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

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

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

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

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

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

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

CRD42024496083.

Stroke is one of the leading causes of disability and mortality worldwide, particularly in China, where it imposes significant economic and psychological burdens on patients and their families. Traditional in-hospital rehabilitation is often limited by resource constraints, leading to interruptions in weekend therapy, which can delay recovery. Remote rehabilitation platforms offer a potential solution by providing continuous, therapist-guided rehabilitation training during weekends. This study aims to evaluate the effectiveness of a remote rehabilitation training platform in improving motor function, self-efficacy and social participation in stroke patients while also assessing its impact on caregiver burden. The findings will provide evidence for the integration of remote rehabilitation into stroke care protocols, offering a scalable solution to enhance recovery and reduce societal costs.

A total of 168 stroke patients will be recruited from three hospitals in Shanghai and randomly assigned to either an intervention group or a control group. A remote rehabilitation platform will be used to perform guided exercises on weekends for the intervention group, whereas the control group will receive standard in-hospital rehabilitation. Primary outcomes will be assessed using the 10 metre walk test, and secondary outcomes will include the Barthel Index, Fugl–Meyer motor function assessment and Zarit Caregiver Burden Scale.

This study was approved by the Ethics Committee of the Institutional Review Board of Shanghai University of Traditional Chinese Medicine (Ethics Approval Number: 2024-2-14-01). All participants will provide written informed consent prior to enrolment. Trial results will be disseminated through peer-reviewed publications, presentations at international stroke and rehabilitation conferences, and engagement with patient advocacy groups. Findings will also be shared with healthcare policymakers to promote the integration of remote rehabilitation into clinical practice. Individual participant data will remain confidential and be stored securely in accordance with data protection regulations.

This trial was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR2500101741). The date of registration was 29 April 2025.

We aimed to understand the factors affecting psychological well-being of patients undergoing haemodialysis (HD). First, we explored how physical symptom severity, emotional distress and social support influence psychological well-being. Second, we examined the impact of different types of social support. Third, we investigated whether any variables mediate the relationship with psychological well-being.

A cross-sectional study, a type of observational design, was conducted on patients at a medical centre in Taiwan in 2020.

A total of 117 outpatients who had undergone regular HD for at least 3 months were enrolled.

The psychological well-being was assessed through self-report questionnaires.

We found that emotional distress (β=–0.25, p=0.033) had a significant negative impact on psychological well-being. However, the presence of appraisal support mitigated this effect. Specifically, appraisal support fully mediated the adverse impact of emotional distress on psychological well-being. In addition, the severity of physical symptoms was generally mild and did not influence psychological well-being.

Receiving appraisal support from family, friends and healthcare professionals not only alleviates emotional distress but also enhances psychological well-being both directly and indirectly among patients undergoing HD. Healthcare professionals should address issues of personal importance while serving as consultants, educators and evaluators to support patients in managing their chronic condition.

The burden of rheumatoid arthritis (RA) is profound, although treated with the treat-to-target strategy for RA patients according to the two most influential organisations for rheumatology worldwide. The need to timely achieve the control of disease activity for RA patients, especially for those difficult-to-treat individuals, is still unmet. Besides, the data on the diagnosis and prognosis of RA-related complications or comorbidities such as sarcopenia, cardiovascular diseases (CVD), malignancies and infections in large real-world cohorts are still limited. Therefore, the aim of this large-scale cohort study is to identify the development of clinical, biomedical, histopathological and imaging biomarkers for the diagnosis and prognosis of difficult-to-treat RA, and RA-related complications/comorbidities and to evaluate their impact on the prognosis of RA.

In this real-world multicentre prospective cohort, consecutive RA patients are planned to be recruited during 2024 and 2033 and with at least 5-year follow-up. Sociodemographic characteristics collection, clinical assessment, muscle assessment, histopathological assessment, imaging examination and biological samples collection will be performed at baseline, 1st, 3rd, 6th and 12th month during the first year and subsequently every 6 months until 5 years to repeat the assessments and collect the information of interested outcomes. The outcomes of interest include RA disease outcomes (including disease activity, functional and radiographic indicators) and RA-related complications/comorbidities (eg, sarcopenia, CVD, malignancies and specific infection).

Ethical approval has been approved by the Medical Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (ID: SYSKY-2023-1235-01); the Affiliated Panyu Central Hospital of Guangzhou Medical University (ID: PYRC-2024-214-01); and ShenShan Medical center, Memorial Hospital of Sun Yat-sen University (ID: 2024-SSKY-118-01). All study participants sign an informed consent form. Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.

NCT06233929.