Cognitive impairment is a common consequence after stroke. Intermittent theta burst stimulation (iTBS) has emerged as a promising cognitive therapy. However, traditional iTBS typically employs lower doses and one-size-fits-all stimulation targets, which may not fully capitalise on the potential of this therapy and warrants further evaluation for both efficacy and safety. This study aims to evaluate the efficacy and safety of high-dose iTBS targeting the individualised frontoparietal cognitive network (FCN) identified by precision functional neuroimaging for post-stroke cognitive impairment (PSCI).

This is a prospective, double-blind, sham-controlled, parallel-group randomised controlled trial. 60 eligible participants with PSCI will be randomly assigned (1:1) to an active iTBS or a sham-controlled group. The active group will receive high-dose iTBS (3600 pulses/day) at 80% resting motor threshold targeting the left individualised FCN, guided by a real-time neuronavigation system. The sham group will follow identical procedures using a sham coil. Both groups will also undergo conventional computerised cognitive training. The intervention will be administered on workdays over a period of 3 weeks, totalling 15 workdays. The primary outcome is the change in Montreal Cognitive Assessment scores from baseline to immediately post-treatment. Secondary outcomes include long-term change in global cognition, activities of daily living and specific cognitive domains (assessed by a comprehensive neuropsychological battery covering memory, attention, executive function and language), as well as mood. Assessments occur at baseline, post-treatment and 3-month follow-up. Safety outcomes, specifically the number of adverse events related to iTBS, will be monitored and recorded throughout the trial.

This study has been approved by the Medical Ethics Committee of the China Rehabilitation Research Center. The results of this study will be published in peer-reviewed scientific journals and disseminated at academic conferences.

NCT05953415.

Evaluation of the impact of atherosclerotic cardiovascular disease (ASCVD), particularly polyvascular disease, on 30-day and 365-day mortality among intensive care unit (ICU) patients diagnosed with sepsis.

Retrospective cohort study.

This study was conducted using data from the Medical Information Mart for Intensive Care IV, a publicly available critical care database from a tertiary care hospital in the US.

A total of 7895 adult ICU patients with sepsis were included between 2008 and 2022. Among them, 3314 (41.97%) had ASCVD, defined by International Classification of Diseases (ICD) codes for coronary artery disease, peripheral artery disease or stroke.

The primary outcomes were all-cause mortality at 30 and 365 days following ICU admission.

ASCVD patients with a greater number of disease beds tend to be male, older, have lower body mass index, heart rates, mean blood pressure, respiratory rate and temperature, compared with non-ASCVD patients. Before propensity-score matching, patients with ASCVD (3314) had significantly higher 30-day (29.21% vs 24.14%, p

Integrated management of sepsis and ASCVD—using targeted interventions such as tailored pharmacotherapy and risk factor modification—may reduce mortality and morbidity in this high-risk population.

Hypertension and depression frequently co-occur, complicating patient management and worsening outcomes. This scoping review aims to systematically map non-pharmacological interventions for managing comorbid hypertension and depression, providing insights into current practices and guiding future research.

Following the Joanna Briggs Institute guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews standards, a comprehensive search was conducted across multiple databases, including PUBMED, Embase, PsycINFO, CINAHL, Cochrane Library, Chinese Biomedical Literature Database and Chinese National Knowledge Infrastructure, covering the literature from January 2004 to December 2023. Studies were selected based on predefined inclusion criteria focusing on non-pharmacological or complex interventions. Data extraction was performed using the Template for Intervention Description and Replication checklist to ensure detailed and structured summaries of each intervention.

Fifteen quantitative studies were included, most of which were pilot randomised control trials, pre-post studies and with generally small sample sizes (20 to 2365). Interventions were categorised into integrated and coordinated care, behavioural and psychological interventions and physical and lifestyle interventions. Delivery methods varied, with most interventions being face-to-face, while a few used digital platforms such as mobile apps and telephone support. Disease-level and patient-level outcomes were mainly reported, while only three examined system-level outcomes. 13 of 15 included studies showed positive results in managing comorbidity. The variability in follow-up periods (ranging from 1 week to 12 months) and measurement instruments across studies limited the ability to draw consistent long-term conclusions.

