Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease, particularly in patients with multivessel disease. Connecting the saphenous vein graft (SVG) to the right internal mammary artery (RIMA) instead of the aorta has been proposed as an alternative approach to minimise aortic manipulation and potentially improve graft patency. This study aims to determine whether the RIMA-SVG technique is non-inferior to the conventional Aorta (Ao)-SVG approach in terms of 1-year graft patency, while also comparing perioperative complications and short-term clinical outcomes.

This non-inferiority, single-centre, prospective, double-blind, randomised clinical trial will enrol 300 patients undergoing CABG. Participants will be randomised into two surgical groups (RIMA-SVG vs Ao-SVG). The primary outcome is the 1-year SVG patency rate, assessed using coronary CT angiography. Secondary outcomes include perioperative complications, all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and surgical site infections occurring during hospitalisation and up to 1 year postoperatively. Randomisation will be computer-generated, and all procedures will be performed by experienced surgeons. Patients will be followed up 12 months post-surgery. Non-inferiority will be established if the upper bound of the one-sided 97.5% CI for the difference in graft occlusion rates is less than the prespecified non-inferiority margin of 10%.

This study has been approved by the Ethics Committee of the Second Hospital of Jilin University (No. 460) and registered at ClinicalTrials.gov (NCT06787651). All participants will provide written informed consent before enrolment. To ensure data integrity and minimise bias, randomisation details will be concealed from researchers until surgery, and data analysts will remain blinded to group assignments. The findings will be disseminated through academic journals and conference presentations to promote knowledge sharing and clinical application in the field of cardiovascular surgery.

NCT06787651.

To predict the outcome of patients with traumatic brain injury (TBI) using the optic nerve sheath diameter (ONSD) and the central venous minus arterial CO₂ pressure to arterial minus central venous O₂ content ratio (Pcv-aCO₂/Ca-cvO₂) in prehospital settings.

A prospective cohort study was conducted in China.

The study was conducted from October 2023 to October 2024, enrolling patients diagnosed with TBI. Participants presenting a Glasgow Coma Scale (GCS) 2/Ca-cvO₂: Group A Pcv-aCO₂/Ca-cvO₂ >1.8 mm Hg/mL and ONSD >5.6 mm; Group B: Pcv-aCO₂/Ca-cvO₂ >1.8 mm Hg/mL and ONSD ≤5.6 mm; Group C: Pcv-aCO₂/Ca-cvO₂ ≤1.8 mm Hg/mL and ONSD >5.6 mm; and Group D: Pcv-aCO₂/Ca-cvO₂ ≤1.8 mm Hg/mL and ONSD ≤5.6 mm.

30-day mortality, functional neurological recovery at discharge (measured by Glasgow Outcome Scale (GOS)), and length of intensive care unit (ICU) stay were compared between the 4 groups.

Our findings show that Group D had the lowest 30-day mortality, the shortest ICU stay and the highest good recovery at discharge (GOS score) among the four groups. Survival curves illustrated a decrease in 30-day mortality in group C patients after mannitol administration compared with patients who did not receive mannitol administration. The area under the receiver operating characteristic curve for Pcv-aCO₂/Ca-cvO₂ combined with ONSD (0.907 (95% CI 0.843 to 0.941)) was higher than those for ONSD (0.851 (95% CI 0.791 to 0.911)) alone, Pcv-aCO₂/Ca-cvO₂ (0.814 (95% CI 0.744 to 0.873)) alone or initial GCS (0.823 (95% CI 0.763 to 0.889)). Calibration plots demonstrated a strong alignment between observed and predicted probabilities for ONSD, Pcv-aCO₂/Ca-cvO₂, the combination of ONSD and Pcv-aCO₂/Ca-cvO₂, and initial GCS.

ONSD combined with Pcv-aCO₂/Ca-cvO₂ is a relatively novel method for predicting the outcome in TBI patients, especially in a prehospital setting. This dual approach may improve the prediction of early prognosis and guide osmotherapy treatment in patients with TBI.

