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To consolidate the best evidence on digital therapeutic interventions for self-management in patients with hip fragility fractures, providing a foundational guide for clinicians in developing digital therapy-based self-management plans.
Integrative review.
A comprehensive electronic search was conducted across multiple databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Health and Clinical Excellence, Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Chinese databases like China National Knowledge Infrastructure and SinoMed. This study retrieved papers published from the establishment of the database to September 2023.
Studies were selected based on inclusion criteria, such as relevance to hip fragility fractures and self-management through digital therapies. Quality assessments were conducted independently by two reviewers using established tools for each type of study, ensuring the inclusion of high-quality evidence.
Fifteen studies were included: 4 guidelines, 5 expert consensus documents, 5 systematic reviews and 1 evidence summary. From these, 26 best practices were identified across 4 domains: digital design, self-management influencing factors, intervention plans and intervention content.
This integrative review provides a comprehensive, evidence-based summary of digital therapeutic interventions for self-management in patients with hip fragility fractures. The findings offer healthcare professionals a scientific basis for integrating digital therapy into clinical practice, highlighting its potential to enhance patient self-management.
This review underscores the value of digital therapies in empowering patients to take an active role in their rehabilitation, potentially improving adherence to self-management strategies and long-term outcomes.
No patient or public contribution was used for this study.
Hand dysfunction following stroke, especially during the flaccid paralysis phase, significantly impairs patients’ motor abilities and daily functioning. Electroacupuncture (EA) is widely used in post-stroke rehabilitation; however, inconsistent clinical outcomes and lack of standardised treatment parameters have limited its broader adoption.
This protocol describes a randomised controlled trial designed to determine optimal EA parameters for post-stroke hand dysfunction using an orthogonal experimental design.
This protocol presents a single-centre, randomised controlled trial design with 10 arms. A total of 110 patients with post-stroke hand dysfunction will be randomly assigned to nine electroacupuncture groups or one sham acupuncture group in equal proportions. Participants will receive 12 treatment sessions over 2 weeks. The EA groups are designed based on a four-factor, three-level orthogonal design to systematically evaluate the main effects of acupoint selection, stimulation frequency, needle thickness and treatment duration. The primary outcome is the effective response rate, defined as reduction in the Chinese Stroke Scale (CSS) score at 2 weeks. Secondary outcomes include assessments with the Modified Lindmark Rating Scale, range of motion measures, Modified Barthel Index and hand motor subscores of the CSS. As this is a trial protocol, results are not yet available. Statistical analyses will be conducted after completion of recruitment and follow-up according to the prespecified analysis plan. Safety and adverse events will be monitored throughout the study.
This trial is designed to address the current lack of evidence-based standardisation of EA parameters for post-stroke hand dysfunction. By systematically evaluating key treatment components using an orthogonal experimental design, the study aims to identify optimal EA strategies and provide a methodological framework to improve consistency, reproducibility and clinical effectiveness in post-stroke hand rehabilitation.
This manuscript describes a study protocol and does not report any data from participants at this stage. Ethical approval for the planned trial was obtained from the Medical Ethics Committee of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (Approval No. TYLL2024(K)072). Written informed consent will be obtained from all participants prior to enrolment. The results of the study will be disseminated through peer-reviewed journals and academic conferences.
ITMCTR2024000819.
Parkinson’s disease (PD) is a common neurodegenerative disorder characterised by high prevalence and disability rates, severely impairing patients’ quality of life and imposing a substantial societal burden. Rehabilitation interventions are an essential component of PD management; however, conventional face-to-face rehabilitation is constrained by limited resources and poor adherence. In recent years, the integration of artificial intelligence (AI) with wearable technologies has offered new avenues for rehabilitation, enabling continuous monitoring, objective assessment and personalised feedback. Although relevant studies have emerged, most are limited by small sample sizes, short-term designs and a lack of comprehensive synthesis. This study aims to conduct a scoping review to summarise the current applications of AI-driven wearable technologies in PD rehabilitation and functional assessment, and to identify existing research gaps.
This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and employ the Joanna Briggs Institute three-step search strategy. After an initial pilot search, a comprehensive search strategy will be developed to systematically search 10 databases (CNKI, Wanfang Data Knowledge Service Platform, SinoMed, the Cochrane Library, PubMed, Web of Science, CINAHL, Scopus, Embase and the IEEE Xplore Digital Library). One researcher will independently perform data extraction, and another will independently verify the extracted data. Eligible studies will include original research articles, dissertations and conference papers published after 2020, involving PD patients and using AI-driven wearable devices for rehabilitation or functional assessment. Data will be synthesised narratively and presented using tables and figures.