This scoping review highlights the role of psychosocial and non-pharmacological interventions, particularly collaborative/integrated care and behavioural therapies, in managing comorbid hypertension and depression. These interventions consistently improve depressive symptoms, with mixed effects on blood pressure control. Further research is needed to standardise core outcomes and evaluate the long-term effectiveness and scalability of these interventions.

Atrial fibrillation (AF) constitutes a growing public health challenge. Consequently, the exploration of modifiable risk factors is essential for advancing AF prevention and management. While obstructive sleep apnoea is established as a risk factor for AF recurrence following catheter ablation, and its treatment with continuous positive airway pressure therapy reduces recurrence rates, the influence of non-sleep apnoea-related sleep indicators remains unclear. This systematic review aims to elucidate the association between these non-sleep apnoea-related sleep indicators and AF recurrence to inform optimised management strategies.

A comprehensive search will be performed in databases, including PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database and Wanfang Data, covering publications from database inception to 27 August 2024. Study selection will be performed independently by two reviewers using predefined eligibility criteria, with the screening process documented in a referred Reporting Items for Systematic Review and Meta-Analysis-compliant flow diagram. Data will be extracted using standardised forms and risk of bias of included studies will be assessed with the Risk Of Bias In Non-randomised Studies-of Interventions tool. Non-sleep apnoea-related sleep indicators, including sleep duration, sleep quality, sleep latency, sleep efficiency, REM (Rapid Eye Movement)/NREM (Non-Rapid Eye Movement), etc, serve as exposure factors. The primary outcome is defined as AF recurrence, whereas the secondary outcome comprises quality of life measures among AF patients. Should sufficient data be available, a meta-analysis will be performed using appropriate statistical methods; otherwise, a narrative synthesis will be conducted.

This study uses publicly available data, so ethical approval is not required. The findings will be disseminated through peer-reviewed journals and scholarly platforms to inform clinical practice and future research.

CRD42024607124.

People with epilepsy are at higher risk for hypertension, diabetes, hyperlipidaemia and obesity than the US general population. It is unknown whether these risk factors translate to increased cardiovascular mortality compared with the US general population.

To examine changes in the proportions of deaths due to cardiovascular causes among people with epilepsy in the USA.

Cardiovascular mortality among people with epilepsy is rising in the USA compared with the general population over the period from 2000 to 2019.

Retrospective, longitudinal US population study of all deaths among people with epilepsy due to cardiovascular causes compared with the US general population for the years 2000 through 2019. Source data were obtained from the Centers for Disease Control and Prevention (CDC) Multiple Cause of Death Database using all International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes for epilepsy (specifically all ICD-10 codes G40.0 through G40.919). The use of administrative datasets, like the CDC Multiple Cause Of Death Database, is a validated method that effectively captures US epilepsy mortality when using the ICD-10 codes G40.0–G40.9. Cardiovascular deaths were operationally defined as ischaemic heart disease, cerebrovascular disease, diabetes and hypertension. Data were stratified by age, race and gender. Relative proportions of each cause of death were expressed as a percentage of total deaths and evaluated on the log-odds scale using a logistic regression model. Standardised proportions were also used and reported.

Within-group and between-group differences in the rate/proportions of deaths due to cerebrovascular disease, ischaemic heart disease, diabetes and hypertension among people with epilepsy and the general population over a 20-year period.

US epilepsy and general populations.