We will recruit 478 paediatric patients with newly diagnosed IgAV across multiple centres. Participants will undergo prospective longitudinal assessment at disease onset and at 1, 3, 6 and 12 months postdiagnosis. Standardised evaluations will include clinical manifestations, physical examinations, laboratory parameters and patient-reported outcomes. The data will be analysed statistically with SPSS software (V.27.0), adopting a significance threshold of p

This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2024-K0480), the Ethics Committee of the First People’s Hospital of Yulin (YLSY-IRB-SR-2025060), the Medical Research Ethics Committee of the Liuzhou Workers’ Hospital (KY2024356) and the Ethics Committee of the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region (No. (2025–1)003) and written informed consent was obtained from all the parents or guardians of the patients involved. It will be disseminated by publication of peer-reviewed manuscripts and presentation in abstract form at national and international scientific meetings.

ChiCTR2500099716.

The application of artificial intelligence (AI) technology in the screening of diabetic retinopathy (DR) has made significant strides. However, there remains a lack of comprehensive validation and evaluation of AI-derived quantitative indicators in DR screening.

This study aims to assess the diagnostic performance of retinal microvascular indicators in the early detection of DR in patients with type 2 diabetes and to identify potential novel indicators for early DR screening.

This cross-sectional study included 533 community-recruited patients with type 2 diabetes mellitus who underwent fundus imaging. Based on the results of the fundus examination, the eyes were categorised into non-DR, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR and severe NPDR groups. AI systems were employed to quantify various retinal microvascular indicators, including microaneurysms (MAs), haemorrhage count (HC), haemorrhagic area (HA), the ratio of HA to retinal area (HA/RA), the ratio of HA to MA (HA/MA) and HC and/or MA (H/MA). Multivariable logistic regression was used to analyse the association between fundus indicators and DR severity, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive and screening value of these indicators, determining sensitivity, specificity, ROC area under the curve (AUC) and optimal cut-off values.

Among the 533 participants (mean age 64.03±9.71 years; 51.6% female), the DR prevalence was 10.0%. After adjusting for age, gender, body mass index, hypertension, diabetes duration, glycated haemoglobin levels, smoking and alcohol consumption, multivariable logistic regression indicated that HA/RA (OR 1.873, 95% CI 1.453 to 2.416) and HA/MA (OR 1.115, 95% CI 1.063 to 1.169) were associated with mild NPDR. Similarly, HA/RA (OR 1.928, 95% CI 1.509 to 2.464) and HA/MA (OR 1.165, 95% CI 1.112 to 1.220) were associated with moderate NPDR, and HA/RA (OR 2.435, 95% CI 1.921 to 3.086) and HA/MA (OR 1.171, 95% CI 1.117 to 1.226) were linked to severe NPDR. ROC curve analysis revealed that before adjustment, HA/RA demonstrated the highest screening value for DR, with an AUC of 0.917, sensitivity of 86.14%, specificity of 93.41%, Youden’s index of 0.796 and an optimal cut-off value of 0.063. After adjusting for confounding factors, the AUC for HA/RA in diagnosing DR was 0.900, with sensitivity of 83.17%, specificity of 86.28%, Youden’s index of 0.695 and an optimal cut-off value of 0.093.

The HA/RA and HA/MA show robust screening performance for early DR. These indicators should be considered for inclusion in AI-based early DR screening systems in the future.

Hip fractures are a prevalent type of fracture and a leading cause of disability and mortality among older patients, imposing a substantial burden on both families and society. As surgical intervention is considered the primary means of improving patient outcomes, perioperative optimisation management is essential for enhancing prognosis. A key component of the Enhanced Recovery After Surgery (ERAS) protocol for hip surgery is the innovation of preoperative fasting concepts, which includes the recommendation of preoperative oral carbohydrates for surgical procedures, particularly hip surgery. While preoperative oral carbohydrates have been shown to alleviate hunger and thirst symptoms in patients and promote postoperative recovery, concerns regarding intraoperative aspiration and gastric content retention persist, rendering the safety and feasibility of this approach for surgery a topic of debate. This study aims to investigate and summarise the clinical outcomes of preoperative oral carbohydrates in patients undergoing hip surgery, providing a comprehensive evaluation of their impact on patient recovery and safety.