This study involves only publicly available published data and therefore does not require ethical approval. Findings will be disseminated through peer-reviewed journal publications and presentations at academic conferences.
To systematically identify and appraise existing risk prediction models for EN aspiration in adult inpatients.
A systematic search was conducted across PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biomedical Literature Database (CBM) and VIP Database from inception to 1 March 2025.
Systematic review of observational studies.
Two researchers independently performed literature screening and data extraction using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and the clinical applicability of the included models.
A total of 17 articles, encompassing 29 prediction models, were included. The incidence of aspiration was 9.45%–57.00%. Meta-analysis of high-frequency predictors identified the following significant predictors of aspiration: history of aspiration, depth of endotracheal intubation, impaired consciousness, sedation use, nutritional risk, mechanical ventilation and gastric residual volume (GRV). The area under the curve (AUC) was 0.771–0.992. Internal validation was performed in 12 studies, while both internal and external validation were conducted in 5 studies. All studies demonstrated a high risk of bias, primarily attributed to retrospective design, geographic bias (all from different parts of China), inadequate data analysis, insufficient validation strategies and lack of transparency in the research process.
Current risk prediction models for enteral nutrition-associated aspiration show moderate to high discriminative accuracy but suffer from critical methodological limitations, including retrospective design, geographic bias (all models derived from Chinese cohorts, limiting global generalisability) and inconsistent outcome definitions.
Recognising the high bias of existing models, prospective multicentre data and standardised diagnostics are needed to develop more accurate and clinically applicable predictive models for enteral nutrition malabsorption.
Not applicable.
PROSPERO: CRD420251016435
To refine fall risk assessment scale among older adults with cognitive impairment in nursing homes.
A cross-sectional survey.
Mokken analysis was conducted to refine the assessment scale based on unidimensionality, local independence, monotonicity, dimensionality, and reliability. Data were gathered from cognitively impaired older adults in a nursing home from January to February 2023. Trained nursing assistants conducted face-to-face assessments and reviewed medical records to administer the scale.
Emotion and State Dimension did not meet unidimensionality criteria (H = 0.14), particularly item Q9, which also violated local independence. Monotonicity analysis showed all items exhibited monotonic increases. After refinement at c = 0.3, the scale consists of nine items. With increasing c-values, the first seven items were ultimately retained to form the final version of the scale. Both optimised scales (9-item and 7-item) satisfied reliability requirements, with all coefficients (Cronbach's α, Guttman's lambda-2, Molenaar-Sijtsma, Latent Class Reliability Coefficient) ≥ 0.74.
The scale is suitable for assessing fall risk among older adults with cognitive impairment, with a unidimensional scale of the first seven items recommended for practical use. Future efforts should refine the scale by exploring additional risk factors, especially emotion-related ones.
The refined 7-item scale provides nursing home staff with a practical, reliable tool for assessing fall risk in cognitively impaired older adults, enabling targeted prevention strategies to enhance safety and reduce injuries.
The refined 7-item scale provides nursing home staff with a reliable, practical, and scientifically validated tool specifically designed for assessing fall risk in older adults with cognitive impairment. Its simplicity enables efficient integration into routine clinical workflows, empowering caregivers to proactively identify risk factors and implement timely, targeted interventions. This approach directly enhances resident safety by translating assessment results into actionable prevention strategies within daily care practices.
This study was reported in accordance with the STROBE guidelines.
No Patient or Public Contribution.
To characterise the risk of subsequent primary non-keratinocyte skin cancers (NKSCs) among adult-onset cancer survivors.
Data analysis of this population-based cohort study was conducted from September to November 2024.
The data are based on 17 Surveillance, Epidemiology and End Results (SEER) registries from 2000 to 2021.
Survivors of first primary cancers diagnosed in individuals aged 20–84 years between 2000 and 2021, across 17 registries in the SEER Program
Primary outcomes were a statistically significant increase in the incidence of subsequent NKSCs. Standardised incidence rate (SIR) and excess risk analysis were used to evaluate the risk of subsequent NKSCs after different primary cancers.