Age-adjusted mortality for cerebrovascular disease and diabetes increased significantly among people with epilepsy compared with the US general population over the 20-year period (p

Age-standardised proportions of deaths attributed to cerebrovascular disease and diabetes increased significantly among people with epilepsy from 2000 to 2019. Age-stratified proportions of deaths due to cerebrovascular disease and diabetes occurred primarily in the 35–64-year age range. The long decline in the proportions of deaths due to ischaemic heart disease among people with epilepsy ended after 2011, despite continuing to decline in the general population. The increase in proportions of cardiovascular deaths among people with epilepsy is likely due to higher cardiovascular risk factors compared with the general US population. Increased surveillance and treatment of cardiovascular risk factors among people with epilepsy are indicated, especially in the critical 35–64-year age group, where improved primary prevention may reduce cardiovascular risk and mortality.

Hepatic encephalopathy (HE), a severe complication of decompensated cirrhosis, is characterised as neurocognitive dysfunction. Emerging evidence suggests the potential role of human albumin infusion for the treatment of HE, but its optimal dosage remains undefined. Therefore, we planned a randomised controlled trial (RCT) to compare the efficacy of human albumin infusion at different dosages in patients with liver cirrhosis and overt HE.

This RCT will be conducted in the Departments of Gastroenterology or Hepatology of 16 tertiary hospitals in China. Overall, 174 patients with a diagnosis of liver cirrhosis, overt HE and a serum albumin level of 23–30 g/L will be enrolled. They will be stratified according to the severity of overt HE and randomly assigned at a ratio of 1:1 into the groups of human albumin infusion at a modified dosage and a routine dosage. The primary end point is the improvement of overt HE within 3–5 days after treatment. The secondary end points include recurrence of overt HE, survival and adverse events. We expect that this RCT will provide high-quality evidence on the optimal dosage of human albumin infused, which can achieve more clinical benefits to patients with liver cirrhosis and overt HE.

The study has been approved by the Medical Ethical Committee of the General Hospital of Northern Theater Command (ethical approval number Y2024-148). The study findings will be published in academic journals.

NCT06483737.

Gastrointestinal dysfunction is one of the most frequent complications in patients after cardiac surgery with cardiopulmonary bypass (CPB). It can seriously affect the patient’s quality of life, increase the length of hospitalisation and in severe cases trigger cardiac arrest. This single-centre randomised controlled study aims to investigate whether transcutaneous electrical acupoint stimulation (TEAS) can effectively relieve gastrointestinal discomfort and improve the quality of life of patients after cardiac surgery.

A total of 426 patients after cardiac surgery with CPB will be randomly assigned to the control group or intervention group (1:1 ratio) to receive either acupressure or TEAS for 3 days. The patients will be recruited from the Department of Cardiovascular Surgery of Nanfang Hospital. The primary outcome is the time of the first postoperative anal defecation, the secondary outcomes include the first postoperative anal exsufflation time, the number of bowel sounds, the proportion of postoperative laxatives used in the two groups, abdominal girth, stool frequency per day and length of postoperative hospital stay.

The procedures have been approved by the Guangdong Regional Medical Ethics Committee of Nanfang Hospital (NFEC-2023–404) and conformed to the Declaration of Helsinki. Written informed consent will be obtained from all the participants. Results will be disseminated through workshops, peer-reviewed publications and conferences.

Registered in Chinese Trial Registry (https://www.chictr.org.cn/) on 1 November 2023 (Registered number: ChiCTR2300077211). Pre-result.

In China, a large number of health-related short videos are posted on video platforms, including educational videos about irritable bowel syndrome (IBS). This study aimed to evaluate the reliability and quality of IBS-related video content on TikTok, Kwai and BiliBili.

Using ‘irritable bowel syndrome’ as the Chinese keyword, a new account was registered on each platform. On 1 November 2023, searches were conducted on TikTok, Kwai and BiliBili, and the top 100 recommended videos from each platform were analysed. After those that met the predefined exclusion criteria were removed, 244 short videos were included and evaluated for their characteristics, content, reliability and quality. Information quality was assessed using the Journal of the American Medical Association (JAMA) criteria, Global Quality Scale (GQS) and the modified Designed Information System Containing Evaluations of Reliability and Need (DISCERN) tool. Correlation analysis was conducted to evaluate the relationship between video characteristics and video reliability and quality.

