Conectar
by Kerong Wang, Guoliang Li, Xiuci Yang, Meiling Ji, Shuainan Hong, Cong Liu, Mengyao An, Jiangning Yin
ObjectiveThis study aims to find a quick bedside ultrasonography evaluation technique that evaluates the optic nerve sheath diameter to eyeball transverse diameter (ONSD/ETD) ratio and middle cerebral artery (MCA) flow parameters at 6 hours post-return of spontaneous circulation (ROSC) for early neurological prognosis.
MethodsThis retrospective study included 49 patients who achieved return of spontaneous circulation (ROSC) and were admitted to our emergency department between September 2023 and September 2025. Collected data encompassed baseline characteristics, GCS-M scores, APACHE-II scores, and bedside ultrasound measurements of ONSD, ONSD/ETD at 6, 24, and 48 hours post‑ROSC and middle cerebral artery hemodynamic parameters at 6, 24 hours post‑ROSC. The statistical analyses included the Mann-Whitney U test, t-test, and Receiver Operating Characteristic (ROC) curve analysis.
ResultsThe ONSD/ETD ratio at 6 hours post-ROSC was a robust predictor of unfavorable neurological outcomes (AUC 0.922, P = 0.001), outperforming ONSD alone (AUC 0.866, P = 0.003), with an optimum threshold of 0.256 (sensitivity 76.5%, specificity 100%). The ONSD/ETD ratio was a significant predictor of CPC scores (OR = 1.979, P = 0.010). Although the majority of middle cerebral artery hemodynamic measures revealed no significant changes, all patients displaying cerebral circulatory arrest (CCA) waveforms or advancing to such waveforms demonstrated a dismal neurological prognosis. The alteration in Pulsatility Index (PI) was borderline significant (P = 0.05), with a threshold of 0.269 (AUC 0.90, sensitivity 80%, specificity 100%).
ConclusionThe ONSD/ETD ratio assessed six hours after cardiac arrest accurately forecasts neurological prognosis, especially for unfavorable results (CPC 4–5). Transcranial Doppler can continuously monitor patients exhibiting an increased pulsatility index or identified cerebral circulatory arrest waveforms. The integration of various methodologies for dynamic evaluation enhances risk categorization and aids clinical decision-making for patients who attain ROSC. However, these findings are preliminary and require validation in larger cohorts.
Colorectal cancer (CRC) is the third leading cause of new cancer cases and the second leading cause of cancer-related deaths worldwide. Current therapeutic modalities for CRC include surgical resection, intravenous chemotherapy (IVC), radiotherapy, immunotherapy, targeted therapy and their combinations. As a mainstream systemic treatment for CRC, IVC leads to widespread drug distribution but relatively low intratumoural drug accumulation. Compared with IVC, transarterial infusion chemotherapy (TAIC) involves selective arterial catheterisation to deliver chemotherapeutic agents directly to the tumour feeding vessels. Hepatic tumours receive their blood supply predominantly through branches of the hepatic artery. Hepatic artery infusion chemotherapy (HAIC) yields significantly superior outcomes compared with IVC and is currently widely employed for the treatment of primary and secondary hepatic malignancies. HAIC in combination with IVC can offer long-term durable disease control in the clinical treatment of liver cancer compared with IVC. CRC is also predominantly grown through angiogenesis. Therefore, we raise the question whether sequential IVC administered after intensive TAIC achieves better clinical efficacy than IVC alone for the treatment of unresectable CRC (uCRC). However, no prospective clinical trials have been conducted to compare the efficacy of these two strategies. This prospective study was therefore designed to fill this clinical knowledge gap.
This is a prospective, multicentre, randomised, open-label clinical trial. The uCRC is defined as inability to achieve an R0 resection owing to locally advanced CRC with clinical T4 disease confirmed by MRI or CT and/or synchronous liver metastases. This study only includes microsatellite stable or proficient mismatch repair uCRC. A total of 50 eligible patients will be randomly assigned to either the IVC group or the TAIC group. Patients in the IVC group will receive FOLFOX (fluorouracil, leucovorin, oxaliplatin)-based IVC every 2 weeks for a total duration of 8 weeks. Patients in the TAIC group will receive FOLFOX-based TAIC at week 0 and week 4 and receive FOLFOX-based IVC at week 2 and week 6. For patients with colorectal liver metastases, cetuximab or bevacizumab will be administered according to the RAS and BRAF status and the primary tumour site. The primary endpoint is the objective response rate. This study is scheduled to commence on 10 January 2026, and complete follow-up on 31 December 2027. The first subject was enrolled on 20 March 2026. To date, one subject in the IVC group and six subjects in the TAIC group have been enrolled.
The present study protocol has been approved by the Medical Ethics Committee of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (ethical approval number 2025-268 KY). On completion of the study, data cleaning and analysis will be performed, and the results will be disseminated at academic conferences and in international peer-reviewed journals. This trial has been registered at ClinicalTrials.gov. The statistical analysis plan will be finalised and approved before the database lock. The final version is retained in the study documentation and will be made available to support the transparency and interpretation of the study results.