Among 5 691 336 survivors (51.3% male), 31 529 subsequent NKSCs were observed during a total follow-up of 36 440 569 person-years (mean, 6.4 years). The risk of subsequent NKSCs was increased after the first primary cancer (SIR, 1.12 (95% CI 1.10 to 1.13)). Across 35 first primary cancers, 19 showed a statistically significant rise in subsequent NKSC incidence. The highest SIR for subsequent NKSCs was observed after eye and orbit cancer (SIR, 2.96 (95% CI 2.55 to 3.41)), followed by cutaneous melanoma (SIR, 2.67 (95% CI 2.41 to 2.94)) and chronic lymphocytic leukaemia (SIR, 2.24 (95% CI 2.10 to 2.38)). Across NKSC types, cancer survivors were more likely to develop subsequent hemangiosarcoma (SIR, 2.66 (95% CI 2.31 to 3.05)), adenocarcinoma, not otherwise specified (SIR, 2.14 (95% CI 1.53 to 2.91)) and sebaceous adenocarcinoma (SIR, 1.70 (95% CI 1.57 to 1.83)). 10 specific first primary cancers demonstrated a consistently high risk of several specific NKSCs throughout the study period. Furthermore, the risk of subsequent NKSCs among cancer survivors was largely elevated following radiotherapy or chemotherapy (range, 13%–18%), especially for hemangiosarcoma.
Several types of primary cancers were strongly linked to an increased risk of subsequent NKSCs, underscoring the critical importance of implementing continuous surveillance and proactive prevention strategies to mitigate the risk of developing subsequent primary NKSCs among cancer survivors.
Given the rapidly evolving therapeutic landscape for type 2 diabetes (T2D) and chronic kidney disease (CKD), this study aimed to characterise the clinical profiles and real-world outcomes of patients with T2D and CKD in China who initiated sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RA).
Retrospective cohort study.
Demographic and clinical data of patients from a regional electronic health records database in Tianjin, China between 2012 and 2019 were used.
Adult patients diagnosed with T2D and CKD who initiated SGLT2i or GLP-1 RA from 2012 to 2019.
Baseline demographic and disease characteristics, comorbidities and comedications, healthcare resource utilisation (HRU), and clinical outcomes were assessed using descriptive statistics.
A total of 935 and 4821 patients were included in SGLT2i and GLP-1 RA cohorts, with the mean ages of 59 and 56 years, respectively. Both cohorts had similar durations of T2D (mean: 5 years) and CKD (mean: 3 years). In SGLT2i and GLP-1 RA cohorts, 54.4% and 56.9% of patients had hemoglobin A1c (HbA1c) >7%, and 50.5% and 54.1% were classified as CKD stage 1 at baseline. During the follow-up period (median 1.4 months for SGLT2i cohort and median 2.3 months for GLP-1 RA cohort), higher numbers of specialist visits compared with general practitioner visits were observed numerically for both cohorts. The incidence rates (95% CI) of kidney failure per 100 person-years were 3.1 (1.0, 7.3) for SGLT2i cohort, and 4.9 (3.9, 6.0) for GLP-1 RA cohort during follow-up.
This study provides descriptive evidence regarding the clinical characteristics and outcomes of patients with T2D and CKD who initiated SGLT2i or GLP-1 RA in China. The results are important for understanding the existing HRU and residual risk of severe clinical outcomes in such patient populations. The findings also provide a solid foundation for future research aimed at examining the clinical outcomes of new therapeutic options for T2D and CKD.
Depression is a significant global health burden, affecting over 300 million people worldwide and contributing substantially to disability and healthcare costs. Despite the widespread use of antidepressants, many patients experience limited efficacy or adverse effects. Non-invasive brain stimulation (NIBS) and acupuncture have emerged as promising non-pharmacological interventions for depression. However, the heterogeneity of treatment protocols and the lack of direct comparisons limit the development of optimal treatment strategies. This study seeks to perform a network meta-analysis (NMA) to compare and rank the comparative efficacy and acceptability of NIBS and acupuncture interventions for depression. This review is expected to inform evidence-based decision-making by comparatively evaluating efficacy and acceptability; any clinical implications will depend on the certainty and consistency of the evidence.
