To analyse trends and characteristics of multidrug-resistant (MDR) bacteria over the past 7 years, in relation to patterns of antimicrobial use, to inform rational antimicrobial use and strengthen hospital infection control measures.

Retrospective cohort study.

A large teaching hospital in Tianjin, a major metropolitan city in northern China.

A total of 190 352 inpatients aged >18 years, admitted between 1 January 2017 and 31 December 2023, were included. Patients were eligible if they had complete clinical data and met the five quality control indicators for multidrug-resistant bacteria (QC-MRB), defined in the ‘Hospital Infection Surveillance Specifications’ (WS/T 312–2023). Patients with MDR infections before admission or those with duplicate results from multiple specimens were excluded.

Statistical analysis revealed a detection rate of 12.11% for the five QC-MRB and an incidence rate of 0.20%. The findings also indicated an upward trend in the detection and incidence rates of carbapenem-resistant Enterobacteriaceae, despite a relatively stable rate of antimicrobial use over 7 years. A positive correlation was observed between the incidence of MDR bacteria and the intensity of antimicrobial use within the hospital setting.

The hospital’s bacterial data align with national trends. It established an interdisciplinary management framework for clinical data analysis and prediction of antimicrobial resistance. This approach enhances infection control measures and supports the rational use of antimicrobials.

Patients undergoing anterior cruciate ligament reconstruction (ACLR) and patellar fracture frequently present with substantial pain, swelling and inflammation. These pathophysiological changes not only intensify postoperative pain but also compromise the intra-articular environment via mechanical compression and localised microcirculatory deficits, thereby impeding recovery. Conventional interventions for postoperative swelling, such as cryotherapy and physical agent modalities, are commonly applied yet exhibit limited efficacy. Multilayer low-stretch bandage (MLB), with its gradient compression properties, has recently demonstrated superior swelling control and functional restoration; however, existing research primarily assesses short-term outcomes and lacks a systematic analysis across the postoperative continuum—acute, subacute and chronic phases—as well as long-term follow-up. This study therefore employs a multi-temporal intervention design and extended follow-up to evaluate the effectiveness of MLB in managing swelling, modulating pain and enhancing long-term knee function and activities of daily living across different recovery stages. The findings aim to furnish high-level evidence for knee rehabilitation protocols, refine clinical practice and ultimately improve patient quality of life.

This prospective, single-blind, randomised controlled trial will enrol 36 patients following ACLR and patellar fracture. Participants will be allocated at a 1:1 ratio through computerised randomisation to either an experimental group receiving MLB plus conventional rehabilitation, or a control group receiving conventional rehabilitation alone. The study spans 12 weeks, with follow-up assessments scheduled at baseline (T0), 4 weeks (T1), 8 weeks (T2) and 12 weeks (T3). Outcome measures comprise the Hospital for Special Surgery (HSS) Knee Rating Score, affected limb oedema regression rate, Visual Analogue Scale (VAS) pain score, knee range of motion, quadriceps and hamstring muscle strength, centre of pressure (COP) displacement parameters, proprioceptive testing, the 36-Item Short Form Health Survey (SF-36) and the Holden Walking Function Classification. A subsequent 1-year follow-up will assess long-term efficacy and patient satisfaction, while adverse events are strictly monitored throughout the entire study period. Adherence to Consolidated Standards of Reporting Trials guidelines is maintained, and a single-blind design ensures that both participants and assessors remain unaware of group assignments. This trial aims to establish an evidence-based foundation for optimising postoperative rehabilitation in this patient population.

Ethical approval for the study was obtained from the Medical Ethics Committee of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School (2025-0141-01). The results of the study will be published in a peer-reviewed medical journal.

ClinicalTrials.gov chiCTR2500100566. Registration date is 10 April 2025.

Perioperative psychological symptoms are prevalent among patients undergoing lung surgery and can contribute to adverse clinical outcomes. Pharmacological interventions for these symptoms have inherent limitations. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-invasive therapeutic approach. This study aims to evaluate the efficacy of taVNS in managing perioperative psychological symptoms in patients undergoing elective thoracoscopic pneumonectomy under general anaesthesia.

