR). We further explored CPR variations associated with EA/TEAS parameters: waveform (dilatational vs continuous wave), frequency (low vs high) and treatment duration (20, 25, 30, 40, 60 min). Additionally, seven subgroup variables were analysed to identify potential influencing factors: routine treatment, intervention dose, intervention modality, mean participant age, control type, randomisation risk and allocation concealment risk.

A total of 27 RCTs (3786 participants) were included, with the quality of evidence ranging from moderate to very low. Compared with control groups, the use of dilatational waves significantly increased CPR (RR=1.36, 95% CI [1.17 to 1.58], p2=0). Similarly, low-frequency currents demonstrated a significant positive association with CPR (RR=1.38, 95% CI [1.25 to 1.51], p2=0) and a treatment duration of 30 min per session was associated with elevated CPR (RR=1.30, 95% CI [1.19 to 1.42], p2=0). Subgroup analyses revealed that the effect of EA/TEAS on CPRs varied significantly depending on therapeutic dose (p=0.029), with stronger associations observed in studies involving patients receiving high therapeutic dose compared with those receiving low therapeutic dose.

Current evidence suggests that dilatational waves, low-frequency currents and 30-minute treatment duration may improve CPRs, though findings require validation in larger trials. While parameter optimisation shows promise, stronger evidence is needed before standardising protocols. Future research should focus on rigorous RCTs to determine optimal parameters and dose-response relationships.

Hyperosmolar therapy is crucial for the management of cerebral oedema and high intracranial pressure. Mannitol and hypertonic saline (HTS) at different concentrations are commonly used in clinical practice, but evidence of their use is mostly derived from studies about traumatic brain injury. The aim of this study was to evaluate the efficacy and safety of hyperosmolar therapy for severe aneurysmal subarachnoid haemorrhage (SAH).

This is a prospective multicentre observational study in which adult patients with severe aneurysmal SAH (Hunt–Hess score ≥3) will be enrolled. At least 124 patients will be enrolled over 2 years. Each enrolled patient will be treated in accordance with relevant management guidelines. The hypertonic agent used will be 20% mannitol (3 mL/kg) or 10% sodium chloride (HTS) (1 mL/kg). The choice and daily dose of the hypertonic agent will be determined by the attending doctor. The primary outcome will be the modified Rankin scale (mRS) score at 30 days after ictus. The secondary outcomes will be the mRS score at 6 months and the incidence of complications during hospitalisation, including phlebitis, acute kidney injury (AKI), hypokalaemia, hyperkalaemia, hyponatraemia, hypernatraemia, vessel spasm, delayed cerebral ischaemia (DCI), subdural effusion and hydrocephalus. An mRS score 0–2 will indicate a favourable outcome, whereas an mRS score 3–6 will indicate an unfavourable outcome. Logistic analysis will be performed to evaluate the association between the hyperosmolar agent and outcome (favourable or unfavourable).

The aim of this multicentre observational study is to provide evidence on the efficacy and safety of hyperosmolar therapy for severe aneurysmal SAH.

This study was approved by the Ethics Committee of Xuanwu Hospital (approval date: 10 July 2023) under protocol V.2.0 (version date: 26 April 2023) (reference number: [2023]086). The results will be published in a peer-reviewed journal and reported at relevant professional conferences.

NCT05858060.

To develop and validate a machine learning model for precise risk stratification of postpancreaticoduodenectomy haemorrhage (PPH), enabling early identification of high-risk patients to guide clinical intervention.

Retrospective international multicentre cohort study with model development and external validation.

Training data from the American College of Surgeons-National Surgical Quality Improvement Program database (USA, 2014–2017) and external validation data from the National Cancer Center (China, 2014–2019).

3609 patients in the training cohort and 1347 in the validation cohort undergoing pancreaticoduodenectomy. Patients with missing data or non-relevant variables were excluded.

Primary outcome: clinically relevant PPH (International Study Group of Pancreatic Surgery grades B/C). Secondary outcomes: model discrimination (area under the curve (AUC)), calibration (Hosmer-Lemeshow test), clinical utility (decision curve analysis) and risk stratification performance.

The least absolute shrinkage and selection operator (Lasso)-gradient boosting machine model identified eight predictors: albumin, haematocrit (HCT), American Society of Anesthesiologists (ASA) class, operative time, vascular resection, sepsis, reoperation and pancreatic fistula. It achieved AUCs of 0.84 (95% CI 0.82 to 0.86) in training and 0.82 (95% CI 0.78 to 0.85) in validation, outperforming logistic regression and other machine learning models. Risk stratification into low-risk, medium-risk and high-risk groups showed strong discriminatory power (AUCs: 0.72–0.75). Decision curve analysis confirmed net clinical benefit, and SHapley Additive exPlanations values highlighted HCT and operative time as top contributors. The model was deployed as an interactive application for real-time risk assessment.

This novel machine learning model for PPH prediction integrates interpretable risk stratification and demonstrates robust performance across international cohorts. Its deployment as a clinical tool may facilitate proactive management of high-risk patients. Prospective validation is warranted prior to broad implementation.

This study addresses the limited evidence of the impact of product characteristics on demand for and the substitutability of electronic cigarettes (e-cigarettes) or heated tobacco products for combusted cigarettes among people who smoke and have newly begun to use e-cigarettes.

A sample of 318 adults who smoke and recently initiated/reinitiated e-cigarette use participated in an online volumetric choice experiment in 2020–2021 to assess stated preferences for consumption and own and cross-price elasticities of three e-cigarette options (cig-a-like, vape pen or tank, closed pod system), heated tobacco product (IQOS) and their usual brand of cigarettes. Product attributes manipulated were price, flavour, level of harm, how well the product reduces cravings to smoke, and how discretely the product can be used. Multilevel zero-inflated negative binomial models were used to model the purchased quantities.

Cigarettes were preferred over all alternatives. However, demand for cig-a-likes, but not IQOS, increased when cigarette prices were higher. Higher prices for e-cigarettes and IQOS did not increase demand for cigarettes. The odds of buying e-cigarettes/IQOS were higher when their harm was stated as low or unknown versus being similar to cigarettes (ie, very high). Other attributes (including various flavour options) were not significantly associated with demand for e-cigarettes or IQOS.

People who smoke and recently began using e-cigarettes might substitute cig-a-likes for cigarettes when cigarette prices are higher. Policies to increase the cost of combusted cigarettes as well as communicate lower relative harm and low absolute harm of e-cigarettes may facilitate switching behaviour.