A comprehensive literature search will be conducted across 14 academic databases and registries (PubMed, Cochrane Library, Web of Science, Embase, OVID, Scopus, ProQuest, CNKI, Wanfang, CBM, VIP, ICTRP, ChiCTR and ClinicalTrials.gov) from inception to May 2025. Eligible studies will include randomised controlled trials assessing NIBS and/or acupuncture for depression. Two reviewers will independently conduct study selection, data extraction and risk of bias assessment using the Cochrane Risk of Bias 2 tool. Primary outcomes will include depressive symptom severity and acceptability (measured by all-cause discontinuation). Secondary outcomes will include response rate and adverse events. At the time of protocol submission, the literature search had been substantially completed, while study selection and data extraction had not yet commenced. Pairwise meta-analyses will be executed applying Review Manager V.5.4 and Stata V.17.0. A Bayesian NMA will be conducted via the GeMTC package in R V.4.2.2, and Stata will also be used for additional statistical analyses and visualisation. Subgroup and sensitivity analyses will explore sources of heterogeneity, and the certainty of evidence will be appraised using the Confidence in Network Meta-Analysis framework.
Ethical approval is not warranted since the study does not involve any confidential or private patient records. The results will be disseminated through publication in peer-reviewed journals.
CRD420250651706.
Nurses commonly experience negative experiences after experiencing a patient safety event, triggering a domino effect on the nurses themselves, subsequent patients, and healthcare organisations, thus requires urgent attention.
To explore the mediating role of psychological capital and coping styles between neurotic personality and negative experiences of nurses' second victims, and to provide theoretical guidance for nursing administrators to develop targeted strategies to mitigate negative experiences of nurses' second victims.
In June–July 2023, a general information questionnaire, a neurotic personality subscale, the Chinese version of the Second Victim Experience and Support Scale, the Nurses' Psychological Capital Questionnaire, and the Coping Styles Questionnaire were used to conduct an online survey of 213 nurses' second victims and structural equation modelling was constructed to clarify the relationship between these elements.
Psychological capital and coping styles partially mediated the relationship between neurotic personality and negative experiences in the nurses' second victims, with a total indirect effect value of 0.203 and a total effect value of 0.303, for a mediating effect of 33.00%.
Neurotic personality and immature coping styles negatively predict the degree of negative experience, while psychological capital and mature coping styles positively predict the degree of negative experience. Psychological capital and coping styles play a partial mediating role between neurotic personality and negative experience.
After a patient safety incident, nursing managers can mitigate the negative experiences of nurses' second victims in patient safety incidents by reducing their neurotic personality tendencies, enhancing their level of psychological capital, and guiding them to adopt mature coping styles.
No patient or public contribution.
Frailty affects over 35% of maintenance haemodialysis (MHD) patients globally—2–3 times higher than the general elderly—and is strongly linked to higher mortality, hospitalisation, and functional decline. Despite its clinical impact, frailty is often underdiagnosed in dialysis settings due to inconsistent assessments and limited resources. Existing prediction models vary widely in predictors and methods, requiring systematic review to guide clinical use and improve risk-stratified care.
To systematically identify, describe, and evaluate the existing risk prediction models for frailty in patients undergoing MHD.
Systematic review and Methodological appraisal.
A comprehensive search was conducted across multiple databases—PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China Biomedical Literature Database (CBM), Wanfang Database, VIP Database—covering studies up to November 1, 2024.
Two researchers independently conducted literature searches, screening, and data extraction. They used the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk of bias and the applicability of the included models.
Fifteen studies (21 models) were analysed, with sample sizes 141–786 and frailty incidence 11.00%–59.57%. Model AUCs ranged 0.720–0.998 (potential overfitting at extreme values). Key predictors included age, serum albumin, gender, Charlson comorbidity index, and activities of daily living scores. Methodological appraisal using PROBAST revealed moderate applicability but high bias risks: 53% of studies used retrospective designs, 95% lacked external validation, and limitations included small samples, non-standard variable selection, and inadequate handling of missing data.
While models demonstrate initial predictive utility, widespread bias and developmental-stage limitations hinder clinical application. Future research must prioritise TRIPOD-guided model development, emphasising large prospective cohorts, rigorous validation, and transparent reporting to enhance reliability and clinical utility in frailty risk stratification for MHD patients.
by Yinyin Wu, Wei Ding, Yuying Liu, Qianhong Deng, Fengqin Tao, Hanbin Chen, Chang Chen, Meng Xiao, Bilong Feng
BackgroundStandardized guidelines for optimal tunnel length in tunneled peripherally inserted central catheters (PICCs) are lacking.
ObjectivesThe objective of this study was to evaluate the real-world impact of tunnel length on clinical outcomes.
