Physical activity (PA) has considerable benefits for older adults, yet they often face various barriers that hinder participation. Peer-led or peer-supported PA interventions represent a promising strategy to address barriers, such as cost and lack of motivation. Although existing reviews suggest that these interventions improve PA adherence, combining randomised controlled trials (RCTs) with other study designs may weaken their validity. Furthermore, their effects on PA levels and physical function are inconsistent, and their impacts on cognitive abilities, psychosocial well-being and social support, as well as the influence of peer characteristics and programme design, remain unexamined. This review aims to synthesise evidence regarding the effectiveness of peer-led or peer-supported PA interventions across multiple health outcomes and identify possible influencing factors.

The search will encompass six English and three Chinese databases, namely, PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Literature, PsycINFO, CENTRAL, China National Knowledge Infrastructure, Wanfang Data and the Chinese Biomedical Literature Database. It will cover literature from inception to December 2025. Trial registries will be searched, and a manual search of relevant studies will also be conducted. RCTs that focus on community-dwelling older adults participating in peer-led or peer-supported PA interventions will be included. Outcomes include PA levels, physical function, cognitive function, psychosocial well-being, self-efficacy, social support, health-related quality of life (HRQoL) and programme adherence. Two reviewers will independently screen the literature, extract data and evaluate the risk of bias by using the Cochrane Risk of Bias Tool 2.0. Meta-analyses will be conducted for outcomes reported in at least two studies, and narrative analyses will be performed for others. Subgroup analyses, metaregression, sensitivity analyses and assessments of publication bias will be conducted as appropriate. The Grading of Recommendations, Assessment, Development and Evaluations approach will be used to assess the certainty of evidence.

Ethical approval is not required because only published data will be used. Results will be disseminated through peer-reviewed publications and conference presentations.

CRD420251112127.

Minimally invasive techniques have been widely adopted for hysterectomy, including Transumbilical Laparoendoscopic Single-Site Surgery (TU-LESS) and Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES). However, their efficacy in patients with an enlarged uterus (≥280 g) remains not fully illustrated due to surgical complexity. We will compare the perioperative outcomes and recovery profiles of TU-LESS and vNOTES of this population in this study.

This single-blinded, two-arm, parallel-group, randomised controlled trial will take place in West China Second University Hospital. A total of 210 women with benign or precancerous uterine enlargement undergoing total hysterectomy (±salpingectomy/adnexectomy) will be randomised (1:1) to TU-LESS or vNOTES. The trial will span 2 years, including a follow-up of half a year. The primary outcomes will be the proportions achieving the indices of enhanced recovery after surgery respectively, including liquid diet tolerance, flatus passage, unassisted urination and mobility, during 24 hours after surgery and discharge within 2 days. Secondary outcomes include pain scores, operative duration, blood loss, complications, scar quality, analgesic use and pelvic/sexual function. Data collection occurs at baseline, perioperatively and 3/6 months postoperatively.

This study was approved by the Ethics Committee of West China Second University Hospital (2023 medical scientific research for ethical approval No.321). Written informed consent will be collected from all participants. Results will be shared through publication in peer-reviewed journals and presentations at conferences.

NCT06663553

Patients with acute myocardial infarction (AMI) and multivessel disease are at elevated risk of recurrent events. Radial wall strain (RWS), a novel indicator derived from angiography, has emerged as a potentially useful adjunct to optical coherence tomography (OCT) for assessing plaque vulnerability. The NASCENT trial is a prospective, multicentre cohort study designed to assess the natural history of coronary plaque in this high-risk AMI population and investigate the predictive value of angiography-based RWS for lesion progression, compared with OCT-assessed vulnerable plaque.

Following successful culprit lesion revascularisation for AMI patients with multivessel disease, we assessed eligible non-culprit lesions (30%–80% diameter stenosis) in non-flow-limiting, non-infarct-related arteries (Murray law-based quantitative flow ratio >0.80) using OCT and offline RWS analysis. The primary endpoint is lesion progression at 1 year, defined as a ≥20% increase in diameter stenosis percentage measured by quantitative coronary angiography. Between April 2024 and April 2025, 131 patients were enrolled. The 1-year angiographic and OCT follow-ups will be completed by May 2026. Clinical follow-ups are planned at 1 month, 6 months, 1 year and annually up to 3 years. As the first prospective trial comparing angiography-based RWS with OCT for predicting lesion progression in the AMI population, this study may provide crucial evidence for RWS as a valuable tool for risk stratification and clinical decision-making.

The protocol has been approved by the Institutional Review Board and Ethics Committee (Fuwai Hospital Approval No. 2023-2039) and will be conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants. The study results will undergo peer-reviewed publication.

