To evaluate the effectiveness of levosimendan in promoting weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiogenic shock through a meta-analysis of clinical trials.

Systematic review and meta-analysis.

PubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception to January 2025.

Studies were included if they were clinical trials comparing outcomes between patients receiving levosimendan and those not receiving it during VA-ECMO support. Eligible studies reported on at least one of the predefined outcomes.

Two independent reviewers extracted data and assessed study quality. The primary outcome was successful VA-ECMO weaning. Secondary outcomes included 30-day mortality, in-hospital mortality, duration of ECMO support and length of stay in the intensive care unit (ICU). A random-effects model was used to synthesise data and estimate pooled effect sizes, with heterogeneity assessed using the I² statistic.

Involving 2083 patients across 16 studies, levosimendan significantly improved VA-ECMO weaning success (OR=2.44, 95% CI: 1.72 to 3.48; p2=57%) compared with the control group. Additionally, it notably reduced 30-day mortality (OR=0.48, 95% CI: 0.29 to 0.81; p=0.006; I²=56%) and in-hospital mortality (OR=0.47, 95% CI: 0.26 to 0.88; p=0.02; I²=70%). Noteworthy, however, is the association of levosimendan with prolonged VA-ECMO support (days; n=1314; weighted mean difference (WMD): 2.86, 95% CI: 1.73 to 4.00; p2=60%) and extended ICU stay (days; n=629; WMD: 5.69, 95% CI: 2.19 to 9.20; p=0.001; I²=61%).

Levosimendan improves VA-ECMO weaning success and reduces mortality. Further high-quality randomised controlled trials (RCTs) are required to confirm its clinical benefits in VA-ECMO patients. While the findings consolidate existing evidence favouring levosimendan, they also highlight residual heterogeneity and moderate-to-high risk of bias in several included studies. Therefore, future investigations, particularly well-powered RCTs with robust methodology, may help further delineate its role in specific patient populations.

The incidence of acute pain subsequent to modified radical mastectomy (MRM) for breast cancer approximates 40%, with more than half of these cases evolving into chronic pain. Currently, the commonly employed analgesic schemes in clinical practice still have inadequacies. Liposomal bupivacaine (LB) is bupivacaine encapsulated in liposomes, and it is reported that its duration of action can extend up to 72 hours. This study will investigate the analgesic efficacy of LB in combination with bupivacaine hydrochloride (BHCl) for transversus thoracic muscle plane (TTP) block and pectoral nerves (PECS) block after MRM for breast cancer.

In this prospective, randomised, controlled trial, we will enrol 80 female patients aged 30 to 65 years who are scheduled to undergo MRM under general anaesthesia in combination with nerve block. They will be randomly assigned in a 1:1 ratio to the LB+BHCl group (Group A) and the BHCl group (Group B). All patients will undergo ultrasound-guided TTP+PECS block prior to surgery. The primary outcomes are the cumulative pain visual analogue scale (VAS) scores from 6 to 72 hours post-surgery and the quality of recovery, assessed using the QoR-40 score at 72 hours post-surgery. The secondary outcomes include the time to first analgesic rescue, the consumption of analgesic drugs within 72 hours postoperatively, the occurrence of adverse events and the VAS scores at 6 and 12 months postoperatively.

Ethical approval was obtained from the Ethics Committee of the Affiliated Hospital of Yangzhou University (2024 Ke Lun Shen (2024-07-01)). All patients will provide written informed consent. The results of this study will be published in a peer-reviewed journal.

Chinese Clinical Trial Registry (ChiCTR2400089933).

The waist-hip ratio (WHR) and waist-height ratio (WHtR) are associated with arterial stiffness (AS), yet there is limited research on this topic in patients with type 2 diabetes mellitus (T2DM). This study aims to investigate the relationship between WHR, WHtR and AS in patients with T2DM.

This cross-sectional study used data from patients with T2DM enrolled in the Metabolic Disease Management Center (MMC) at Changde Hospital, Xiangya School of Medicine, Central South University between May 2020 and October 2023.