This single-centre, prospective, randomised, double-blind, controlled trial will enrol 176 patients scheduled for elective thoracoscopic lung resection. Participants will be randomly allocated to either the active taVNS or the sham taVNS groups in a 1:1 ratio. Both groups will receive 30 min active or sham stimulation sessions at four time points: (1) the afternoon prior to surgery, (2) the morning of the surgery, (3) following extubation and (4) the first afternoon postsurgery. The primary outcome is the incidence of perioperative anxiety, assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale. Secondary outcomes include depression scores, stress index, sleep quality, pain scores, incidence of postoperative delirium, fatigue, cough symptoms and postoperative recovery quality, all evaluated through validated assessment tools. Analyses will be conducted using intention-to-treat and per-protocol populations.

The Ethics Committee of Affiliated Hospital of Xuzhou Medical University granted approval for the study with approval number: XYFY2024-KL444-01. Dissemination will be via national anaesthesia conferences and publication in the peer-reviewed literature.

ChiCTR2400090542.

To develop survey items for a national patient registry on Long COVID using a modified Delphi process.

This study was based on a modified Delphi process involving three rounds of anonymous, online surveys to develop consensus on and prioritise survey elements to be included in a minimum dataset for use in a national patient registry in Canada. Initial Long COVID items were identified through an environmental scan of the literature.

This study focused on healthcare systems in Canada and was conducted online.

A panel of 52 experts (patients, caregivers, clinicians and researchers) participated in all three rounds of the online survey. These participants were recruited through the Long COVID Web network and word of mouth.

In total, 243 survey elements related to care, quality of life and symptoms were included in round 1 of the survey. 200 reached consensus and moved to round 2 with two additional elements being developed based on open-ended responses. In round 2, participants ranked these survey elements and 34 advanced. In round 3, 33 survey elements met the threshold of consensus with one added a priori. The 33 survey elements were then used to develop a Long COVID minimum dataset, which consists of 48 items.

The findings affirm broad consensus for collecting data related to fatigue, post-exertional malaise, cardiovascular issues, respiratory problems and cognitive issues. This highlighted the desire for quality-of-life indicators and information related to care utilisation, quality and access.

Flexible ureteroscopy has advanced modern stone management; however, lower pole renal stones remain a challenge due to suboptimal ureteroscope deflection and navigation using conventional flexible and navigable suction ureteral access sheaths (FANS). The SCULPT trial is designed to assess whether the novel steerable FANS—which enables active controlled deflection—can improve the success rate of lower pole access during flexible ureteroscopy.

This multicentre, prospective, single-blinded, randomised controlled superiority trial will recruit 400 adult patients (aged 18–75 years) with solitary lower pole renal stones ≤2 cm diagnosed by CT from 20 high-volume urological centres in China. Participants will be randomised 1:1 to undergo flexible ureteroscopy with either steerable or conventional FANS. The primary outcome is the success rate of navigating into the lower pole calyx (defined as successful direct stone visualisation, laser lithotripsy and aspiration without adjunct use). Secondary outcomes include immediate and 1 month stone-free rates, operative time, complication profiles (graded by Clavien–Dindo), instrument damage rates, quality-of-life assessments and cost analysis. Statistical analysis will be performed using appropriate tests for continuous and categorical data, with their significance set by prespecified superiority margins.

The study protocol has been designed in accordance with the Declaration of Helsinki and ICH-GCP guidelines. Ethical approval was centrally granted by the Institutional Review Board of The First Affiliated Hospital of Guangzhou Medical University and adopted by all participating centres following local feasibility review. The trial results will be disseminated via peer-reviewed publication and presentation at international conferences.

NCT06898216.

To construct a nursing diagnosis index system for burn patients under prolonged field care (PFC).

A modified Delphi study.

13 class A tertiary hospitals and 2 universities.