NCT06040073.

There is a lack of evidence on the efficacy of extracorporeal blood purification (EBP) to reduce the mortality rate in septic shock. We have designed the EABPSS (Efficacy of Adaptive Blood Purification for Septic Shock) study to confirm whether adaptive blood purification (ABP) intervention could confer a clinical benefit.

In this multicentre, open-label, randomised controlled trial, we are recruiting a total of 276 patients with septic shock. Eligible patients who provide informed consent will be randomly assigned in a 1:1 ratio to either the control group or the intervention group. Patients in the control group will receive standard care according to the Surviving Sepsis Guidelines. Patients in the intervention group will receive two 6-hour sessions of ABP treatment within 24 hours of enrolment, based on standard care. ABP is a novel, adaptive EBP strategy proposed by our research team. Specifically, for patients with septic shock who do not require renal replacement therapy (RRT), plasmafiltration-adsorption (PFAD) will be used alone, and for patients with septic shock and acute kidney injury meeting RRT indications, a combination of PFAD–RRT will be employed. The primary endpoint of this study is all-cause mortality at 90 days after enrolment. Secondary endpoints of the study include the declining proportion of serum cytokines such as tumour necrosis factor-α (TNF-α), IL-4, IL-6, IL-8, IL-10 and high-mobility group box 1 within 24 hours after enrolment. Additionally, the study will evaluate the improvement of the Sequential Organ Failure Assessment score on day 7 postenrolment, as well as the 30-day mortality rate.

The study was approved by the respective ethical committees of the participant centres, including: Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University (2024-KE-348); Ethics Committee of PLA General Hospital (S2024-716-01); Ethics Committee of China–Japan Friendship Hospital (2024-KY181); Clinical Research Ethics Committee of Peking University First Hospital (2024YAN258-001); Ethics Committee of Beijing Hospital (2024BJYYEC-KY106-02); Ethics Committee of Air Force Medical Center, PLA (KONGTE2024-29-PJ01); Ethics Committee of Beijing Jishuitan Hospital, Capital Medical University (JILUN(K2023)(370)-00). The findings of the study will be disseminated in peer-reviewed journals and presented at national and international conference presentations.

NCT06692036.

The number of people living with dementia is increasing worldwide. Alzheimer’s disease (AD) is the most common type of dementia. It typically manifests itself initially with cognitive impairment in the memory domain and gradually progresses towards affecting all activities of daily living. Active music interventions, particularly singing, may improve mood, social behaviour and quality of life. However, little is known about their effects on cognition, although some studies have provided promising results. The Memory for Music (M4M) project aims to fill this gap in research by measuring the effects of learning new songs on cognitive functioning. Specifically, M4M will examine memory for new songs in non-musician adults with AD after undergoing intensive versus minimal individual musical training based on singing novel songs.

Home-dwelling adults with AD, 65 years or older, will receive 5 months of intensive intervention (2x/week) and 5 months of minimal intervention (1x/month). In a crossover design, participants will be randomised to receive either the intensive or minimal intervention first, with 2 months between the intervention periods. Participants will receive individual music lessons to learn new songs, provided by a music instructor with adequate training. The main outcomes will be measured at the beginning and end of each intervention period. General cognition will be measured with the AD Assessment Scale – Cognitive by an assessor blinded to the randomisation. Participants’ memory for music will be measured using the N400 component of electroencephalographic (EEG) event-related potentials in response to music stimuli. Additional outcomes evaluated during intervention sessions include mood and musical performance observations. With 113 participants randomised, the trial will have 80% power to detect clinically meaningful effects. Relations between mood, memory for music and cognitive abilities will be examined, with sex, age, AD stage, previous musical training and education as covariates. M4M will be conducted in close collaboration between academic researchers, service providers and service users to ensure relevance and applicability.

Dissemination of findings will apply to local, national and international levels. The study has been approved by the Regional Committees for Medical and Health Research Ethics in Norway (reference number 759936) and by Mautalén Salud e Investigación, CECOM in Argentina (register code 14412).

Clinicaltrials.gov, NCT06611878.

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).

The global healthcare landscape is undergoing a significant shift in demographics, evolving disease epidemiology and an ageing population, prompting the expansion of healthcare roles, including the healthcare assistant (HCA). However, there remains limited clarity regarding the scope and standards of their competence.