Fibromyalgia (FM) is a prevalent chronic pain condition that significantly impairs quality of life. The current treatments for FM still have some disadvantages and limitations. Pregabalin, a standard pharmacological treatment, provides relief for some patients but is associated with dose-dependent adverse events (AEs) and incomplete efficacy, highlighting a significant unmet clinical need. Mirogabalin, as a novel α2 ligand similar to pregabalin but with distinct binding properties, has shown a favourable safety profile and potential analgesic effects in preclinical studies and trials for other neuropathic pain conditions. However, data on its efficacy in FM are limited and no studies have directly compared mirogabalin with pregabalin in an Asian FM population.
This is a prospective, multicentre, randomised, open-label, blinded endpoint trial to compare the efficacy and safety of mirogabalin versus pregabalin for the management of pain and other core symptoms in adult patients with FM. This study will be conducted at the Department of Pain Management, Beijing Tiantan Hospital, the First Affiliated Hospital of Nanchang University, Chongqing University Three Gorges Hospital, the First Affiliated Hospital of Army Medical University and the Affiliated Hospital of Yanbian University. Patients aged over 18 years, diagnosed with FM according to the 2016 Revisions to the 2010/2011 FM diagnostic criteria, will be enrolled. 674 qualified patients experiencing moderate-to-severe FM will be randomly assigned to either the pregabalin group or the mirogabalin group in a 1:1 ratio. Treatment will involve individualised dose titration based on treatment response and tolerability. All participants will be followed for a duration of 12 weeks. The primary outcome will be the proportion of patients achieving a pain reduction of at least 50% at 12 weeks. Secondary endpoints will include the average pain intensity, the worst pain intensity, the Revised FM Impact Questionnaire, the Brief Pain Inventory severity and interference subscales, the Short-Form 36 Health Survey, the Medical Outcomes Study Sleep Scale, the Beck Depression Inventory-II, AEs throughout the study. An open-label administration is selected to reflect real-world clinical practice and to allow individualised dose titration according to tolerability and response, while blinded endpoint assessment is implemented to minimise evaluation bias and preserve methodological rigour.
This study was approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University (KY2025-217-03), the First Affiliated Hospital of Nanchang University (IIT (2026) Clinical Ethics Review no. 676), Chongqing University Three Gorges Hospital (2026 Scientific Ethics Review no. 41), the Affiliated Hospital of Yanbian University (Yan Medical Ethics no. 20260275) and the First Affiliated Hospital of Army Medical University (AIIT2026081KX). All participants will provide written informed consent prior to enrolment. This study will be conducted in accordance with the Declaration of Helsinki. Findings from this study will be disseminated through peer-reviewed journals and at scientific conferences.
Recanalisation rates following standard intravenous thrombolysis (IVT) for acute ischaemic stroke due to medium or large vessel occlusion (MeVO/LVO) remain unsatisfactory, leading to poor clinical outcomes. Tenecteplase (TNK), a fibrin-specific thrombolytic agent, demonstrates potential advantages over alteplase, including higher recanalisation rates in LVO. Preliminary evidence suggests that a second dose of thrombolytic in patients with persistent vessel occlusion after initial IVT may be feasible and beneficial. This study aims to evaluate the efficacy and safety of a second intravenous dose of TNK administered to patients with acute anterior and posterior circulation MeVO/LVO who have not recanalised 1 hour after standard IVT.
RITIS-TNK2 is a prospective, randomised, open-label, blinded endpoint, multicentre, superiority trial. Eligible patients will be randomly assigned (1:1) to receive a second dose of TNK (0.25 mg/kg intravenously, capped at a maximum total dose of 16 mg) plus standard medical care or standard medical care alone. The primary efficacy outcome is the recanalisation rate of the occluded artery at 24 hours after randomisation. The primary safety outcome is symptomatic intracranial haemorrhage within 24 hours. Secondary outcomes include functional status at 90 days (modified Rankin Scale score). The expected recanalisation rate at 24 hours in the control group is estimated at 45%. We hypothesise rescue TNK will raise 24-hour recanalisation rate from 45% to 65%, representing an absolute 20 percentage-point improvement and a relative 44.4% increase. A maximum of 198 patients are required to test the superiority hypothesis with 80% power according to a two-sided 0.05 level of significance.
This study has been approved by the central Institutional Review Board (General Hospital of Northern Theater Command; IRB: Y (2025) 502). The study results will be disseminated through peer-reviewed journals and presentation at relevant national and international scientific conferences, regardless of the direction of the findings.