Nine experts were selected for expert interview: (1) bachelor’s degree or higher; (2) ≥10 years’ experience in burn care, nursing quality management or health service management, including participation in ≥3 PFC operations; (3) intermediate or higher professional title; (4) willingness to participate. 22 experts were selected for expert consultation: (1) bachelor’s degree or higher; (2) ≥3 years’ nurse management experience with theoretical expertise in burn nursing diagnosis; participation in ≥3 major non-combat military operations; (3) intermediate or higher professional title; (4) commitment to complete consultations.

Including a two-stage process: (1) system construction: developed a preliminary index system using The North American Nursing Diagnosis Association international’s framework, guided by US military ‘10 PFC Core Competencies’ and UK military SHEEP VOMIT standards, via literature analysis and expert interviews. (2) Delphi refinement: conducted three Delphi rounds with 22 experts. Finalised indicators using Analytical Hierarchy Process to assign weights.

The burn PFC nursing diagnosis index system established in this study comprises 7 primary indicators, 18 secondary indicators and 44 tertiary indicators. The valid questionnaire response rate for the expert consultation reached 100%, with an expert authority coefficient of 0.85. After three rounds of the Delphi expert consultation, Kendall’s coefficient of concordance (Kendall’s W) for indicators at all levels ranged from 0.104 to 0.305 (p

This systematic, scientific and rational index system provides a foundation for standardising burn PFC nursing plans, potentially enhancing care quality and efficiency in PFC settings.

Chinese Visceral Adipose Index (CVAI) is a newly developed composite index that integrates age, Body Mass Index (BMI), waist circumference (WC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) to effectively estimate visceral adipose tissue (VAT) in Chinese patients with coronary heart disease (CHD). Given the central role of VAT in the pathogenesis of metabolic syndrome (MetS), current evidence on the relevance of CVAI in diagnosing MetS is scarce, and its predictive value for major adverse cardiac events (MACEs) in MetS patients with CHD after percutaneous coronary intervention (PCI) remains unclear. This study aimed to assess the value of CVAI in evaluating MetS patients with co-existing CHD after PCI.

This was a retrospective study conducted at a single centre, with enrolment from January to December 2024 and 12-month follow-up after PCI. A total of 561 patients who underwent cardiac catheterisation were recruited from the Department of Cardiology at the Affiliated Hospital of Jiangnan University. According to the diagnostic criteria for metabolic syndrome, participants were categorised into MetS (n=249) and non-MetS (n=312) groups for diagnostic evaluation. Clinical and laboratory data were collected, from which the CVAI was calculated using gender-specific formulas. Diagnostic performance for MetS was evaluated via receiver operating characteristic (ROC) curves. For prognostic analysis, 156 patients with both MetS and CHD who underwent PCI were stratified into high and low CVAI groups based on the median CVAI value. The prognostic value for MACEs within 12 months post-PCI was assessed using multivariate Cox regression and Kaplan-Meier (K-M) analysis.

Compared with WC, BMI and TG, the CVAI demonstrated the highest diagnostic accuracy for MetS, with an area under the curve (AUC) of 0.812 and cut-off value of 109.389. After adjusting for known confounders, Cox regression analysis revealed that both high CVAI (HR=2.251, 95% CI 1.139 to 4.450, p

The CVAI showed good diagnostic performance in identifying MetS, outperforming several conventional indices in estimating visceral adiposity. It also demonstrated prognostic value in predicting MACEs within 12 months among patients with MetS and CHD undergoing PCI. These findings suggest that CVAI shows promise as a potential clinical tool for cardiometabolic risk assessment and secondary prevention in this patient population, though further validation in larger, prospective studies is warranted.

Endometriosis, a chronic oestrogen-dependent disorder, presents significant clinical challenges including pelvic pain, dysmenorrhoea, dyspareunia and infertility. While numerous interventions exist, evidence guiding the choice among surgical, hormonal and non-hormonal therapies is fragmented. This protocol outlines a systematic review and network meta-analysis designed to comprehensively evaluate the comparative effectiveness and safety of all available treatments for endometriosis-associated pain and infertility.