MethodsThis retrospective cohort study included 207 cancer patients who received tunneled PICCs, categorized into a control group (tunnel length > 4 cm, n = 134) and an observation group (tunnel length ≤ 4 cm, n = 73). Propensity score matching (PSM) was used to address baseline heterogeneity. Cox regression analyses were used to assess the risk of complication during a 120-day follow-up.
ResultsCompared to the control group (tunnel length > 4 cm), the observation group (tunnel length ≤ 4 cm) had a significantly higher adjusted overall complication risk (HR = 2.92, 95% CI: 1.07–7.94, P = 0.036) and unplanned catheter removal rate (4.4% vs. 0.0%, P = 0.027), confirming the safety of longer tunnels despite comparable comfort levels between groups. After PSM, Cox regression analysis showed results consistent with those from the unmatched cohort. Subgroup analyses revealed a reduced risk of complications with longer tunnels in patients with BMI ≤ 25 kg/m² (HR = 0.29, 95% CI: 0.11–0.82), without hypertension (HR = 0.36, 95% CI: 0.13–1.00), without diabetes (HR = 0.38, 95% CI: 0.15–0.97), and with solid tumors (HR = 0.31, 95% CI: 0.11–0.85).
ConclusionThe results show that tunnel lengths > 4 cm reduce overall complications and prolong catheter retention, supporting the implementation of standardized protocols while advocating for personalized adjustments based on BMI, comorbidities, and cancer type.
Pressure injuries remain a significant concern in military hospital settings, leading to increased morbidity and healthcare costs. Understanding the interplay of multiple risk factors is critical for effective prevention. To identify key risk factors and their combined effects on pressure injury development among inpatients in multi-centre military hospitals using factor analysis. A cross-sectional study was conducted involving 4876 inpatients across multiple military hospitals. Data were collected on 15 potential risk factors, including incontinence, care dependency, mobility limitations, comorbidities, medication use, nutritional status, and demographics. Factor analysis with principal component analysis and varimax rotation was applied, and maximum canonical correlation coefficients were calculated to evaluate the predictive contribution of single and combined factors. Single-factor analysis identified incontinence as the strongest predictor (MaxCanonicalCorr = 0.50126), followed by care dependency (0.31982) and bedridden status (0.30061). Two-factor analysis revealed incontinence combined with care dependency as the highest-performing model (MaxCanonicalCorr = 0.50867). Three-factor models incorporating incontinence, health conditions, and care dependency achieved the greatest predictive capacity (MaxCanonicalCorr = 0.5157), demonstrating that multi-factor interactions enhance risk prediction beyond single-factor effects. Incontinence is the primary modifiable risk factor for pressure injury in military hospital inpatients. Integrating continence management with assessments of functional status and comorbidities can improve early identification of high-risk patients and guide targeted preventive strategies.
Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, with most Chinese patients diagnosed at a locally advanced stage. Neoadjuvant chemotherapy (NAC) is increasingly used to improve resectability and survival. Laparoscopy-assisted distal gastrectomy (LADG) provides short-term recovery benefits compared with open distal gastrectomy (ODG), but its safety and oncologic efficacy following NAC remain uncertain. This trial aims to determine whether LADG is non-inferior to ODG in terms of long-term survival outcomes in patients with locally advanced distal gastric cancer (LAGC) after NAC.
This is a multicentre, randomised, controlled, non-inferiority trial conducted at high-volume GC centres in China. Eligible patients (aged 18–75 years; cT3–4a, N0/+, M0) with histologically confirmed distal gastric adenocarcinoma who have completed standard NAC will be randomised 1:1 to LADG or ODG with D2 lymphadenectomy. Surgical quality will be standardised through operative manuals, intraoperative video recording and central auditing. The primary endpoint is 3-year disease-free survival. Secondary endpoints are 3- and 5-year overall survival. A total of 998 patients (499 per arm) will be enrolled, providing 80% power to test non-inferiority with an absolute 8% margin, accounting for 15% attrition. Analyses will follow the intention-to-treat principle, with Cox models used for survival comparisons and subgroup analyses according to nodal status, tumour size and pathological response.
This trial has been reviewed and approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University (Approval No. 2025 (865), 16 July 2025). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed journals and international conferences, providing high-level evidence to guide the surgical management of LAGC after NAC.
Chinese Clinical Trial Registry, ChiCTR2500109677; registered on 23 September 2025. Protocol V.2.1, dated 29 June 2025.