A total of 244 eligible short videos were included. BiliBili videos were longer than TikTok and Kwai videos (p

Short videos of IBS-related health information on TikTok, Kwai and BiliBili were of poor quality; however, videos uploaded by health professionals and science communicators were relatively more reliable and comprehensive. Thus, the public are recommended to learn about IBS-relevant information through videos uploaded by health professionals and science communicators.

Depression is a common and serious mental health issue in individuals with diabetes, especially among middle-aged and elderly women, leading to reduced treatment adherence, an overall decline in well-being and a significant reduction in quality of life. Although previous studies have investigated the prevalence and risk factors of depression in this population, the results have been inconsistent and lack consensus. The aim of this review is to determine the prevalence of depression and explore associated risk factors among middle-aged and elderly women with diabetes.

A comprehensive search will be performed in eight electronic databases, including PubMed, Web of Science, Scopus, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and Chinese Biomedicine Literature Database from their inception to 15 April 2025. Studies published in English and Chinese that report on the prevalence and risk factors of depression among middle-aged and elderly women with diabetes will be included. Two reviewers will independently screen studies for eligibility, extract data and evaluate the risk of bias. Any disagreements will be addressed by a third reviewer. The quality of the included studies will be assessed using Joanna Briggs Institute Critical Appraisal Tools. All statistical analyses will be conducted using Review Manager V.5.4. Heterogeneity will be assessed using the I² statistic and Q test. Subgroup analysis and sensitivity analysis will be performed to identify potential sources of heterogeneity and assess result robustness.

This review does not require ethical approval as it is based on previously published studies. Its findings will be disseminated through peer-reviewed publications and conference presentations, providing evidence on the prevalence and risk factors of depression in middle-aged and elderly women with diabetes.

CRD420251014849.

The Omicron variant of SARS-CoV-2 has emerged as the predominant strain of COVID-19 since 2022. Its association with prior vaccines remained under investigation.

Retrospective cohort study.

Clinical data for patients, from 1 May 2022 to 31 January 2023, were extracted from the Chi-Mei Medical Center, Chiali electronic medical record databases.

Hospitalised COVID-19 patients in dedicated wards were enrolled in the study. Cases of COVID-19 reinfection and relapse were also included. Patients who did not have COVID-19, those with PCR repositivity, or those with incomplete laboratory data were excluded.

Various doses of vaccines included primary series, additional dose and booster. The types of vaccines included ChAdOx1-S, mRNA-based vaccines and recombinant protein vaccine. The interval between the last vaccination date and the diagnosis date of COVID-19 was assessed.

The primary outcome was all-cause mortality by day 30. The secondary outcomes were severe disease of COVID-19 and 90-day survival.

Among 469 cases, the adjusted HR for 30-day mortality in vaccinated compared with unvaccinated patients was 0.831 (95% CI 0.541 to 1.277; p=0.398), indicating no statistically significant association. Age, Charlson Comorbidity Index (CCI), quick Sequential Organ Failure Assessment score and administration of dexamethasone were recognised as powerful predictors for survival in multivariable analysis. In subgroup analysis, a statistically significant association with better 30-day survival was observed among patients aged

Vaccination was associated with lower mortality in younger or low-CCI patients, but not in older or highly comorbid patients.

The financial impact on trauma patients can be devastating. Although Taiwan has universal health insurance coverage, medical bill reimbursement cannot compensate for the damage to a person’s ability to work. The aim of this study was to investigate personal financial outcomes after major trauma.

A retrospective cohort study.

Nationwide data from Taiwan’s National Health Insurance Research Database.

This study included all patients with major trauma (injury severity score ≥16) in Taiwan from 2003 to 2007, and a 10-year follow-up was conducted. Patients aged 18–70 were enrolled. Patients who returned to work after trauma (RTW) and those who did not return to work (non-RTW) were compared. Basic demographics and short-term outcomes were analysed, and the 10-year trend of income variation was calculated.