A scoping review will be conducted following the updated Joanna Briggs Institute methodological framework. Five databases encompassing PubMed, Cumulative Index to Nursing and Allied Health Literature Complete (EBSCOhost), EMBASE, Web of Science and PsycINFO (EBSCOhost) will be searched. Selected studies will include all types of studies on the competence of HCAs. Two reviewers will independently perform the screening and data extraction process. The quality of evidence in this review will be assessed by the Crowe Critical Appraisal Tool. Data synthesis will be presented using the narrative descriptions and tabular illustrations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be employed for transparent reporting.

No ethical clearance is required for this review. The final review will be submitted for publication to a peer-reviewed journal. Additionally, the results of the final review will be disseminated both locally and nationally to inform clinical practice.

This protocol has been registered with the Open Science Framework. Registration number is OSF.IO/5RGUC.

To systematically compare the effects of various antithrombotic strategies on prespecified outcomes including 28-day all-cause mortality (primary outcome), major thrombotic events and major bleeding events (secondary outcomes) in adult COVID-19 patients.

Systematic review and Bayesian network meta-analysis (NMA).

PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to February 2024.

We included randomised controlled trials (RCTs; published in English) comparing different antithrombotic strategies (eg, anticoagulants, antiplatelet (AP) agents, fibrinolytics or combinations) in adults (aged≥18 years) with laboratory-confirmed SARS-CoV-2 infection. Eligible trials had at least one active antithrombotic arm versus another strategy or standard care.

Two reviewers independently extracted data using a standardised form; disagreements were resolved by consensus or third-party adjudication. Bayesian NMA was performed using Markov chain Monte Carlo methods with random/fixed effects models selected by the deviance information criterion. The risk of bias (RoB) was assessed using the Cochrane Collaboration’s tool. The confidence in NMA framework was used to assess the quality of evidence.

35 RCTs that randomly assigned 39 949 participants were included in the main analysis. Primary outcome: evidence of low to moderate certainty suggested that, compared with standard of care (SoC), both prophylactic-dose anticoagulation (PA) (risk ratio (RR) 0.71, 95% credible interval (CrI) 0.44 to 0.99) and therapeutic-dose anticoagulation (TA; RR 0.65, 95% CrI 0.38 to 0.94) reduced the 28-day all-cause mortality. Secondary outcomes: TA (RR 0.19, 95% CrI 0.09 to 0.31), TA+AP (RR 0.27, 95% CrI 0.05 to 0.95), PA (RR 0.33, 95% CrI 0.18 to 0.53) and AP+PA (RR 0.52, 95% CrI 0.25 to 0.94) were effective in reducing major thrombotic events. AP was associated with an increased risk of major bleeding events (RR 2.27, 95% CrI 1.01 to 5.07). Subgroup analyses by hospitalisation status showed that PA significantly reduced 28-day mortality versus SoC (RR 0.52, 95% CrI 0.26 to 0.90) for non-hospitalised patients, whereas no strategies showed significant benefit in hospitalised patients. Subgroup analysis based on severity of hospitalised patients indicated that TA was more favourable than PA in decreasing the 28-day mortality in non-critically ill patients (fixed-effect model: RR 0.75, 95% CI 0.61 to 0.91; random-effect model: RR 0.71, 95% CI 0.48 to 1.05), but for critically ill patients, all antithrombotic strategies showed no significant difference.

Our NMA indicates that both PA and TA reduced the 28-day all-cause mortality of adult COVID-19 patients. However, subgroup analyses revealed substantial heterogeneity, and the benefit may differ across hospitalisation status and disease severity.

CRD42022355213.

The visceral traction response (VTR) occurring during caesarean sections with neuraxial anaesthesia represents a common and significant complication that can greatly affect perioperative results and maternal contentment. Traditional methods for managing VTR frequently face limitations due to differences among individuals, highlighting the necessity for tailored approaches that incorporate personalised risk evaluations, cutting-edge monitoring techniques and enhanced treatment options. Despite the substantial potential of this emerging idea to tackle such an important clinical issue, there is a notable absence of a comprehensive review of the current evidence available.

This protocol for a scoping review outlines a methodical strategy to chart the existing research landscape related to precision management of VTR in the context of caesarean delivery performed under neuraxial anaesthesia. By developing a conceptual framework, assessing the combined benefits of cutting-edge technologies and summarising tailored intervention techniques, this review aims to pinpoint key attributes, critical areas and new research directions, ultimately contributing to the enhancement of clinical practices and the formulation of rigorous future studies.

This research will thoroughly follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The eligibility criteria will be outlined using the population, concept, context framework. A comprehensive search across various international and Chinese databases (such as PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, Scopus, Google Scholar, China National Knowledge Infrastructure, WanFang and VIP) will be performed for literature published until March 2025, with a final update conducted before submission. Two reviewers will independently assess the literature and extract data. The data will be synthesised in a narrative format, supplemented by tabular and graphical representations, including conceptual framework diagrams and technology application matrices.