A total of 3201 patients were collected, and after applying the exclusion criteria, data from 3006 patients were finally analysed.

The primary outcome of AS was assessed using brachial-ankle pulse wave velocity (baPWV).

After adjusting for gender and age, there was an increasing trend in baPWV across the quartiles of WHR and WHtR. In the multivariate regression analysis adjusting for confounding factors, it was observed that for each one-unit increase in the WHR z-score, baPWV increased by 18.1 cm/s (95% CI: 7.8 to 28.4). Similarly, for each one-unit increase in the WHtR z-score, baPWV increased by 28.6 cm/s (95% CI: 16.6 to 40.6). In the multivariate logistic regression analysis, after fully adjusting for confounding factors, it was found that for every one-unit increase in the WHR z-score, the OR for elevated baPWV was 1.2 (95% CI: 1.1 to 1.4). Similarly, for every one-unit increase in the WHtR z-score, the OR for elevated baPWV was 1.3 (95% CI: 1.1 to 1.5). According to the generalised additive model, we found that WHR and WHtR were positively correlated with baPWV and elevated baPWV. Subgroup analysis revealed that elevated WHR and WHtR are significant predictors of AS, with this association being substantially amplified by poor glycaemic control (glycated haemoglobin ≥7%).

In Chinese patients with T2DM, both WHR and WHtR are positively and independently associated with baPWV and the presence of elevated baPWV.

To analyse global trends in aortic aneurysm mortality from 1990 to 2021 and project future trends through 2036, examining variations across Socio-Demographic Index (SDI) quintiles, regions, nations, age groups and sexes.

We conducted a comprehensive analysis using mortality data from the Global Burden of Disease (GBD) Study 2021.

Data were obtained from the GBD 2021 database, covering 204 countries and territories across 21 GBD regions.

Individuals with aortic aneurysm-related mortality between 1990 and 2021.

Absolute deaths and age-standardised mortality rates (ASMR) per 100 000 from 1990 to 2021, stratified by SDI quintiles, GBD regions and individual nations. Temporal trends were quantified using estimated annual percentage change (EAPC) and net drift, while decomposition analysis assessed contributions of population ageing, growth and epidemiological changes to mortality patterns. Risk factor attribution across regions and SDI levels was examined, alongside projections of ASMR and deaths through 2036 using the Nordic prediction method.

Global aortic aneurysm deaths increased from 88.35 thousand in 1990 to 153.93 thousand in 2021, while ASMR decreased from 2.54 to 1.86 per 100 000 (EAPC: –1.28%). High SDI regions showed significant ASMR declines (EAPC: –1.982%), while low-middle SDI regions experienced increases (EAPC: 1.272%). Marked regional variations were observed, with Australasia showing the largest decrease (EAPC: –4.114%) and Central Asia the highest increase (EAPC: 2.498%). Japan diverged from other developed countries with significant mortality increase. Decomposition analysis revealed that increased mortality was primarily driven by population growth (59.109 million) and ageing (46.385 million), partially offset by epidemiological improvements (–39.92 million). The male-to-female ASMR ratio decreased globally from 2.45 to 2.00. Tobacco remained the leading risk factor globally, while body mass index emerged as an increasing concern. Projections indicate a slight global ASMR decrease by 2036, with concerning increases in regions like high-income Asia Pacific and South Asia.

Despite declining global ASMR, the absolute burden of aortic aneurysm mortality continues to grow with significant regional and sex-based disparities. These findings highlight the need for targeted interventions, particularly in regions facing increasing mortality rates, and emphasise the importance of addressing modifiable risk factors while strengthening healthcare infrastructure in vulnerable areas.