The primary outcomes are the ratio of non-RTW after major trauma, and the independent risk factors for non-RTW. The secondary outcome is the 10-year trend of income variation of major trauma patients.

5965 patients were included, with 4741 (79.5%) in the RTW group and 1224 (20.5%) in the non-RTW group. Hospital-acquired pneumonia, urinary tract infection, prolonged intensive care unit length of stay (LOS) and prolonged hospital LOS were identified as independent risk factors for future non-RTW. The mean monthly income of all patients declined in the three consecutive years postinjury and slowly returned to the preinjury level 9 years after the injury.

Loss of working ability was noted in 20.5% of major trauma patients, and the income level for all patients did not recover to the preinjury level until 9 years after the injury. Further welfare planning beyond the extent of the National Health Insurance programme should be made to protect the financial shortcomings experienced by these patients.

ISRCTN18269986.

The prevalence of pulmonary nodules (PNs) has been rising in China, but PN patients’ perceptions towards the management remain underexplored. This study aimed to investigate the knowledge, attitudes and behaviours (KAB) regarding PN management among Chinese patients.

A cross-sectional study was conducted to evaluate the KAB scores using a self-designed questionnaire.

The study included 519 PN patients (275 males, aged 41.07±19.47) diagnosed at Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University between November 2022 and January 2023. Participants completed a self-designed questionnaire assessing their KAB regarding PN management.

The primary outcomes included mean scores for KAB, with secondary outcomes examining correlations and associations with demographic factors.

The mean KAB scores were 4.24±2.93 (range: 0–10), 17.97±4.88 (range: 0–32) and 31.30±11.98 (range: 0–52). Pearson’s correlation analysis revealed a weakly positive correlation between knowledge and behaviour (r=0.248, p

PN patients demonstrate insufficient knowledge and moderate attitudes and behaviours regarding PN management. These findings highlight the need for targeted educational interventions to improve understanding among PN patients.

Post-chronic pancreatitis (CP) diabetes mellitus (PPDM-C) is a distinct form of diabetes, in which complex pathogenesis hampers adequate glycaemic control. This study aimed to identify risk factors for poor glycaemic status in PPDM-C to guide clinical management.

Cross-sectional study.

Shanghai, China.

Between January 2018 and March 2023, 1677 patients with CP were enrolled in the CP database of the National Clinical Research Center. After application of strict exclusion criteria, 302 patients diagnosed with PPDM-C were included in the study.

The primary outcome was glycaemic control. The secondary outcomes were factors that affect glycaemic control among patients with PPDM-C.

This retrospective study was conducted in patients with PPDM-C. Poor glycaemic status was defined as a glycated haemoglobin A1c level of >7% at admission. Patients were stratified into those with and without diabetes treatment. Multivariate logistic regression was performed to identify risk factors. The area under the curve (AUC) analysis was used to evaluate the predictive efficacy of these risk factors.

A total of 302 patients with PPDM-C were analysed. Poor glycaemic status was observed in 72.6% (61/84) of patients without diabetes treatment and 52.8% (115/218) of those with diabetes treatment. For those without diabetes treatment, a history of acute pancreatitis (AP) attacks (OR: 4.838, p=0.014) and smoking (1–20 pack-years, OR: 4.418; >20 pack-years, OR: 9.989; p0.001). In patients with diabetes treatment, AP attack history (OR: 5.640, p20 pack-years, OR: 11.395; p

Patients with PPDM-C in China exhibited a high prevalence of poor glycaemic status. Smoking and a history of AP attacks were significantly associated with an increased risk of poor glycaemic control. The early identification of patients with PPDM-C at elevated risk of poor glycaemic control may facilitate timely and optimised management of glycaemia.

Type 2 diabetes mellitus (T2DM) is a chronic non-communicable disease that requires long-term management to maintain blood glucose levels and prevent complications. Smart healthcare technologies have shown promising potential in enhancing self-management and treatment adherence among people with T2DM. However, current research on the use of smart healthcare in the continuum of care for T2DM showed considerable variation in intervention approaches, content and evaluation metrics, resulting in substantial heterogeneity across studies.