A systematic and comprehensive search will be conducted across multiple databases, including CINAHL, PubMed, CNKI, VIP database, Wanfang database, Embase, CBM, Web of Science, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov (https://www.clinicaltrials.gov/), from their inception to November 2024, to identify randomised controlled trials that examine the effect of preoperative oral carbohydrates on patients with hip fractures. The primary outcome of interest will be postoperative insulin sensitivity. The literature search will be screened independently by two researchers to identify eligible articles for inclusion in this meta-analysis. Subsequent data extraction and assessment of risk of bias will be performed. This meta-analysis will provide a comprehensive summary of the available data for each outcome, provided that sufficient data are available. The presence of heterogeneity among the included studies will be evaluated using the ² test and the I² statistic, allowing for the quantification of inconsistency across the studies. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols are adhered to in this systematic review and meta-analysis.

This study uses previously published data, and as such, does not require additional ethical approval. The findings will be disseminated through peer-reviewed journals.

CRD42024611468.

The functional cure of chronic hepatitis B (CHB) is an ideal goal of therapy, as it is associated with improved long-term outcomes. Patients with low levels of HBsAg have higher rates of functional cure by pegylated interferon α (PEG-IFNα) therapy, and similar results have been observed in patients treated with PD-1 antibody. However, the combination therapy of PD-1 antibody and PEG-IFNα for promoting functional cure has not been studied. This study protocol aims to evaluate the efficacy and safety of a novel combined strategy, PD-1 antibody combined with PEG-IFNα therapy, in nucleos(t)ide analogues (NAs)-treated CHB patients.

This is a prospective, multicentre, open-label, randomised controlled study. Virologically suppressed CHB patients by NAs therapy will be recruited and randomised into PEG-IFNα group, PD-1 antibody group or PD-1 antibody combined PEG-IFNα group. PD-1 antibody will be injected intravenously once per 3 weeks for 24 weeks, and PEG-IFNα will be injected subcutaneously once a week for 48 weeks. The primary outcomes are the rate of HBsAg loss at 24 weeks. For safety analysis, adverse events in different groups will be compared.

This study has been approved by the Ethics Committee of the Fifth Medical Center of the Chinese PLA General Hospital (KY-2023-12-86-3). All results of the study will be submitted to a peer-reviewed journal.

NCT06357806.

Acute decompensated heart failure (ADHF), characterised by rapid deterioration of cardiac function, imposes substantial clinical and economic burdens due to high mortality (10%), frequent rehospitalisations (30% within 3 months) and impaired health-related quality of life. While exercise-based cardiac rehabilitation (ExCR) is a guideline-recommended intervention for stable heart failure, its utilisation remains critically low (11%) in ADHF populations, particularly during the vulnerable period spanning 90 days post-discharge—a high-risk phase marked by elevated mortality and morbidity. Current evidence gaps persist regarding optimal ExCR timing, dosage and efficacy during this critical window. This randomised controlled trial investigates the feasibility and impact of early ExCR initiation in the ADHF vulnerable period, evaluating outcomes in physical capacity, cardiac function and quality of life to inform evidence-based exercise protocols for this high-risk population.

This prospective, non-inferiority, randomised controlled trial will recruit 88 patients with ADHF. Participants will be randomised 1:1 to a 12-week personalised ExCR group or a traditional health education-based CR control group. Assessments will occur at baseline and 1, 2 and 3 months. The primary outcome is the change in 6 min walk distance post-intervention. Secondary outcomes include changes in grip strength, New York Heart Association Classification(NYHA class), brain natriuretic peptide, left ventricular ejection fraction, hospital stay, Short Physical Performance Battery score, Activities of Daily Living, Minnesota Living with Heart Failure Questionnaire score, and frailty status. Safety measures include all-cause readmission and mortality within 3 months post-discharge, as well as adverse events during the trial.