Fibrosing interstitial lung diseases (F-ILD) affect substantial patient populations with significant mortality and socioeconomic burden. Approximately one-third of patients with F-ILD develop a progressive fibrosing phenotype with poor outcomes. Current monitoring methods, including pulmonary function testing and high-resolution CT (HRCT), often lag behind increases in fibrotic activity, limiting early risk identification and optimal treatment timing. Fibroblast activation protein (FAP) imaging can capture fibrotic activity at the pathological level. This study aims to evaluate the incremental value of ⁹⁹Tc-FAPI single-photon emission CT (SPECT)/CT for early warning of disease progression in F-ILD and develop a predictive model integrating fibroblast activation protein inhibitor (FAPI) quantitative parameters with clinical variables.
This prospective, single-centre, observational cohort study will recruit 380 adult patients with confirmed F-ILD diagnoses from December 2024 to June 2027, with 12-month follow-up. Comprehensive baseline evaluation includes pulmonary function testing, 6-min walk test, laboratory investigations and ⁹⁹Tc-FAPI SPECT/CT imaging. Follow-up visits at 3, 6 and 12 months will assess clinical outcomes. The primary outcome is disease progression within 12 months, defined as ≥5% forced vital capacity decline, ≥10% diffusing capacity of the lungs for carbon monoxide decline, increased fibrosis on HRCT, acute exacerbation or death. Cox proportional hazards regression models will be used for predictive model construction, with internal validation using bootstrap resampling and temporal split methods.
The study protocol has been approved by the Ethics Committee of Fujian Provincial Hospital (K2024-11-010) and will be conducted according to the Declaration of Helsinki and Good Clinical Practice guidelines. Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publications and academic conference presentations. De-identified individual participant data will be available upon reasonable request after primary publication.
Chinese Clinical Trial Registry ChiCTR2400093808.
Knee osteoarthritis (KOA) is a chronic disease that affects physical function, psychological well-being and has an impact on quality of life (QoL). Despite efforts to monitor QoL of patients with KOA, patient-reported outcome measures (PROMs) developed based on the comprehensive framework of the International Classification of Functioning, Disability and Health (ICF) remain limited. This protocol presents the phases of the development of a comprehensive KOA-specific PROM based on the ICF system
This study follows the Patient-Reported Outcomes Measurement Information System (PROMIS) scientific standards for instrument development and validation. A qualitative phase, involving a systematic literature review and focus group interviews, will be conducted to establish the conceptual framework. A standardised item pool will be generated based on the ICF framework using refined ICF linking rules and thematic analysis. A modified Delphi process will be performed with a multidisciplinary expert panel to refine the items and establish the initial version, with consensus evaluation via a 4-point rating scale. Item reduction and psychometric evaluation will be informed by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline.
This study received ethical approval (K2024-082-01) from Tongren Hospital, Shanghai Jiao Tong University School of Medicine. Results from this cohort will be submitted to peer-reviewed scientific journals and reported at the leading national and international meetings in the field.
Hepatic encephalopathy (HE) is a major complication following transjugular intrahepatic portosystemic shunt (TIPS) placement, significantly affecting patients’ quality of life and long-term prognosis. This study aims to compare the efficacy of underdilated TIPS versus standard TIPS in preventing variceal rebleeding in patients with cirrhosis and portal hypertension and to evaluate the incidence of post-procedural HE.
This multicentre randomised controlled trial will be conducted across five Grade A tertiary hospitals in China. A total of 648 patients with portal hypertension-related oesophagogastric variceal bleeding undergoing TIPS will be enrolled and randomly assigned in a 1:1 ratio to either the experimental or control group. In the experimental group, underdilated TIPS will be performed using 6 mm balloon for stent expansion. In the control group, standard TIPS will be performed using progressive balloon dilation, starting at 8 mm and increasing stepwise as needed until the portosystemic pressure gradient is reduced to
The study protocol (V.2, 1 July 2025) has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Air Force Medical University (Approval No.: KY20252233-F-2). Written informed consent will be obtained from all participants prior to enrolment. Findings will be presented at academic conferences and published in peer-reviewed journals.
ChiCTR2500110490; NCT07253389.
To identify latent profiles of perceived workplace violence climate (PWVC) among nurses in tertiary hospitals and explore central network characteristics across profile groups.
A cross-sectional study.
A multicentre cross-sectional study was conducted from July to September 2023 among 2064 nurses from eight tertiary hospitals across eight provinces in China. Data were collected using the Nurses' PWVC Scale, Clinical Communication Ability Scale, and Emotional Intelligence Scale. Latent Profile Analysis (LPA) identified heterogeneous subgroups, multinomial logistic regression examined factors associated with profile membership, and network analysis explored central and bridge nodes.
The prevalence of workplace violence (WPV) exposure was 82.4%. Three distinct PWVC profiles were identified: Vulnerable-Sensitive (17.0%), Stable-Perceptive (48.3%), and Resource-Empowered (34.7%). Nurses classified within the Resource-Empowered profile generally demonstrated higher emotional intelligence, stronger communication ability, better health status, and more frequent participation in violence-prevention training. Network analysis identified profile-specific central nodes, including violence-prevention visibility, management responsiveness, and post-incident managerial support, while individualised risk assessment emerged as a key bridge node across networks.