Mediastinal and/or hilar lymphadenopathy (MHL) is increasingly identified owing to various underlying conditions. Minimally invasive biopsy techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), transbronchial mediastinal cryobiopsy (TBMC) and transbronchial forceps biopsy (TBFB), are common diagnosis tools. However, their safety and diagnostic efficiency remain unclear. This trial aims to compare the diagnostic yield and safety of these three techniques.

This study is a three-arm, parallel-design, randomised controlled trial involving 972 adult patients with MHL recruited from multiple medical centres. Participants will be randomly assigned to the EBUS-TBNA, TBMC via a tunnel or TBFB via a tunnel group. The primary outcome is diagnostic yield, and the secondary outcomes include diagnostic sensitivity, sample quality and procedure-related complications. Statistical analyses will be conducted using the appropriate methods. An independent sample ² test will be used to test the differences in the diagnostic yield and incidence of procedure-related complications.

Ethics approval was obtained from the China-Japan Friendship Hospital Ethics Committee (2022-KY-194).

Written informed consent will be obtained from all patients or their guardians before their enrolment in the study. This study will be conducted per the principles established in the Declaration of Helsinki and the International Council for Harmonisation Guidelines for Good Clinical Practice.

www.clinicaltrials.gov (NCT06262620).

The optimal method for conducting spontaneous breathing trials (SBTs) remains a subject of ongoing debate. High-flow oxygen via endotracheal tube (HFOT) has emerged as a novel alternative for SBTs. However, studies investigating the associated physiological changes are lacking. Compared to high-flow nasal cannula (HFNC), HFOT has demonstrated diminished physiological effects, likely due to the bypassing of the upper airway, which may limit its widespread adoption as an SBT strategy. Two HFOT interfaces with different expiratory port diameters will be evaluated. It is hypothesised that the narrower interface would generate higher airway pressure and mitigate weakening physiological effects compared to the HFNC. This study aims to compare the physiological effects of two HFOTs compared to T-piece during SBTs.

This is a single-centre, prospective, physiological randomised crossover study in adult patients receiving mechanical ventilation for more than 24 hours who are deemed ready for SBT. After enrolment, each patient will be disconnected from the ventilator and undergo five SBT phases in random order: T-piece at 6 L/min, HFOT via interface with an expiratory port diameter of 9.8 mm at 40 L/min and 60 L/min and HFOT via interface with an expiratory port diameter of 6.9 mm at 40 L/min and 60 L/min. To reduce carryover effects, each phase will be separated by a 10-min washout period during which baseline mechanical ventilation is resumed. Key physiological parameters will be assessed in each study phase, including airway pressure, changes in end-expiratory lung volume, vital signs, oxygenation levels and inspiratory effort. Postextubation inspiratory effort will also be measured. Finally, 20 patients with the complete five SBT phases and postextubation datasets will be analysed

The study protocol has been approved by the Institutional Ethics Committee and Review Board of Beijing Shijitan Hospital, Capital Medical University (IIT2024-157-002). The data generated in the present study will be available from the corresponding author on reasonable request. The results of the trial will be submitted to international peer-reviewed journals.

NCT06816706.

Faced with the challenge of ageing populations and growing rehabilitation demands, misallocating healthcare resources may impede tiered service. This study aimed to (1) evaluate gaps between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and rehabilitation tiered service (RTS) tool results using the first-hand data from the field survey in China and (2) identify factors associated with these gaps across institution, doctor and patient levels.

Population-based, multicentre cross-sectional study.

41 medical institutions across 21 cities in China.

5856 participants were included in our study. The inclusion criteria of participants were (1) he/she had dysfunctional problems, (2) he/she had visited rehabilitation doctors, (3) he/she was outpatients, (4) he/she would complete all evaluation procedures and (5) he/she agreed to participate in our study.

Gaps between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and RTS tool results. The results included outpatient rehabilitation treatment, visiting other clinical departments, admission to primary healthcare, secondary hospitals, tertiary hospitals, nursing homes and other clinical departments.