The study protocol was approved by the Peking University First Hospital Ethics Committee (Approval No. 2024yan180-002) in accordance with the Declaration of Helsinki. All participants will provide written informed consent prior to enrolment. The findings will be disseminated via peer-reviewed publications and conference presentations.

This study protocol was registered at ClinicalTrials.gov (Identifier: NCT06795737, https://www.clinicaltrials.gov/.) on 26 January 2025.

The study aims to define the prevalence of Do-Not-Resuscitate (DNR) orders among patients with shock in the emergency department (ED) and explore their impact on clinical management and mortality outcomes.

A retrospective observational cohort study was conducted involving patients presenting to the ED with shock.

An ED in a tertiary hospital in western China.

2001 patients (aged ≥18 years) presenting to the ED with shock from 1 January 2022 to 31 December 2023.

The enrolled patients were divided into DNR (order issued within 24 hours of ED admission)/non-DNR groups. Demographics, vitals, comorbidities, laboratory values, medications and prognoses were obtained from electronic healthcare records. DNR prevalence and its associations with mortality, ICU admission, vasopressor administration and antibiotic administration were assessed via logistic regression.

Compared with patients without DNR orders, patients with DNR orders (n=399 (19.9%)) were older (p

Compared with patients with shock in the ED who did not have DNR status, those with DNR status (prevalence ~20%) had higher in-hospital and 30-day mortality (but most survived) and similar ICU admission and intervention treatments.

The development of simple tools to identify individuals at high risk of coronary heart disease (CHD) would enable rapid implementation of preventive measures. This study was designed to construct predictive models and scoring systems for CHD using monocyte count and its ratio to high-density lipoprotein cholesterol (HDL-C) (MHR).

Population-based prospective cohort study.

The Shanghai Suburban Adult Cohort and Biobank (SSACB).

This prospective study included 44 013 CHD-free participants of the SSACB. The Songjiang subcohort served as the training set, in which three predictive models and corresponding scoring systems were developed with monocyte count or MHR using stepwise Cox regression. The models and algorithms were tested internally using 10-fold cross-validation and externally in the Jiading subcohort. Discriminations were assessed based on area under the curve (AUC) values, while calibrations were evaluated using the Hosmer-Lemeshow goodness-of-fit test.

During a mean follow-up period of 4.8 years, 883 CHD events occurred, with an incidence of 415.7/100 000. Monocyte count and MHR were significantly associated with the risk of CHD. The constructed model incorporating monocyte count (Model 2) achieved AUC values of 0.746 (0.726, 0.766) for 4-year CHD prediction in the training set, 0.746 (0.690, 0.796) in the cross-validation, and 0.717 (0.674, 0.761) in the external validation, comparable to the models including HDL-C (model 1) or MHR (model 3). Calibration plots demonstrated good agreement between predicted and actual probabilities. Similar results were observed for the corresponding scoring algorithms.

The monocyte-based model is a simple, low-cost and well-calibrated risk-stratification tool for CHD. However, the declined discrimination in external validation indicates limited generalisability. Prospective multicentre validation and recalibration are therefore warranted before clinical adoption.

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

Population-based, multicentre cross-sectional study.

41 medical institutions across 21 cities in China.

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

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

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

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

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

Retrospective cohort study.

Tertiary care, Xiangtan Central Hospital, Hunan, China.

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

All-cause mortality within 3 years of hospital discharge.

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

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

NCT06487468.