Advance Care Planning (ACP) has the potential to enhance end-of-life care and improve the allocation of healthcare resources for patients with cancer. However, its successful implementation requires considerable effort to overcome challenges and deliver health benefits. Healthcare providers and patients are key players in ACP, and their perceptions of the process must be understood to address implementation challenges effectively.
To identify barriers and facilitators to ACP implementation in Chinese oncology settings, providing a foundation for culturally appropriate healthcare strategies.
A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews (n = 30) were conducted between April and August 2022 to synthesise the perspectives of nurses, physicians, patients with cancer and their families who had participated in ACP. Data were analysed using a directed qualitative content analysis approach, and reporting followed the SRQR guidelines.
Twenty implementation determinants were identified across four CFIR domains, including 13 barriers and 7 facilitators. Key barriers included limited adaptability of ACP to local cultural and family norms, high complexity of ACP processes, insufficient knowledge and skills among clinicians, unclear team responsibilities, low organisational readiness, limited resources and poor public awareness. Facilitators included strong team culture, clinician motivation, supportive leadership and alignment with national policies. Two determinants showed mixed influences: the relative advantage of ACP compared to existing practices, and the extent of collaboration with external organisations.
Our study highlights the challenges of implementing ACP in China, as well as the unique and specific barriers to implementation. These findings contribute to a deeper understanding of context-specific determinants and offer actionable insights to inform the development of culturally tailored ACP implementation strategies in resource-limited healthcare settings.
To inform the development of implementation strategies to promote ACP in healthcare systems dominated by traditional medicine.
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.
by Bing Wu, Pengli Wei, Jiaxiang Deng, Yuanyuan Rui
BackgroundThe atherogenic index of plasma (AIP) is a recognized marker of atherosclerosis and cardiovascular disease (CVD). However, the association between AIP and the risk of acute kidney injury (AKI) in critically ill patients with sepsis has not yet been investigated.
MethodsThe data used in this study were derived from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The clinical outcome was the occurrence of AKI. Logistic regression was used to assess the association between AIP and the risk of AKI in sepsis patients. Restricted cubic spline (RCS) analysis was applied to explore potential non-linear relationships. Threshold analysis confirmed a turning point at this value. Subgroup analyses evaluated the consistency of the association across different strata. Mediation analysis was performed to explore potential intermediate variables.
ResultsAmong 1,874 sepsis patients, higher AIP levels were associated with increased AKI incidence. Logistic regression showed a significant association between AIP and AKI in unadjusted and partially adjusted models, but the association was no longer significant after full adjustment. RCS analysis revealed a nonlinear relationship with a peak AKI risk at AIP = 1.333. Threshold analysis confirmed a turning point at this value. Subgroup analyses showed consistent associations, while nonlinear effects were more evident in specific groups. Mediation analysis suggested that SOFA score, creatinine, WBC count, and respiratory rate partially mediated the AIP-AKI relationship.
ConclusionAIP was nonlinearly associated with AKI in sepsis, with a clear threshold effect. This relationship was partially mediated by SOFA score, creatinine, WBC, and respiratory rate. AIP may serve as a useful marker for AKI risk assessment.
by Xiaoliang Wan, Feiyao Deng, Xue Bai, Chenxi Xiang, Chuan Xu, Linxiao Qiu
Dysregulated serum chloride levels are prevalent in critically ill patients. However, their clinical impact remains unclear. This first systematic review and meta-analysis quantified the prevalence of hypochloremia and hyperchloremia, and their associations with mortality and acute kidney injury (AKI) in critically ill populations. We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies reporting hyperchloremia prevalence or outcomes in adult ICU patients until August 2025. Statistical analyses were conducted using Stata v16.0, and study quality was assessed using the Newcastle-Ottawa Scale. 34 studies (n = 175,021 patients) were included. The aggregated prevalence of hyperchloremia was 34% (95% CI [26%−43%]) and hypochloremia was 14% (95% CI [1%−28%]). Meta-analysis demonstrated that both hyperchloremia and hypochloremia were significantly associated with increased mortality, conferring a 28% (OR = 1.28, 95% CI [1.08–1.52]) and 55% (OR = 1.55%, 95% CI [1.33–1.81]) elevated risk for mortality, respectively. Crucially, a dose-response analysis revealed a non-linear relationship between serum chloride levels and mortality, confirming that the risk is independently elevated at both extremes. Furthermore, hyperchloremia was linked to an increased risk of AKI (OR = 1.40, 95% CI [1.07–1.85]). These findings establish dysregulated serum chloride as a common and clinically significant biomarker, underscoring the necessity of monitoring and managing both high and low chloride levels in critically ill patients. Future large-scale studies are warranted to validate these results and elucidate the mechanistic pathways linking chloride dysregulation to such adverse outcomes.Coronary artery involvement remains the primary focus in the long-term management of Kawasaki disease (KD). However, previous studies suggest that myocardial abnormalities frequently persist beyond coronary artery involvement in KD patients. Yet, their temporal evolution and clinical implications remain poorly characterised. To address this gap, we established the Kawasaki disease cardiac imaging (KDCI) cohort, integrating cardiac magnetic resonance (CMR) with echocardiography, coronary CT angiography (CCTA) and invasive angiography. These multimodal imaging approaches enable comprehensive assessment of cardiac abnormalities and elucidate the role of cardiac imaging in optimising long-term KD management.