The mean age of participants was 47.5 years (SD: 24.4), and half (53.6%) were male. Most were diagnosed with orthopaedic disorders (55.2%) and neurological disease (29.0%). The majority had mobility difficulty (81.8%), self-care ability (69.8%), controlled disease (89.5%) and stable vital signs (98.9%). The minority participants had an onset of over 1 year (8.5%). The first gap (the rate of misalignment between patients’ healthcare-seeking behaviour and doctors’ clinical judgement) was 21.0%; doctors with higher educational level (OR=4.89, 95% CI 1.35 to 17.73), those who majored in western medicine (OR=2.97, 95% CI 1.15 to 7.67), elder patients (OR=1.01, 95% CI 1.01 to 1.02) and patients with neurological disease (OR=2.11, 95% CI 1.34 to 3.30), geriatric diseases (OR=1.60, 95% CI 1.17 to 2.19) and childhood diseases (OR=2.72, 95% CI 1.04 to 7.13) were associated with the increased first gap, whereas doctors from public institution (OR=0.10, 95% CI 0.02 to 0.44), receiving more medical training (OR=0.94, 95% CI 0.88 to 1.00) and patients with cardiopulmonary disease (OR=0.44, 95% CI 0.29 to 0.67) were associated with reduced first gap. The second gap (the rate of misalignment between doctors’ clinical judgement and RTS tool results) was 49.3%; doctors from primary healthcare (OR=24.60, 95% CI 7.82 to 77.42), male doctors (OR=2.66, 95% CI 1.45 to 4.86), those who majored in western medicine (OR=1.91, 95% CI 1.04 to 3.51) or Chinese and western medicine (OR=4.19, 95% CI 1.47 to 11.91) and elder patients (OR=1.01, 95% CI 1.00 to 1.01) were associated with increased second gap, whereas doctors from public institution (OR=0.13, 95% CI 0.05 to 0.36) and having higher monthly income (OR=0.52, 95% CI 0.34 to 0.78) were associated with reduced second gap.

Gaps exist between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and RTS tool results. Target interventions such as enhancing training for private institutions, western medicine doctors and elderly patients diagnosed with neurologic, cardiopulmonary or childhood diseases may help reduce these gaps.

To identify risk factors and develop a predictive model for postdischarge all-cause mortality in patients with heart failure with preserved ejection fraction (HFpEF).

Retrospective cohort study.

Tertiary care, Xiangtan Central Hospital, Hunan, China.

9419 patients with HFpEF, diagnosed between May 2014 and January 2023 according to 2021 European Society of Cardiology criteria (N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125 pg/mL, left ventricular ejection fraction ≥50%, New York Heart Association (NYHA) class II-IV). Exclusions were age

All-cause mortality within 3 years of hospital discharge.

10 independent predictors were identified: NT-proBNP, albumin, age, NYHA class III-IV, C reactive protein, right atrial end-systolic diameter, haemoglobin, chronic obstructive pulmonary disease, hyponatraemia and prior percutaneous coronary intervention. The prediction model demonstrated good discrimination, an area under the receiver operating characteristic curve of 0.756 (95% CI 0.743 to 0.769) in the training cohort and 0.764 in the validation cohort. Based on calculated risk scores, patients were classified into low-risk (≤200.36), medium-risk (200.37–232.24) and high-risk (≥232.25) groups, corresponding to 3-year mortality rates of 12.6%, 40.8% and 68.0%, respectively.

A simple clinical model using routinely available parameters enables effective 3-year mortality risk stratification in HFpEF patients after discharge. External validation is needed to confirm its generalisability.

NCT06487468.

To investigate whether quantitative retinal markers, derived from multimodal retinal imaging, are associated with increased risk of mortality among individuals with proliferative diabetic retinopathy (PDR), the most severe form of diabetic retinopathy.

Longitudinal retrospective cohort analysis.

This study was nested within the AlzEye cohort, which links longitudinal multimodal retinal imaging data routinely collected from a large tertiary ophthalmic institution in London, UK, with nationally held hospital admissions data across England.