Although emerging evidence supports the short-term efficacy of transcranial magnetic stimulation (TMS), including repetitive TMS (rTMS) and theta-burst transcranial magnetic stimulation (TBS-TMS), and transcranial direct current stimulation (tDCS) for managing patients with chronic musculoskeletal pain (CMP), their clinical utility in managing CMP remains inconclusive. This uncertainty may arise from methodological limitations, including heterogeneity in treatment parameters such as stimulation targets and dosages. Additionally, safety profiles for these non-invasive brain stimulation interventions in patients with CMP remain insufficiently reported, with limited data on adverse events, cumulative risks and long-term safety outcomes. Hence, in this scoping review protocol, we aim to systematically (1) identify and map the stimulation targets and dosages of TMS and tDCS used in previous studies to treat patients with CMP; (2) summarise the rationale for using the stimulation targets and dosages of TMS and tDCS; and (3) summarise the reports on the safety of TMS and tDCS in managing patients with CMP, including whether safety was reported and how it was described.

We will adopt Arksey and O’Malley’s methodological framework and report findings according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Two authors will independently screen articles and extract data from PubMed, Scopus, Web of Science and Embase, including publications from inception to 1 August 2025. Discrepancies regarding study inclusion will be resolved through consultation with a third author. We will synthesise results using descriptive statistical methods.

This scoping review does not require ethical approval. The findings will be disseminated through presentation at national or international conferences and peer-reviewed publication.

Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/8HFBZ).

Atrial fibrillation (AF) is the most common cardiac arrhythmia, significantly affecting patients’ quality of life (QoL) and increasing the risk of complications such as heart failure, stroke and dementia. In addition to the physical burden, psychological distress, including depression and anxiety, is prevalent among patients with AF and can exacerbate clinical symptoms and worsen overall well-being. While radiofrequency ablation (RFA) is widely used for rhythm control in AF, its long-term effects on both physical and psychological outcomes, including symptom severity, anxiety, depression and QoL, remain underexplored. This study aims to investigate the long-term impact of RFA on both physical and psychological health in patients with AF, using network analysis to explore symptom interrelationships and their collective influence on QoL.

This longitudinal observational study will investigate the evolution of symptom severity, depression, anxiety and QoL in patients with AF undergoing RFA. Data will be collected at four time points: preprocedure (T0), 3 months (T1), 6 months (T2) and 12 months (T3) postprocedure. The study will employ network analysis to examine the dynamic interactions between physical and psychological symptoms, focusing on core symptoms and their impact on patient outcomes. To assess symptom severity, depression, anxiety and QoL, the following standardised tools will be used: the Atrial Fibrillation Severity Scale, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 and WHO Quality of Life—Brief Version, respectively. Statistical analyses will include network analysis with R software to explore the interrelationships between symptoms, as well as repeated measures multivariate analysis of variance (MANOVA) to assess changes over time and interactions among variables.

The study was approved by the Ethics Committee of the Second Affiliated Hospital, Zhejiang University School of Medicine (SAHZU, No 20250128) and will be conducted in accordance with the Helsinki Declaration and its amendments. Results will be published in peer-reviewed journals, presented at scientific conferences and shared through various popular science forums and patient organisations.

Migraine, a major headache disorder of high prevalence, affects approximately one billion individuals globally and imposes a substantial socioeconomic burden. Acupuncture, as a modality of complementary and alternative medicine, is increasingly used by patients for migraine management. Nevertheless, the effectiveness of acupuncture in randomised controlled trials (RCTs) for this condition remains a subject of debate. The varying non-specific effects of different sham acupuncture (SA) techniques complicate the accurate assessment of true therapeutic effectiveness of acupuncture. This protocol details a systematic review and network meta-analysis (NMA) aimed at comprehensively evaluating both the effectiveness of acupuncture compared with various sham controls and the differential non-specific effects of different SA methods in migraine. Our aims involve: (1) evaluating the effectiveness of acupuncture relative to SA controls in migraine treatment; (2) comparing the effect sizes across different SA methods and (3) identifying potential factors that influence the outcomes associated with various sham interventions.