PWVC among nurses demonstrates substantial heterogeneity across profile groups. Findings suggest that organisational strategies addressing management responsiveness, violence-prevention visibility, and individualised risk assessment may help strengthen perceived workplace safety, particularly among nurses with less favourable perception profiles.
This study identifies distinct violence climate profiles among nurses and highlights several central network components that may represent potential organisational intervention targets. These findings may support the development of more tailored workplace violence prevention strategies within nursing management contexts.
No patient or public contribution.
by Hui-ling Yan, Jia-yu Fu, Mao-ting Huang, Wen-ting Yi, Jia-jun Liu, Xiao-yan Huang, Yao Fang, Ling Zhao, Yun-shan Chen, Ying Zeng
BackgroundInadequate bowel preparation (IBP) can impair the safety, efficiency, and diagnostic accuracy of colonoscopy. Numerous multivariable prediction models have been developed to identify patients at high risk of IBP, yet their reported performance varies substantially.
ObjectivesTo systematically evaluate the predictive performance and methodological quality of existing risk prediction models for IBP before colonoscopy.
MethodsPubMed, Embase, Web of Science, the Cochrane Library, CINAHL, CNKI, Wanfang, and VIP were systematically searched from inception to December 16, 2024, and updated on December 16, 2025. Data extraction was guided by the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals from internal and external validations were pooled separately using random-effects models (Stata 18). Risk of bias and applicability were evaluated with PROBAST. The protocol was registered in PROSPERO (CRD42024627756).
ResultsThirty-one studies reporting 46 prediction models were included, with sample sizes ranging from 152 to 23,456 participants and IBP event incidence rates of 6.3%–50.0%. Frequently used predictors included constipation, diabetes, age, body mass index (BMI), and history of colorectal surgery. Pooled AUCs were 0.76 (95% CI: 0.73–0.79) for internal validation and 0.72 (95% CI: 0.68–0.76) for external validation, both with substantial heterogeneity (I² > 90%). External validation was reported in ten studies, comprising 15 external validation cohorts, including four independent external validation studies of previously published models. Calibration was infrequently reported. Most studies were at high risk of bias, mainly in the analysis domain, while applicability concerns were generally low.
ConclusionsExisting IBP prediction models show moderate to good discrimination on average, but pooled estimates are accompanied by substantial heterogeneity and widespread risk of bias, and robust external validation remains limited. Future studies should standardize outcome definitions and reporting and conduct large, multicenter, independent external validations to improve clinical utility.
by Koki Nambu, Naoki Kaneko, Shiho Yokomizo, Hu Chen, Lijing Yan, Wang Shiyao, Ryusei Shizuma, Eiji Iwata, Yukiko Ohyama, Shohei Akagawa, Soichiro Ibaragi, Shintaro Kawano, Masafumi Moriyama
Oral lichen planus is a chronic inflammatory disease of the oral mucosa characterised by immune dysregulation, but its pathogenesis remains incompletely understood and no curative treatment has been established. Our previous work showed that patients with oral lichen planus exhibit gut dysbiosis, including reduced microbial diversity and depletion of butyrate-producing bacteria. Because butyrate promotes regulatory T-cell differentiation and supports immune homeostasis, targeting this dysbiosis may represent a microbiota-directed approach for immune modulation in oral lichen planus. This study aims to investigate the effects of inulin supplementation on the gut microbiota and related immune markers in patients with oral lichen planus. This multicentre, double-blind, randomised, placebo-controlled parallel-group trial will enrol 80 patients with oral lichen planus. Participants will be randomly assigned in a 1:1 ratio to receive either inulin (8 g/day) or a maltose placebo for 4 weeks, in addition to standard care. The primary outcome is the change in the relative abundance of prespecified butyrate-producing gut bacteria from baseline to the end of intervention at Week 6. Secondary outcomes include changes in gut microbiota diversity, salivary microbiota composition, faecal short-chain fatty acid concentrations, peripheral blood regulatory T-cell counts, blood test parameters, and clinical symptoms of oral lichen planus. Analyses will follow the intention-to-treat principle, and between-group differences will be assessed using appropriate statistical methods. This trial is designed to evaluate, in a randomised placebo-controlled setting, whether a microbiota-directed intervention can modify gut microbial profiles and related immune markers in patients with oral lichen planus. The findings are expected to clarify whether inulin supplementation can modify gut microbial profiles and related immunological markers in patients with oral lichen planus. Trial registration: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000060840, registered on 1 April 2026 (https://rctportal.mhlw.go.jp/detail/um?trial_id=UMIN000060840#).To identify latent fatigue profiles in adolescent and young adult (AYA) cancer patients and explore associated clinical and socioeconomic factors to guide precision nursing.
A cross-sectional observational study.
A total of 218 AYA cancer patients were recruited from a tertiary cancer center between December 2025 and February 2026. Latent Profile Analysis was used to identify fatigue subgroups based on the Piper Fatigue Scale-Revised. Multinomial logistic regression was applied to examine correlates.