A total of 675 individuals (1129 eyes) with PDR were included from the AlzEye cohort. Participants were aged ≥40 years (mean age 57.3 years, SD 10.3), and 410 (60.7%) were male.

The primary outcome was all-cause mortality. Quantitative retinal markers were derived from fundus photographs and optical coherence tomography using AutoMorph and Topcon Advanced Boundary Segmentation, respectively. We used unadjusted and adjusted Cox-proportional hazards models to estimate hazard ratios (HR) for the association between retinal features and time to death.

After adjusting for sociodemographic factors, each 1-SD decrease in arterial fractal dimension (HR: 1.54, 95% CI: 1.18 to 2.04), arterial vessel density (HR: 1.59, 95% CI: 1.15 to 2.17), arterial average width (HR: 1.35, 95% CI: 1.02 to 1.79), central retinal arteriolar equivalent (HR: 1.39, 95% CI: 1.05 to 1.82) and ganglion cell-inner plexiform layer (GC-IPL) thickness (HR: 1.61, 95% CI: 1.03 to 2.50) was associated with increased mortality risk. When also adjusting for hypertension, arterial fractal dimension (HR: 1.45, 95% CI: 1.08 to 1.92), arterial vessel density (HR: 1.47, 95% CI: 1.05 to 2.08) and GC-IPL thickness (HR: 1.56, 95% CI: 1.03 to 2.38) remained significantly associated with mortality.

Several quantitative retinal markers, relating to both microvascular morphology and retinal neural thickness, are associated with increased mortality among individuals with PDR. The role of retinal imaging in identifying those individuals with PDR most at risk of imminent life-threatening sequelae warrants further investigation.

Frailty is a global health issue, particularly among older adults, and is strongly associated with adverse health outcomes. The intermediate stage of pre-frailty, which represents a transition from robust health to frailty, has garnered growing concern due to its potential reversibility. This systematic review and meta-analysis will aim to identify predictors associated with the progression from pre-frailty to frailty in older adults.

A comprehensive literature search will be conducted in PubMed, Web of Science, Embase, Cochrane Library, CINAHL, PsycINFO, CNKI, Wanfang Database, China Science and Technology Journal Database, and China Biomedical Literature Database from inception to the most recent search date. Eligible studies will report predictors of frailty progression among older adults with pre-frailty at baseline. Two reviewers will independently screen the studies, extract relevant data and assess methodological quality using the Newcastle Ottawa Scale. Meta-analysis and meta-regression will be performed to estimate pooled effect sizes and explore potential predictors. Subgroup analyses will be conducted to investigate possible sources of heterogeneity.

Ethical approval will not be required, as this study will not involve primary data collection. The findings will be submitted for publication in a peer-reviewed scientific journal.

CRD42024594175.

The optimal blood pressure (BP) target for patients with heart failure (HF) remains a topic of debate. The relationship between out-of-office BP measurements and the prognosis of HF patients is still unclear. However, there is a lack of large-scale studies investigating out-of-office BP levels in Chinese populations with HF. This study aims to outline the rationale and design of the Out-of-Office Blood Pressure Measurements in Patients with Heart Failure registry (OOBPM-HF) study in China.

The OOBPM-HF study is a prospective, multicentre, observational cohort study involving participants recruited from 26 hospitals in China. Patents with relatively stable HF symptoms will undergo a screening process to determine their eligibility for study participation. Data from baseline clinical, laboratory and imaging examinations will be collected. BP parameters, including office BP, ambulatory BP and home BP, will be measured and documented. The primary endpoint of the study is the composite endpoint of death from cardiovascular causes and HF hospitalisation. Participants will be followed up for a duration of 18 months.

The study will establish a comprehensive understanding of the associations between out-of-office BP measurements and HF prognosis within the Chinese population. The findings of this study will provide valuable insights into the optimal BP range for patients with HF and will contribute to the management of BP in this patient group.

ChiCTR2400090786; Result.