Delayed antibiotic prescribing (DAP) has demonstrated efficacy in reducing inappropriate antibiotic use for uncomplicated respiratory tract infections (uRTIs) in primary care across high-income countries. However, evidence regarding its effectiveness in low-income and middle-income countries remains limited. This cluster-randomised controlled trial (cRCT) aims to evaluate the effectiveness of DAP for optimising antibiotic use in primary healthcare institutions (PHIs) in China.

We designed a pragmatic, multicentre, open-label, three-arm cRCT in adult patients with uRTIs. The study will involve 12 PHIs in Korla City of China. Participating institutions will be randomised at a 1:1:1 ratio to three parallel arms: (1) DAP-intervention arm, (2) Immediate antibiotic prescribing comparator arm and (3) Usual care (observational arm). The primary outcome is symptom duration. Secondary outcomes include symptom severity, antibiotic use, adverse events, patient satisfaction and patient belief regarding antibiotic efficacy.

Ethics committee approval of this study was obtained from Peking University Institution Review Board (IRB00001052-24169). The findings will be disseminated through peer-reviewed publications and presentations at scientific conferences.

ChiCTR2500097330.

With the acceleration of globalisation and the increasing frequency of international exchanges, the risk of cross-border transmission of emerging respiratory infectious diseases (ERIDs) has significantly increased. Since the year 2002, epidemics of SARS, Middle East respiratory syndrome (MERS) and COVID-19 have exemplified this trend. These epidemics have impacted the prevalence and transmission of traditional respiratory infectious diseases (RIDs), such as influenza, which share similar transmission routes and control measures. To better explore the impact of ERIDs epidemics on influenza, our study quantitatively evaluates the epidemiological changes in influenza during three representative emerging respiratory coronavirus epidemics: SARS, MERS and COVID-19.

Using Global Influenza Surveillance and Response System data, we examined influenza trends across different periods and regions affected by the three coronavirus epidemics. The impact of the epidemic on influenza was revealed by comparing and analysing the reported positive cases (RPCs) of influenza during the pre-epidemic and epidemics, and during the three postpandemic periods. Based on the Susceptible-Exposed-Infected-Asymptomatic-Recovered (SEIAR) compartmental model, the time-varying effective reproduction number () over time was calculated, and the Farrington surveillance algorithm was used to calculate the RPCs in the absence of an epidemic to analyse the characteristics of influenza transmissibility during the epidemics of the three respiratory coronavirus changes.

There was a significant decline in the RPCs of influenza and transmissibility. The suppressive effect of the COVID-19 epidemic on influenza prevalence was the most pronounced. During the COVID-19 epidemic, the RPCs of the three major influenza subtypes showed the largest decrease compared with historical predictions, with reduction rates of –53.30% for A(H1N1), –57.50% for A(H3N2) and –48.56% for influenza B (p0.05). During the MERS epidemic, the RPCs of A(H1N1) and A(H3N2) decreased by 28.75% and 17.62%, respectively, although influenza B partially rebounded in the later stages, resulting in a relatively smaller overall impact.

The COVID-19 epidemic demonstrated the most pronounced suppressive effect on influenza prevalence. The impact of SARS was secondary, while MERS had the least effect. Among different influenza subtypes, A(H3N2) and influenza B exhibited greater declines compared with A(H1N1). The decrease in RPCs during coronavirus epidemics highlighted the importance of non-pharmaceutical interventions (NPIs), demonstrating the broad applicability and high efficacy of comprehensive control strategies for RIDs. Furthermore, when NPIs are lifted during the later stages of coronavirus epidemics, attention should be paid to the potential rebound of traditional respiratory diseases such as influenza.

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.

Prophylactic ileostomy plays a critical role in the radical resection of low rectal cancer, but the incidence of stoma site incisional hernia (SSIH) after stoma closure remains high. No study has been reported in which radiomics has been used to predict SSIH. The primary aim of this study is to evaluate the safety and efficacy of biological mesh in preventing incisional hernia in patients with high-risk incisional hernia factors, as identified by image-based deep learning model, undergoing ileostomy closure surgery.

40 patients who need to undergo ileostomy closure and have been identified with high risk factors for SSIH by image-based deep learning model will be selected for this study. Patients will be randomly assigned equally to the prophylactic biological mesh placement group and the control group, and outcomes will be tracked via clinic review at 1 month, 3 months, 6 months and 12 months postoperatively. The outcome measures are the rate of postoperative incisional hernia, local pain, incisional infection, seroma and so on. This study demonstrates that prophylactic placement of biological mesh with ileostomy closure reduces the incidence of SSIH. Furthermore, it validates the feasibility of image-based deep learning models in predicting postoperative complications and identifying high-risk SSIH patients.