Three distinct profiles emerged: ‘Low-Fatigue Well-Adapted’ (32.6%), ‘High-Fatigue Somatic-Dominant’ (38.1%), and ‘High-Fatigue Emotional-Cognitive Exhaustion’ (29.4%). The Somatic-Dominant group exhibited severe sensory fatigue but mild distress, strongly associated with chemotherapy (OR = 2.42, 95% CI: 1.03–5.68, p = 0.041) and non-working status (OR = 3.02, 95% CI: 1.38–6.58, p = 0.006). Conversely, the Emotional-Cognitive Exhaustion group showed severe affective and cognitive exhaustion. This profile was significantly linked to active chemotherapy (OR = 4.95, 95% CI: 1.98–12.38, p < 0.001), lower income levels (higher income: OR = 0.52, 95% CI: 0.38–0.71, p < 0.001), and gastrointestinal cancer (OR = 3.15, 95% CI: 1.12–8.85, p = 0.029).
Fatigue in AYA patients appears highly heterogeneous, manifesting either as somatic-dominant patterns potentially associated with chemotherapy or multidimensional exhaustion linked to survival and economic pressures.
Nursing practice should transition from a uniform approach to phenotype-based precision symptom management. Patients with somatic-dominant fatigue require physical rehabilitation, whereas those experiencing emotional-cognitive exhaustion urgently need integrated nutritional, psychological, and socioeconomic support to mitigate their multidimensional burden.
What problem did the study address? ○
The study addressed the limitation of treating cancer-related fatigue as a uniform symptom in AYA patients, which masks individual variability and the hidden burden of chronic socioeconomic constraints.
What were the main findings? ○
Three distinct fatigue phenotypes were identified, revealing significant symptom heterogeneity. Severe emotional-cognitive exhaustion was strongly linked not only to chemotherapy but also to chronic economic constraints of maintaining employment while ill.
Where and on whom will the research have an impact? ○
This research will impact oncology nurses, social workers, and clinical policymakers globally by providing an evidence-based framework for precision symptom management and targeted socioeconomic interventions for vulnerable AYA cancer survivors.
This study adhered to the STROBE reporting guidelines for cross-sectional studies.
No patient or public contribution.
To explore how Chinese women with gestational diabetes mellitus understand and navigate dietary management within family power dynamics and the factors influencing these management practices.
Interpretative Phenomenological Analysis.
Fifteen women with gestational diabetes were purposively recruited from two tertiary hospitals in Jiangsu Province, China. Semi-structured interviews and participant-provided artefacts were collected between April and July 2025. Data were analysed using Interpretative Phenomenological Analysis, supplemented by metaphorical methods.
Five themes were identified, which included four interactional states of dietary management within family power dynamics: (1) Passive Compliance (Sailing with the current); (2) Strategic Compliance (Sailing over hidden undercurrents); (3) Mild Resistance (Rowing against the tide); (4) Collaborative Negotiation (Charting the course together). The fifth theme, Determinants (The riverbed shaping the flow), described factors influencing shifts across these states, including individual willingness, management capability and family power structures.
Dietary management in gestational diabetes mellitus is not merely an individual health behaviour but a dynamic process shaped by shifting family power dynamics. This perspective helps to explain differences in management and offers a novel framework for family-centered, culturally adaptable interventions in collectivist settings.
People's choices, including their personal experiences, perceived risks and individual values, were shaped by family power dynamics. Recognizing these factors is essential in improving patient-centered care and shared decision-making. Nurse-led patient education should identify women's current interactional states in dietary management and tailor support accordingly.
There is limited evidence exploring the experiences of women with gestational diabetes managing their diet within family power dynamics. This enriched understanding supports improvement of the care pathway and service delivery for these women and their families.
COREQ.
No patient or public contribution.
by Yi Zhang, Yao Yu, Bin Ge, Dacai Gong, Lan Zheng, Yuanyi Wang, Peng Chen
BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) affects 25–38% of the global population, yet the contribution of environmental polyethylene terephthalate (PET) microplastics to its pathogenesis remains unclear. PET microplastics accumulate in the liver at approximately 4.6 particles per gram of tissue and have been implicated in metabolic disturbance, oxidative stress, and inflammation, but their molecular targets and mechanisms in MASLD are not well defined.
MethodsWe integrated three GEO microarray cohorts (GSE37031, GSE63067, GSE89632) and performed differential expression analysis, weighted gene co-expression network analysis (WGCNA), and PET target prediction using ChEMBL, PharmMapper, and SwissTargetPrediction. Functional enrichment, protein-protein interaction network analysis, CIBERSORT-based immune deconvolution, molecular docking, and 100 ns molecular dynamics simulations were employed to identify and validate hub genes.