This scoping review aims to identify recurring intervention strategies, summarise commonly reported components and outline outcome indicators in the application of smart healthcare within the continuum of care for T2DM, to inform future research and practice by healthcare professionals.

This scoping review will follow the methodological framework proposed by Arksey and O’Malley. A comprehensive literature search will be conducted across PubMed (National Library of Medicine), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO), Web of Science (Clarivate Analytics), the Cochrane Library (Wiley), Scopus (Elsevier), China National Knowledge Infrastructure (CNKI; China Academic Journals (CD-ROM) Electronic Publishing House), Wanfang Data (Beijing Wanfang Data Co., Ltd.), VIP Database (Chongqing VIP Information Co., Ltd.) and Chinese Biomedicine Literature Database (CBM; Chinese Academy of Medical Sciences). The search will include studies published from the inception of each database up to 25 April 2025. Two reviewers will independently screen the literature and extract data. Any disagreements will be resolved through discussion with a third reviewer. The review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

Ethics approval is not required. Findings will be disseminated through professional networks, conference presentations and publication in a scientific journal.

The management of bleeding and coagulation after total knee arthroplasty (TKA) has long been recognised as a significant challenge for orthopaedic surgeons. Despite the notable success of empirical anticoagulation in preventing venous thromboembolism (VTE) following TKA, the increased risk of postoperative bleeding has also raised extensive concern. Ecchymosis, as one of the most common manifestations indicating postoperative bleeding, holds the potential to indicate the balance of bleeding and hypercoagulation. However, there is still a lack of evidence-based medical research to determine the importance of postoperative ecchymosis and related personalised anticoagulation therapy. Therefore, we have designed a randomised controlled trial aimed at assessing the safety and efficacy of personalised delayed anticoagulation strategies in the management of postoperative bleeding in TKA patients.

This is a prospective, randomised, controlled trial. Patients diagnosed with end-stage knee osteoarthritis will be grouped based on the presence of ecchymosis after TKA. Those without ecchymosis will receive standard anticoagulation therapy, while those with ecchymosis will be randomised in a 1:1 ratio into either the standard anticoagulation group or the delayed anticoagulation group. The primary outcomes will compare the blood routine examination, coagulogram, thromboelastography and the incidence of VTE. The secondary outcomes will include surgical-related complications. Additionally, patient baseline data and surgery-related data will also be recorded and analysed.

Ethics approval has been obtained from The First Affiliated Hospital of Chongqing Medical University (2024-194-01). The results will be disseminated at international conferences and in peer-reviewed publications.

ChiCTR2400084440.

Frailty is a common condition in older adults with diabetes, which significantly increases the risk of adverse health outcomes. Early identification of frailty in this population is crucial for implementing timely interventions. However, there is a lack of specific prediction models for frailty in older adults with diabetes. This study aims to develop and validate a prediction model for frailty in this high-risk group.

This study uses data from the national follow-up of the China Health and Retirement Longitudinal Study (CHARLS), which range from 2011 to 2020. The study population includes older adults with diabetes aged 60 and above. Frailty is assessed using Fried’s frailty phenotype. Potential predictors will be identified through a systematic review and expert consultation. Eight machine learning models will be developed to predict frailty, with model performance to be evaluated using receiver operating characteristic curves, calibration plots and internal validation through leave-one-out cross validation. Finally, the optimal model will be deployed via an electronic risk calculator with Shapley Additive Explanation-based visualisations.

The CHARLS was approved by the Biomedical Ethics Committee of Peking University (approval number: IRB00001052-11015), and all participants were required to sign informed consent. This study was approved by the Medical Research Ethics Committee of the University of South China (approval number: 2023NHHL006). We will disseminate results via presentations at scientific meetings and publication in peer-reviewed journals.

CRD42023470933.