Informed consent has been obtained from all subjects. This protocol has been approved by the Ethics Committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine (KY2022-087-B). The findings will be disseminated through peer-reviewed manuscripts, reports and presentations.

ChiCTR2200064995. Registration date: October 2022. Registration authority: Chinese Clinical Trial Registry.

High blood pressure (BP) is one of the optional components of metabolic dysfunction-associated fatty liver disease (MAFLD). However, whether subclinical elevations in BP are related to MAFLD even in the absence of hypertension remains unclear. We investigated the association between BP and MAFLD among adults without hypertension.

A nationwide, multicentre and cross-sectional study of the National Health and Nutrition Examination Survey (NHANES).

2022 US adults without hypertension were recruited in the 2017–2018 cycle of the NHANES.

Systolic BP (SBP) and diastolic BP (DBP).

MAFLD was defined by the novel consensus of diagnostic criteria in 2020.

MAFLD is common among US adults even at the ‘normal’ BP ranges, with a prevalence of 38.8%. We observed a positive, linear relationship between SBP and MAFLD down to 90 mm Hg, and between DBP and MAFLD down to 50 mm Hg. The MAFLD risk was elevated significantly with increasing SBP level (per 10 mm Hg increase: adjusted OR, 1.59 (95% CI, 1.21 to 2.09)) in the range of 90–129 mm Hg. The relationship between DBP and MAFLD was not evident (per 10 mm Hg increase: adjusted OR, 1.42 (95% CI, 0.96 to 2.21)) in the range of 50–79 mm Hg. Similar findings were identified in the sensitivity analyses.

In a population without hypertension, SBP is significantly associated with MAFLD, indicating potential early intervention to prevent MAFLD.

To evaluate the efficacy and safety of adding Superior Vena Cava Isolation (SVCI) to Pulmonary Vein Isolation (PVI) in patients with drug-refractory paroxysmal atrial fibrillation (PAF).

Systematic review and meta-analysis of randomised controlled trials (RCTs) using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, supplemented with Trial Sequential Analysis (TSA) to assess evidence sufficiency.

We searched PubMed, EMBASE, the Cochrane Library (CENTRAL) and Web of Science for relevant studies published up to 13 July 2025.

We included prospective RCTs comparing SVCI+PVI versus PVI alone in adults with drug-refractory PAF, with at least 3 months of follow-up and reporting on atrial fibrillation (AF) recurrence and procedural complications. Case reports, reviews, observational studies, editorials, expert opinions and non-RCT studies were excluded.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. A meta-analysis was conducted using random effects models, and TSA was conducted to evaluate the conclusiveness of evidence. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.

Three RCTs involving 332 patients were included. The addition of SVCI to PVI significantly reduced AF recurrence compared with PVI alone (Risk Ratio 0.54, 95% CI 0.32 to 0.91, p=0.02; I² = 0%, P_heterogeneity=0.79) at a mean 12-month follow-up. TSA confirmed that the current evidence is sufficient. There were no significant differences in procedural complications between groups (Risk Difference 0.00, 95% CI –0.04 to 0.03, p=0.99; I² = 0%, P_heterogeneity=0.96).

Adding SVCI to PVI for PAF ablation significantly reduces AF recurrence without increasing procedural risks. TSA confirms the robustness of the findings, supporting the potential integration of SVCI into routine clinical practice for PAF.

Tubal ectopic pregnancy (TEP) frequently presents as a gynaecological emergency, often necessitating prompt medical intervention. Although methotrexate therapy offers the advantage of being non-invasive, it still poses the risk of tubal rupture and consequent haemorrhage, which may require emergency surgery. The major challenges encountered in practice are the lack of reliable methods to anticipate the likelihood of failure of single-dose methotrexate therapy and identify associated risk factors and thereby preclude unnecessary medical procedures. Effective counselling, therefore, remains a pivotal step in clinical management. This study is aimed at developing a predictive model to assess response to single-dose methotrexate therapy in cases of TEP by employing a dynamic prediction model approach based on the clinical data of a large cohort.