ResultsIntegration of MASLD transcriptomes and PET target predictions yielded 19 overlapping genes enriched in pathways related to lipid metabolism, fatty acid degradation, glycolysis/gluconeogenesis, and chemical carcinogenesis. Network topology consistently highlighted FABP4, PTGS2, and HPGD as central hub genes. Immune deconvolution revealed MASLD-associated alterations characterized by increased M2 macrophages and γδ T cells, with decreased monocytes, dendritic cells, and naive B cells. PTGS2 and FABP4 expression showed strong correlations with innate immune cells. Molecular docking demonstrated favorable PET binding to all three proteins (–6.3 to –6.9 kcal/mol), and molecular dynamics simulations confirmed stable complexes over 100 ns, with predominantly hydrophobic interactions.
ConclusionsThrough integrated bioinformatics analysis and molecular simulation, this study identifies FABP4, PTGS2, and HPGD as potential molecular targets through which PET microplastics may influence lipid metabolism, prostaglandin signaling, and innate immune responses in MASLD. Molecular docking and dynamics simulations suggest favorable binding interactions between PET and these proteins.
Respiratory syncytial virus (RSV) is an important viral pathogen in children, older adults and adults with certain high-risk conditions. In our prospective community-based cohort study of adults 50 years and older before the COVID-19 pandemic, the incidence of RSV acute respiratory infection (ARI) was 48.6 cases/1000 person-years (PY), which decreased to near zero during the COVID-19 pandemic. Our objective was to determine the incidence of RSV-ARI during the 2 years following the initial phase of the pandemic (2021–2022 and 2022–2023).
This is a community-based prospective cohort study.
Adults living in southeast Minnesota from October 2021 to September 2022 (year 3) and October 2022 to September 2023 (year 4).
Adults≥50 years (n=2500).
We calculated incidence and attack rates for RSV-ARI as primary outcome and reported hospitalisations, pneumonia and death following ARI as secondary outcome.
There were 2500 participants in the study with a mean age of 68.2 years (SD 9.3) at the start of year 3. Participants were predominantly female (60%), non-Hispanic white (96%) and residing in urban areas (76%). The incidence rate of RSV-ARI was 6.12/1000 PY (95% CI 3.42 to 10.09) in 2021–2022 and 16.40/1000 PY (95% CI 11.66 to 22.42) in 2022–2023. We noted higher attack rates of RSV-ARI during the winter months. There were no hospitalisations, pneumonia or deaths within 30 days of RSV-ARI.
Compared with the period before the COVID-19 pandemic, RSV-ARI incidence was lower in both 2021–2022 and 2022–2023 periods. In 2022–2023, the incidence increased 2.7-fold compared with the 2021–2022 period. The observed incidence rates, particularly the significant increase in the most recent season, underscore the continued public health relevance of RSV-ARI and support the rationale for ongoing RSV vaccination efforts to mitigate its overall burden in the population.
To identify latent profiles of job demands, job resources and personal resources among hospital nurses based on the Job Demands-Resources model, and to examine whether these profiles differed in multidimensional work fatigue and demographic and occupational characteristics.
A cross-sectional survey study.
An online survey was conducted with clinical nurses in tertiary public hospitals in Jiangsu Province, China, between February and April 2024. Latent profile analysis was performed using seven standardised Job Demands–Resources indicators. Overall, physical, mental and emotional work fatigue were compared across profiles. Multinomial logistic regression was used to explore demographic and occupational correlates of profile membership. The study was reported in accordance with the STROBE guideline for cross-sectional studies.
Among 1804 nurses, three profiles were identified: Balanced Neutrals, Strained Survivors and Resilient Achievers. Strained Survivors were characterised by higher non-clinical work stress and work-to-family conflict, together with lower organisational identification, work-to-family facilitation, work-related meaning and self-efficacy. This profile reported the highest overall, physical, mental and emotional fatigue. Resilient Achievers showed the most favourable demand–resource configuration and the lowest fatigue, while Balanced Neutrals showed intermediate patterns. Profile membership was associated with employment type, age, gender, professional title, managerial role and clinical department.
Hospital nurses experience distinct demand–resource configurations that correspond to meaningful differences in multidimensional work fatigue. A person-centred Job Demands–Resources approach can support more targeted identification of fatigue risk.
Profile-informed strategies may help create healthier nursing work environments by identifying nurses who require demand reduction, work–family support, resource rebuilding or preventive monitoring.
This study addresses the tendency to treat nurses' work fatigue risk as uniform. The findings show that fatigue aligns with distinct configurations of job demands, job resources and personal resources, supporting profile-informed rather than one-size-fits-all healthy work environment strategies.
Reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
Spinal cord injury (SCI) frequently results in severe neurological impairment due to neural tissue destruction and scarring, representing a substantial and increasing global health burden. Current standard treatments primarily focus on preventing secondary complications but offer limited efficacy in repairing neural circuits or reversing neurological deficits. Stem cell transplantation, particularly using induced pluripotent stem cell (iPSC)-derived therapies, presents a regenerative strategy that avoids the ethical constraints associated with embryonic stem cells while providing a scalable source for cellular therapeutics. Specifically, allogeneic, ‘off-the-shelf’ iPSC-derived motor neuron progenitors offer a standardised and scalable approach, supported by a dual therapeutic mechanism observed in preclinical models.