As this is a secondary analysis of published literature, ethics approval is not required. Results will be disseminated through peer-reviewed publications and presentations at international conferences, establishing an evidence foundation for clinical pathways and guiding future research initiatives. The protocol is registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/VS94Y).

To enhance nursing students’ critical thinking abilities, numerous educators have explored alternative teaching methods. While meta-analyses have confirmed that various approaches are effective in developing critical thinking, consensus regarding their comparative effectiveness remains elusive. Furthermore, few investigations have directly contrasted the outcomes across these methods, highlighting the necessity to undertake a comprehensive evaluation of their impact on nursing students’ critical thinking skills. Accordingly, this study aims to assess the effects of six teaching methods on nursing students’ critical thinking abilities.

A comprehensive literature search will be carried out up to May 2025 across various databases, such as PubMed, Embase, The Cochrane Library, Web of Science, OVID, CNKI, Wanfang Database and the China Biological Literature Database (CBM). The search strategy will specifically target randomised controlled trials meeting predefined inclusion criteria. Two independent reviewers will screen the selected studies and extract pertinent data. The methodological quality of the included studies will be assessed using the Cochrane risk of bias tool. A network meta-analysis will then be performed using Stata software, incorporating the following analytical components: heterogeneity, network evidence diagrams, publication bias plots, league tables, forest plots, subgroup analyses or meta-regression and sensitivity analyses. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system will be leveraged to appraise the overall quality of evidence related to critical thinking abilities across all compared interventions.

No formal research ethics approval is required. The results will be submitted to a peer-reviewed journal for publication.

CRD42024618735.

Proximal gastrectomy (PG) has emerged as the preferred surgical approach for adenocarcinoma of the upper 1/3 stomach and selected cases of oesophagogastric junction adenocarcinoma. We developed a novel oesophagogastric anastomosis technique with an antireflux mechanism (Hao’s Esophagogastrostomy by Fissure Technique). It may have a superior effect on patient weight maintenance compared with the double-tract reconstruction. We intend to conduct a prospective, multicentre, randomised controlled clinical trial to validate this hypothesis.

The primary objective evaluates body weight loss at 12 months postoperatively. Secondary objectives assess surgical safety through comprehensive analysis of complication rates and nutritional parameters, including serial haematological evaluations during follow-up. The study will enrol 52 participants across multiple centres with planned 3-year longitudinal monitoring to evaluate both immediate postoperative outcomes and intermediate-term clinical impacts.

This study was approved by the hospital institutional review board of Huashan Hospital, Fudan University (2024-1173) and is being conducted in accordance with the Declaration of Helsinki and the Good Clinical Practice guidelines. On completion of the study, the results will be published in a peer-reviewed journal.

NCT06679244.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterised by heterogeneous motor and non-motor symptoms. The classification of PD into distinct subtypes remains a major challenge, limiting the development of precision medicine approaches. Existing subtyping methods have relied on clinical features, genetic markers or isolated biomarkers, but an integrated classification system incorporating neuroimaging and fluid biomarkers is lacking. The Prospective Assessments with Neuroimaging and fluid Data Analysis in PD (PANDA) study is a single-centre, longitudinal cohort study designed to explore PD heterogeneity by integrating multimodal neuroimaging, fluid biomarkers and comprehensive clinical assessments.

The PANDA study aims to recruit 500 PD patients and 100 healthy controls (HC) at Guangdong Provincial People’s Hospital from March 2021 to July 2026. Participants undergo three study visits: baseline, 2-year and 4-year follow-ups. Data collection includes brain MRI scans, blood and cerebrospinal fluid sampling, clinical scales, gait assessment, ambulatory blood pressure monitoring and eye-tracking evaluations. A standardised electronic data capture system ensures data accuracy and completeness. The primary objective is to identify biologically and neuroimaging-defined PD subtypes, track disease progression and explore potential biomarkers for stratification. Statistical analyses will include data-driven clustering techniques and longitudinal modelling to assess subtype stability over time.

The PANDA study has been approved by the Institutional Review Board of Guangdong Provincial People’s Hospital (No KY2024-719-01) and is conducted in accordance with the Declaration of Helsinki. Written informed consent is obtained from all participants or their legal guardians prior to study enrolment. The findings from this study will be disseminated through peer-reviewed journals and conference presentations, ensuring accessibility to researchers, clinicians and stakeholders involved in PD research and treatment.

ChiCTR2400091709.