We will systematically search PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and WHO International Clinical Trials Registry Platform. Randomised controlled trials evaluating any intervention for endometriosis will be identified through a two-stage independent screening process by two reviewers. Primary outcomes are overall pain reduction and live birth rate. Secondary outcomes include clinical pregnancy rate, miscarriage rate, endometriosis recurrence, relief of other endometriosis-related symptoms, adverse events, quality of life and obstetrical outcomes. Data will be synthesised using pairwise and network meta-analyses.

This systematic review of published literature does not require ethical approval. Results will be disseminated through peer-reviewed publication. The findings aim to establish a robust evidence base for clinical decision-making and to inform future research priorities in endometriosis management.

CRD420251051917.

Arthrogenic muscle inhibition (AMI) is a neuromuscular control disorder that occurs following joint injuries such as ligament tears, joint inflammation or postoperative conditions. It is characterised primarily by reflexive inhibition of the muscles surrounding the affected joint, substantially impeding rehabilitation. After anterior cruciate ligament reconstruction (ACLR), effective rehabilitation is essential to restore joint function, facilitate a return to preinjury activity levels and reduce the risk of reinjury. Vibration therapy may mitigate AMI by modulating somatosensory input to joint and cutaneous mechanoreceptors, thereby activating neuromuscular pathways through stimulation of mechanoreceptors in the skin, articular structures and musculotendinous tissues. Accordingly, this study employs cycloid vibration therapy (CVT) to evaluate its efficacy and safety in the management of AMI post-ACLR. The findings aim to determine whether integrating CVT into postoperative rehabilitation can effectively mitigate AMI, thereby optimising recovery of neuromuscular control and functional outcomes in ACLR patients.

This prospective, single-centre, randomised controlled trial will enrol 44 patients with AMI who have undergone ACLR. Participants will be randomly allocated in a 1:1 ratio to either an experimental group, receiving CVT plus conventional rehabilitation or a control group, receiving conventional rehabilitation alone. All participants will complete an 8-week rehabilitation programme consisting of 24 sessions. Outcome measures will be assessed at baseline, at a 4-week interim evaluation and immediately postintervention at week 8. These assessments will include surface electromyography parameters, ultrasonographic muscle thickness, range of motion, knee joint proprioception, Visual Analog Scale pain scores, Lysholm Knee Scoring Scale, Holden Functional Classification and adverse event rates. A follow-up study will evaluate patient satisfaction and long-term outcomes, while all adverse events will be monitored and documented throughout the trial.

The Medical Ethics Committee of Drum Tower Hospital, affiliated with Nanjing University School of Medicine, approved this study (2024-1022-02). The results will be submitted for publication in a peer-reviewed medical journal.

ChiCTR2500096882.

This study aims to investigate the predictors of very poor outcomes in patients with acute ischaemic stroke due to large vessel occlusion after successful endovascular thrombectomy.

A multicentre, retrospective study.

Data were derived from tertiary care facilities in five cities of China.

This study included 1242 patients with anterior circulation large-vessel occlusion who underwent endovascular thrombectomy, and they were stratified by 90-day modified Rankin Scale (mRS) scores into a very poor outcome group (mRS 5–6) and a non-very poor outcome group (mRS 0–4).

The primary outcome was very poor outcomes. Data from 1242 patients were analysed for demographic, laboratory, imaging and perioperative data.

Among the 1242 recruited patients, 318 (25.60%) exhibited very poor outcomes. In multivariate analysis, predictors of very poor outcomes were higher age (OR 1.059, 95% CI 1.043 to 1.075, p

The very poor outcomes were associated with advanced age, CHD history, stroke history, high NIHSS score, high neutrophil count, low ASPECTS and presence of MCE and sICH, while receiving intravenous thrombolysis was a protective factor. These poor outcome predictors might play a crucial role in informing clinical decision-making.

ClinicalTrials.gov (NCT06290076); pre-results.