This is a prospective, multicentre, open-label, single-arm clinical study involving 12–24 adult patients with subacute SCI. To evaluate safety and tolerability, the trial is structured into sequential Single Ascending Dose (SAD; n=6–12) and Multiple Ascending Dose (MAD; n=6–12) phases. Both phases employ a standard ‘3+3’ dose-escalation design across two dose levels (level 1: 5x10⁷ cells/dose; level 2: 1.5x10⁸ cells/dose). Participants in the SAD phase receive a single intrathecal administration, whereas those in the MAD phase receive four biweekly intrathecal administrations. Dose escalation, cohort expansion and progression from the SAD to the MAD phase are strictly contingent on the absence of dose-limiting toxicities (DLTs) over a 28-day observation window following the single dose (SAD) or the final dose (MAD). The primary endpoint is to determine the incidence of treatment-related adverse events (AEs) and serious AEs, identify DLTs and establish the maximum tolerated dose as well as the recommended phase II dose. Efficacy will be assessed by evaluating longitudinal changes in American Spinal Injury Association (ASIA) Impairment Scale grade, American Spinal Injury Association (ASIA) sensory/motor scores and Spinal Cord Independence Measure score at predefined follow-up visits (days 29, 71, 90, 180, 270 and 360) up to 360 days post-baseline. Exploratory objectives include characterising the potential therapeutic mechanisms and broader clinical impact through longitudinal assessment of cerebrospinal fluid biomarkers, neurophysiological function, bladder outcomes and spinal cord imaging metrics.
The study protocol has received ethical approval from the Institutional Ethics Committees of the Third Affiliated Hospital of Sun Yat-sen University (Approval No. YW2025-012-01) and the Third Hospital of Hebei Medical University (Approval No. 2025–071-2). Furthermore, the investigational product has secured regulatory clearance for clinical trials from both the China National Medical Products Administration (Clinical Trial Notification No. 2025LP01101) and the US Food and Drug Administration (IND No. 31234). Written informed consent will be obtained from all participants before participation. Moreover, strict adherence will be maintained to the Declaration of Helsinki and Good Clinical Practice guidelines throughout the study. To ensure transparency and broad dissemination, the study results will be disseminated through peer-reviewed publications and conference presentations.
To synthesise relevant theories and empirical evidence on telehome-based palliative care, with a focus on care delivery, caregiver involvement and service coordination in nursing practice.
Integrative review.
Peer-reviewed studies of telehome-based palliative care for adults with life-limiting illnesses were included if they reported evidence relating to healthcare providers, patients, or family caregivers. Methodological quality was appraised using the Mixed Methods Appraisal Tool. Data were synthesised using thematic synthesis informed by Normalisation Process Theory and a dual supply–demand framework.
Eleven electronic databases were searched from database inception to 3 March 2026: PubMed, Web of Science, Embase, Scopus, the Cochrane Library, Ovid, China National Knowledge Infrastructure, Wanfang Data, VIP, Duxiu and Chinese Biomedical Literature Database.
Thirty-three studies were included. Telehealth-supported palliative care improved access to specialist support, enabled more proactive symptom management and strengthened continuity of care at home. Implementation, however, depended on the interaction between service design and user capability, with digital literacy, language barriers, caregiver burden and organisational readiness shaping engagement.
Telehome-based palliative care is a socio-technical and relational care model rather than an isolated digital intervention. Its implementation and sustainability rely on effective alignment between service structures and patient–caregiver needs and capacities.
Nursing leaders and organisations should prioritise workforce digital competence, interdisciplinary coordination, and caregiver-inclusive telehealth design.
This review provides an equity-focused framework for developing and implementing telehome-based palliative care.
The review was reported in accordance with PRISMA 2020 and SWiM where applicable.
No patient or public contribution was involved because this was a review of published literature.
The review protocol was prospectively registered in PROSPERO (CRD420261303371).