We will undertake a thorough investigation using multiple databases, including Wanfang Data, Cochrane Library, Web of Science, Embase, ClinicalTrials.gov, PubMed, Chongqing VIP Database, SinoMed, Cochrane Central Register of Controlled Trials, Chinese Clinical Trial Register, International Traditional Medicine Clinical Trial Registry and China National Knowledge Infrastructure, spanning from their initial records up to 12 November 2024. The inclusion criteria are RCTs that compare acupuncture with SA controls for migraine treatment. Studies with waiting-list or no-treatment controls will be included only if they also contain an SA arm. Studies focusing exclusively on chronic migraine patients (≥15 headache days per month) will be excluded. Two independent reviewers will perform study selection, data extraction using a standardised prepiloted form and risk of bias assessment. The primary outcome will be the standardised mean difference (SMD) in migraine frequency measures, allowing for the inclusion of various frequency metrics (eg, migraine attacks, migraine days, headache days). Secondary outcomes will include response rate (≥50% reduction in frequency), days with acute medication use, the number of migraine days per month, pain intensity (measured using tools such as the Visual Analogue Scale or Numeric Rating Scale), and scores from migraine-specific questionnaires, among others. The Cochrane Risk of Bias tool 2 (RoB 2) will be employed for bias assessment, along with the Confidence in Network Meta-Analysis online tool and the Grading of Recommendations Assessment, Development and Evaluation system. A frequentist NMA will be executed using Stata (V.18.0). The network structure will comprise: acupuncture as a single node (or multiple nodes if heterogeneity warrants), different SA methods as separate nodes, and waiting-list/no-treatment as a single node. In terms of continuous outcomes, the synthesis will be conducted using the SMD with a 95% CI for estimating effects. Heterogeneity, network inconsistency and potential publication bias will be scrutinised. As needed, meta-regression, subgroup analyses and sensitivity analyses will be executed.

Since this research is based on data from published sources, it does not necessitate formal ethical clearance. The results will be shared via articles in scholarly journals and during presentations at academic symposiums.

CRD42024620550.

While transcatheter aortic valve replacement (TAVR) has become a well-established standard of care for patients with symptomatic severe aortic stenosis, the optimal antithrombotic strategy post-TAVR remains a subject of debate, particularly in patients without clear indications for anticoagulation or dual antiplatelet therapy. This study aims to investigate the safety and efficacy of rivaroxaban compared with antiplatelet monotherapy in this specific patient population.

This study is designed as a prospective, multicentre, open-label, randomised controlled trial. A total of 454 patients, who have successfully undergone TAVR and do not have indications for long-term anticoagulation or dual antiplatelet therapy, will be consecutively enrolled from seven centres across China. Participants will be randomly assigned to receive either anticoagulation with rivaroxaban (20/15 mg) or conventional antiplatelet therapy (aspirin or clopidogrel) for 1 month. Follow-up evaluations are scheduled at 1, 3, 6 and 12 months post-procedure. After the initial 1-month antithrombotic therapy, the regimen may be adjusted by the investigator based on the patient’s clinical and imaging follow-up results. The primary endpoint is a hierarchical composite of cardiovascular death, first occurrence of myocardial infarction or stroke, first occurrence of life-threatening, disabling or major bleeding, and grade 3 or higher hypo-attenuated leaflet thickening and reduced leaflet motion at 12 months post-TAVR. The win ratio method will be employed to analyse the primary endpoint.

This trial was approved by the Ethics Committee of the Beijing AnZhen Hospital. All relevant results will be disseminated through publications in peer-reviewed journals and presentations at conferences.

ChiCTR2400087453.