This multicentre study will encompass 100 and 900 participants for the prospective and retrospective cohorts with TEP, respectively. Between 2010 and 2024, eligible patients who are diagnosed with TEP and opt for single-dose methotrexate therapy will be recruited as part of a retrospective cohort, from three participating hospitals in Zhejiang province, China. The comprehensive medical and obstetric histories of the patients will be collected, along with their clinical data, including the results of serological tests following the initial consultation. The control group will comprise patients who achieve uneventful, complete resolution of TEP, as evidenced by serum human chorionic gonadotropin level of

Ethical approval for data collection has been obtained from the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (No. 2024-KLS-346–02), Hangzhou First People’s Hospital (No. ZN-20240627-0219-01), Anji Hospital of Chinese Medicine (No. 2025年第5号), Qingyuan Hospital of Chinese Medicine (No. (2024)伦审第(9)号) and Beilun Hospital of Chinese Medicine (No. 2024年伦审第12号). Additionally, written informed consent will be obtained from all participants and they will retain the right to withdraw from the study at any stage. The findings of this study will be disseminated through publication in a peer-reviewed journal.

ChiCTR2400085829.

To investigate the association between incremental quality-adjusted life years (QALYs) predicted in economic evaluations and clinical benefits assessed by the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS), examining how accurately predicted QALYs reflect actual clinical outcomes in cancer drug reimbursement decisions.

Cross-sectional observational study.

Health technology assessment (HTA) documents from Australia, Canada and England, supplemented by published economic evaluations from China. Economic evaluation data were collected from database inception to 31 December 2023.

A total of 240 economic evaluation documents were identified from Australia (n=61), Canada (n=114) and England (n=65), along with 106 published studies from China, all focused on solid tumour cancer drugs with publicly available ESMO-MCBS scores. Documents were included based on completeness and consistency of data sources; those that were incomplete or relied on external controls were excluded.

The primary outcomes were the incremental QALYs from manufacturer submissions and HTA agency reevaluations. Secondary outcomes included associations stratified by data maturity, country, treatment setting and reimbursement recommendations.

Incremental QALYs showed a moderate positive correlation with ESMO-MCBS scores (Spearman’s =0.42, 95% CI: 0.31 to 0.53). All country-specific correlations were statistically significant: England (=0.53), Australia (=0.37), Canada (=0.39) and China (=0.49), all p70% events observed) demonstrated the strongest association (OR=1.53, 95% CI: 1.10 to 2.13). Among countries, England exhibited the highest association (OR=1.42, 95% CI: 1.15 to 1.74), followed by China (OR=1.30, 95% CI: 1.04 to 1.62), Australia (OR=1.28, 95% CI: 1.01 to 1.63), and Canada (OR=1.15, 95% CI: 1.05 to 1.26).

This study highlights a moderate alignment between incremental QALYs derived from economic evaluations and clinical benefit scores, emphasising the importance of rigorous reassessment, mature survival data and independent validation processes. Future research should explore strategies for enhancing data maturity and incorporating independent review mechanisms to strengthen healthcare decision-making globally.

To identify the barriers and facilitators to implementing the social franchising model ‘Smart Focus’ for delivering eye care services to children in rural China, using the updated Consolidated Framework for Implementation Research (CFIR 2.0) as a theoretical basis to evaluate implementation performance drivers and propose strategies for effective scaling and sustainability.

This qualitative study involved semi-structured interviews with key stakeholders from both the supply side and demand side. Interview guide development, coding, analysis and reporting of findings were thoroughly informed by the CFIR 2.0.

Smart Focus operated in 23 poverty-designated counties across four western provinces in China, collaborating with local public hospitals, private optical shops and third-party non-governmental organisations.

Key informants included two Smart Focus project managers, six representatives from local education and health bureaus and ten vision centre employees and franchise operators.

Key facilitators of implementation included a robust evidence base, high trialability and adaptability of the innovation, relative advantages over competitors, standardised resources and effective training programmes. Major barriers included challenges in cross-departmental collaboration, underestimated variable costs, competition from private providers, high employee turnover due to inadequate incentives and the lack of feedback mechanisms for contextual adaptation.

This study highlights critical barriers and facilitators to implementing social franchising models for eye care in low-resource settings. While Smart Focus demonstrated success in scalability, achieving sustainability requires addressing financial constraints, staff retention and adaptive feedback mechanisms. The findings provide a context-specific framework for scaling health innovations in low- and middle-income countries, offering valuable lessons for bridging the gap between social and business objectives in hybrid models.