Diabetic foot ulcer (DFU) is a severe complication characterised by poor healing. Although adjunctive therapies like acupressure may improve outcomes, controlled evidence remains limited. This study evaluated whether acupressure reduces postoperative infection rates and hospital stay in patients with Wagner grade 2–3 DFUs. This single-center retrospective cohort study included eligible patients undergoing surgical debridement and moist wound healing between 2018 and 2024. Patients receiving standardised acupressure (ST36, SP6, KI3) were compared to a standard care-only cohort. To control confounders while maximising statistical power and generalizability, we employed an unstratified propensity score subclassification approach, dividing the full cohort into five quintiles. Primary outcomes were postoperative wound infection and hospital stay length. Secondary outcomes included antibiotic duration and re-debridement rate. We analyzed the full cohort of 423 patients (acupressure group: 186; standard care group: 237). After adjusting for propensity score strata, the acupressure group exhibited significantly lower postoperative infection rates (unadjusted 16.7% vs. 32.1%, adjusted p = 0.001) and shorter hospital stays (unadjusted median 10.0 vs. 12.0 days; adjusted mean difference −2.1 days, 95% CI −3.4 to −0.8, p = 0.002). Systemic antibiotic duration was significantly reduced (unadjusted median 6.0 vs. 8.0 days, adjusted p = 0.003), alongside a clinically relevant decrease in re-debridement rates (9.1% vs. 17.3%, adjusted p = 0.057). Doubly robust multivariate regression confirmed adjunctive acupressure as an independent protective factor against postoperative infection (adjusted OR 0.47, 95% CI 0.28–0.80, p = 0.005), with interaction tests demonstrating consistent benefits across all propensity score subclasses. Adjunctive acupressure significantly reduces postoperative infection risk and shortens hospitalisation in Wagner 2–3 DFU patients. Retaining the full cohort via propensity score subclassification strengthens generalizability, suggesting acupressure as a safe, effective, and low-cost complementary therapy for standard wound care.
This study sought to synthesize qualitative evidence pertaining to intensive care unit (ICU) nurses' experiences in pressure injury prevention and thereby to systematically delineate the facilitators and barriers shaping these behaviors so as to support the formulation of targeted intervention strategies.
A qualitative meta-synthesis was conducted following the Joanna Briggs Institute methodology and was underpinned by the Theoretical Domains Framework alongside the Capability-Opportunity-Motivation-Behaviour (COM-B) model.
A systematic search was performed across nine databases—namely PubMed, Web of Science, Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database and China Biomedical Literature Database—covering the period from database inception to 21 January 2026. Two researchers independently undertook study screening and data extraction. Study quality was evaluated using the 2016 iteration of the Qualitative Research Quality Assessment Tool developed by the Joanna Briggs Institute. Extracted findings were subsequently mapped and synthesized according to the Theoretical Domains Framework and the COM-B model.
PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, Wanfang Database, VIP Database and China Biomedical Literature Database.
Twelve studies were included from which 52 discrete findings were derived. Following a process of mapping and synthesis guided by the Theoretical Domains Framework and the COM-B model, the various facilitators and barriers associated with ICU nurses' pressure injury prevention practices were consolidated into 13 distinct categories and two overarching synthesized findings.
Pressure injury prevention practices among ICU nurses constitute a complex behavioral process whose formation involves multiple interacting elements. Future intervention efforts should therefore adopt coordinated strategies that simultaneously address the enhancement of knowledge and skill development alongside the optimization of resource and environmental conditions while also reinforcing individual beliefs and motivation so as to elevate the overall quality of preventive care.
Healthcare providers are encouraged to implement multi-component approaches that concurrently support the development of nurses' clinical competencies and the improvement of organizational resources and that further cultivate sustained motivation, thereby ensuring the delivery of high-quality pressure injury prevention within intensive care environments.
By systematically identifying the principal facilitators and barriers that influence ICU nurses' pressure injury prevention practices, this study offers an evidence-informed basis for designing comprehensive interventions aimed at improving prevention quality and patient outcomes in critical care settings.
This study adheres to the Joanna Briggs Institute methodology for meta-aggregation and its reporting conforms to the ENTREQ guideline.
No patient or public contribution was made.
PROSPERO database: CRD420261286790
by Qianyao Yuan, Dai Zhang, Rui Xu, Wenjun Yao, Hong Zhao
ObjectiveAdenosquamous carcinoma (ASC) of the lung, containing both adenocarcinoma (AC) and squamous cell carcinoma (SCC) components, is associated with aggressive behavior and poor prognosis. Due to overlapping imaging features with AC and SCC, its preoperative diagnosis remains challenging. This study aimed to compare CT and pathological characteristics among ASC, AC, and SCC; identify key differentiators.
MethodsThis retrospective study included 27 patients with pathologically confirmed ASC who underwent surgical resection from November 2018 to January 2025. Forty cases each of AC and SCC, matched for age, sex, and smoking history, were selected for comparison. Clinical, radiological, and pathological features were analyzed. Variables with statistical significance (P Results
Compared with SCC, ASC lesions were more peripheral and associated with higher distance ratios (DR), pleural retraction, spiculation, and lymph node metastasis (LNM). Compared with AC, ASC tumors were larger, more often solid, and exhibited lobulation, bronchial cutoff sign, and advanced staging. Among the evaluated analyses, the combined pathology–imaging approach showed the highest discriminatory performance, with AUCs of 0.909 (ASC vs SCC) and 0.900 (ASC vs AC). LNM and DR were more strongly associated with ASC relative to SCC, whereas larger tumor size, ill-defined margins, and advanced stage were more strongly associated with ASC relative to AC.
ConclusionCertain CT imaging features, especially DR and LNM, were associated with ASC and may provide useful information for preoperative radiological assessment and subtype stratification.
FreshRSS 