Delirium is a prevalent neuropsychiatric disorder in the intensive care unit (ICU), associated with poorer health outcomes, including extended duration of mechanical ventilation, prolonged ICU stays, and persistent or long-term cognitive impairment. Substantial evidence has indicated that the frequency, duration and severity of delirium during hospitalisation are significant risk factors for cognitive dysfunction in patients after ICU discharge. While existing studies have investigated the association between ICU delirium and subsequent cognitive outcomes, their analytical approaches have predominantly employed conventional longitudinal methods. Such methodological constraints impede the detection of clinically meaningful heterogeneous patient populations and the comprehensive evaluation of subgroup-specific determinants. The Latent Growth Curve Model (LGCM) and the Latent Class Growth Model (LCGM) serve as statistical tools capable of delineating the trajectory of cognitive change following delirium, along with identifying subgroups exhibiting distinct patterns of change. These methods may uncover clinically significant subtypes that were previously unrecognised. Therefore, this study aims to employ LGCM and LCGM to analyse the trajectory of cognitive level and risk factors in patients with delirium in the ICU one year after transfer.

This prospective study aims to investigate the 1-year trajectory of cognitive changes in ICU patients with delirium. It is planned to recruit 250 participants and gather comprehensive data, including general demographics, disease-related information and scores from the Mini-Mental State Examination, Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. All data will be collected at the following time points: on the day of ICU transfer, 1 month post-transfer, 3 months post-transfer, 6 months post-transfer and 1 year post-transfer. Ultimately, we will employ LGCM and LCGM to analyse the trajectory of cognitive changes and identify potential subgroups, while conducting logistic regression analysis to explore risk factors. The results of this study will provide a theoretical framework for the clinical implementation of precision nursing interventions within this demographic, aiming to prevent or mitigate cognitive decline and improve patients’ quality of life.

Ethical approval was obtained from the ethics committee of Guizhou Nursing Vocational College (ethical approval number: gzhlllscb-2024-09-01). The findings of this study will be disseminated on a national and international scale through the publication of scholarly articles in research journals.

NCT06674603.

Extensive progress has been made in improving pregnancy outcomes for in vitro fertilisation and embryo transfer (IVF-ET) patients through the use of electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS). However, a clear and suitable recommendation for the parameter selection scheme of EA/TEAS remains elusive.

To evaluate evidence-based conclusions of different EA/TEAS parameters on improvement of pregnancy outcomes in patients undergoing IVF-ET and evaluate other factors that may affect pregnancy outcomes.

This meta-analysis systematically searched eight databases from inception to 27 August 2024, focusing on randomised controlled trials (RCTs) that evaluated the effectiveness of EA/TEAS in improving IVF-ET outcomes, with the primary outcome defined as clinical pregnancy rate (CPR), and secondary outcomes including biochemical pregnancy rate (BPR) and live birth rate (LBR). We further explored CPR variations associated with EA/TEAS parameters: waveform (dilatational vs continuous wave), frequency (low vs high) and treatment duration (20, 25, 30, 40, 60 min). Additionally, seven subgroup variables were analysed to identify potential influencing factors: routine treatment, intervention dose, intervention modality, mean participant age, control type, randomisation risk and allocation concealment risk.

A total of 27 RCTs (3786 participants) were included, with the quality of evidence ranging from moderate to very low. Compared with control groups, the use of dilatational waves significantly increased CPR (RR=1.36, 95% CI [1.17 to 1.58], p2=0). Similarly, low-frequency currents demonstrated a significant positive association with CPR (RR=1.38, 95% CI [1.25 to 1.51], p2=0) and a treatment duration of 30 min per session was associated with elevated CPR (RR=1.30, 95% CI [1.19 to 1.42], p2=0). Subgroup analyses revealed that the effect of EA/TEAS on CPRs varied significantly depending on therapeutic dose (p=0.029), with stronger associations observed in studies involving patients receiving high therapeutic dose compared with those receiving low therapeutic dose.

Current evidence suggests that dilatational waves, low-frequency currents and 30-minute treatment duration may improve CPRs, though findings require validation in larger trials. While parameter optimisation shows promise, stronger evidence is needed before standardising protocols. Future research should focus on rigorous RCTs to determine optimal parameters and dose-response relationships.