Chronic low back pain (CLBP) is characterised by multifaceted pathophysiology involving both central sensitisation and peripheral dysfunction. Conventional therapies often fail to address this complexity due to their unidimensional targets. Paired associative stimulation (PAS), a dual-target neuromodulatory approach that combines central and peripheral interventions, has demonstrated efficacy in enhancing motor recovery post-stroke by synchronously inducing corticospinal plasticity and peripheral neuromuscular adaptation. Building on this paradigm, we propose a novel combined primary motor cortex (M1) and multifidus muscle stimulation protocol. The intervention pairs transcranial magnetic stimulation over M1 with peripheral magnetic stimulation targeting the multifidus muscle, hypothesising that temporally coordinated central and peripheral stimulation will synergistically enhance the corticospinal drive to the lumbar spine and restore multifidus neuromuscular control, thereby alleviating pain and improving functional capacity in CLBP.

This study will enrol 82 individuals diagnosed with CLBP between 18 and 65 years of age. Study participants will undergo randomisation into two parallel groups: the experimental arm receiving active PAS therapy (n=41) and the control arm receiving sham PAS treatment (n=41). The intervention protocol consists of 20 treatment sessions delivered across a 4-week timeframe, with participants attending five sessions weekly. Assessment time points are scheduled at study entry (baseline) and 4, 8 and 12 weeks following intervention initiation. The study’s primary outcome is the Oswestry Disability Index (ODI). Secondary outcomes encompass the Visual Analog Scale (VAS), Short-form McGill Pain Questionnaire (SF-MPQ), Short Form 36 Health Survey (SF-36), Pain Catastrophizing Scale (PCS), and functional magnetic resonance imaging (fMRI). Data analysis will adhere to the intention-to-treat methodology. Between-group comparisons across temporal measurement points will employ mixed-effects modelling approaches.

Ethical approval for the research protocol was obtained from the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (approval number: 2025-K-45), with trial registration completed in the China Clinical Trial Registry on 27 April 2025. On study completion, findings will be prepared for submission to peer-reviewed academic publications.

ChiCTR2500101574.

Combining immunotherapy with neoadjuvant chemoradiotherapy (neoCRT) has been shown to be safe, achieving a pathological complete response (pCR) rate of 56% in patients with locally advanced oesophageal squamous cell carcinoma (ESCC) in the PALACE-1 trial. This high pCR rate encourages us to explore the feasibility of postponing surgery after immunotherapy combined with neoCRT under active surveillance. This study aims to assess the efficacy, safety and patient-reported quality of life (QOL) of camrelizumab combined with neoCRT and watch-and-wait strategy versus neoCRT followed by surgery in locally advanced resectable ESCC.

The PALACE-3 trial is a multicentre, open-label, randomised non-inferiority trial expected to recruit 356 patients from six high-volume centres in China. The study is planned to start in May 2024 and end in December 2028. Eligible patients will be randomly assigned (1:1 ratio) to either camrelizumab combined with neoCRT and watch-and-wait strategy or neoCRT followed by surgery (standard surgery). In the active surveillance group, patients achieving a clinical complete response (cCR) to camrelizumab combined with neoCRT will undergo active surveillance, while those with residual disease or locoregional recurrence will undergo immediate surgery. Patients in the standard surgery group will proceed to surgery after neoCRT. The primary endpoint is the 3-year overall survival (OS) rate. The secondary endpoints include cCR rate, salvage surgery incidence, objective response rate, adverse events during the neoadjuvant therapy, pCR, tumour regression grade, R0 resection rate, lymph node ratio, perioperative complications, disease-free survival (DFS) and 3-year DFS rate, OS and health-related QOL.

This study has been approved by the Ethics Committee of Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital (Shanghai, China), as well as the ethics committees of the following participating centres: National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (Beijing, China); Sichuan Cancer Hospital and Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China (Chengdu, China); The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital (Zhengzhou, China); Fujian Medical University Union Hospital (Fuzhou, China). Complete information about the study status, relevant events and results will be regularly updated on the project’s webpage on ClinicalTrials.gov. Written informed consent (Supplemental Material) will be obtained from each participant. All research outputs will be published in peer-reviewed journals and presented at national or international conferences.

The trial was meticulously registered in advance on 1 April 2024 and can be accessed through the following link: https://www.clinicaltrials.gov/study/NCT06339060. The current protocol version number is V.2.0, and the protocol date is 30 June 2024.