The KDCI cohort is a prospective study aiming to enrol 400–500 KD patients diagnosed at West China Second University Hospital from September 2018 to September 2035. To date, 207 participants have been recruited. Participants will perform the multimodal cardiac imaging including echocardiography, CMR, CCTA, invasive angiography and comprehensive laboratory testing under a scheduled protocol in the follow-up.
The KDCI cohort has established baseline characteristics for 207 KD patients. Of those included to date, 72.0% (149/207) received intravenous immunoglobulin (IVIG) treatment, with 26.1% (54/207) demonstrating IVIG resistance, and 37.7% (78/207) exhibiting coronary artery dilatation. Longitudinal follow-up data are available for 80.7% (167/207) of participants, with a median follow-up duration of 2.7 years and a follow-up patient-years of 594 patient-years. Of the 207 patients, 16.9% (35/207) patients experienced endpoint events, encompassing coronary artery thrombosis (8.2%, 17/207), coronary stenosis/obstruction (5.3% 11/207) and clinical myocardial infarction (1.9%, 4/207). Based on the data collected, we have demonstrated the cardiac abnormalities beyond coronary artery involvement in KD by CMR and CCTA.
The KDCI cohort will maintain ongoing recruitment and longitudinal follow-up, with a projected enrolment exceeding 400 participants by 2035. This expansion will yield a median follow-up duration of 10 years, providing robust long-term outcome data. We have implemented standardised protocols for scheduled follow-up assessments and data collection in newly enrolled patients. Furthermore, planned genomic analyses will be incorporated to investigate the molecular pathogenesis and prognostic determinants of KD.
To explore the symptom experiences and self-management strategies of patients with chemotherapy-induced hand-foot syndrome (HFS), and to identify approaches for improving symptom control and quality of life.
A qualitative study using semi-structured interviews and thematic analysis.
We conducted this study in the oncology inpatient ward of a tertiary hospital in Shanghai, China.
We used a purposive sampling approach to recruit 25 inpatients with chemotherapy-induced HFS from July 2022 to March 2024. The interviews were audio-recorded and transcribed verbatim. We employed an adapted version of Colaizzi’s qualitative analysis approach to examine the data.
25 patients (mean age 58 years; 56% male) with grade I–III chemotherapy-induced HFS were interviewed. Four inter-related themes emerged.
(1) Symptom experience: pain, numbness and burning sensations disturbed sleep; visible peeling and hyper-pigmentation triggered embarrassment and self-consciousness.
(2) Emotional responses: most participants accepted symptoms as ‘part of treatment’, yet persistent anxiety about progression and guilt over becoming a family burden were common.
(3) Social impact: patients avoided outdoor activities, stopped caring for grandchildren and reported lost income because ‘hands can’t touch cold or rough items’.
(4) Future expectations: participants wanted pictorial self-care guides, a nurse hotline after discharge and earlier introduction of pain-relief strategies. All expressed frustration at ‘no-one to ask’ once home.
Chemotherapy-induced HFS imposes a considerable multidimensional burden. Tailored, patient-centred interventions that integrate education, psychological support and family involvement are essential to improve symptom management and overall well-being. Future work should develop and test sustainable, long-term support strategies in broader populations.
This study provides the first qualitative evidence base for understanding and managing chemotherapy-induced HFS in Chinese patients, informing nurse-led interventions, patient-reported outcome development and national supportive-care policy.
FreshRSS 