Conectar
To identify distinct social network types among young-old adults based on the characteristics of social network structure and to explore the relationship between different types, socio-demographic characteristics and subjective cognitive decline.
A cross-sectional study was conducted from July 2022 to October 2023.
A total of 652 young-old adults aged 60–74 years completed the sociodemographic questionnaire, the subjective cognitive decline questionnaire-9 and the self-designed egocentric social network questionnaire. The types of social networks were identified by latent profile analysis. Univariate analysis and binary logistic regression were used to analyse the influencing factors of subjective cognitive decline.
The incidence of subjective cognitive decline was 38%. Social networks of young-old adults tended to be large, predominantly family-centred and characterised by strong contact strength, high density and significant demographic heterogeneity among network members. Four social network types were identified: diverse-moderate, family-dense, family-strong and friend-loose. Young-old adults embedded in the family-dense and family-strong types were more likely to develop subjective cognitive decline than those in the diverse-moderate type. Additionally, age, education level, previous occupation, daily sleep duration and exercise were related to the incidence of subjective cognitive decline.
The findings highlight the relatively high incidence of subjective cognitive decline in young-old adults that is notably influenced by the type of social network they are embedded in. More attention needs to be paid to identifying and supporting young-old adults at high risk of subjective cognitive decline, especially to promote their social integration and friend network building, to improve their subjective cognitive function.
The findings emphasise the importance of considering the structure and composition of social networks when addressing subjective cognitive decline among young-old adults. A diversified social network incorporating both familial and friendship ties may provide enhanced cognitive protection. Therefore, interventions targeting subjective cognitive decline should promote the expansion of friendship-based relationships and foster the development of more heterogeneous and multi-source networks.
STROBE checklist.
Not applicable.
The study aims to investigate patients' perceptions of recurrence risk associated with atrial fibrillation, with the goal of establishing a theoretical foundation for developing future measurement scale and intervention strategies.
A qualitative interview study.
Seventeen patients diagnosed with atrial fibrillation at a Grade-A tertiary hospital participated in semi-structured, in-depth interviews conducted between October and December 2024. Participants were selected via purposive sampling. The data were analysed employing thematic analysis in accordance with Colaizzi's method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
The perceptions of recurrence risk among patients with atrial fibrillation can be summarised into five themes: (1) perceived likelihood of recurrence, (2) perceived severity of recurrence, (3) perceived triggers of recurrence, (4) emotional reaction to recurrence, and (5) efficacy perception of managing recurrence risk.
Perceptions of recurrence risk among patients with atrial fibrillation are diverse and often underestimated due to limited knowledge and subjective symptom interpretation, affecting health behaviours. Understanding patients' subjective appraisals, emotions, and perceived efficacy is essential. Validated assessment tools and tailored risk communication may enhance self-management and support targeted interventions.
This study provides critical insights into how atrial fibrillation patients perceive their risk of recurrence. It also provides a theoretical foundation for creating validated assessment tools and tailoring individualised health education and intervention programmes.
Patients were involved in the study design, data collection, and interpretation of findings. Their contributions included providing feedback on the initial interview guide to ensure relevance and clarity, participating in in-depth interviews to share their lived experiences with atrial fibrillation recurrence, and offering reflections on key themes emerging from the data.
To examine the relationship between job stress and job burnout among healthcare professionals (HPs) in a tertiary hospital in East China following the adjusted COVID-19 prevention policies and to explore the effects of demographic and work environment factors on burnout and its subtypes (emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA)).
Cross-sectional, using a questionnaire-based survey method.
A tertiary hospital located in Qingdao, East China.
A total of 434 HPs were included, with 138 men (31.8%) and 296 women (68.2%); the mean age was 35.05±7.96 years. Participants included physicians (37.1%), clinical nurses (49.5%), clinical pharmacists (3.9%), medical technicians (5.1%) and administrative staff (4.4%). Demographic factors (age, sex, marital status, education level, professional title, length of employment, income) and work-related factors (weekly working hours, sleep duration) were collected.
No specific interventions were implemented; this was an observational study focusing on the burnout assessment and associated factors.
Primary outcomes: burnout levels assessed via the Chinese version of the Maslach Burnout Inventory—Human Services Survey (MBI-HSS), including three subscales: EE (9 items), DP (5 items) and PA (8 items). Severe burnout was defined as meeting ‘high-level’ criteria for all three subscales (EE ≥27, DP ≥10, PA ≤33).
Secondary outcomes: demographic (sex, professional role, length of employment) and work-related (weekly working hours, daily sleep duration) factors associated with burnout.
Among 434 HPs, 74 (17.1%) experienced severe burnout. The median scores of MBI-HSS subscales were 17 (IQR: 9–27) for EE, 3 (IQR: 0–7) for DP and 37 (IQR: 27.75–43) for PA. Multivariate logistic regression showed that: nurses had a higher risk of high EE than physicians (OR=2.86, 95% CI: 1.32 to 6.21, p40 hours (OR=2.30, 95% CI: 1.32 to 3.99, p
A high prevalence of severe burnout (17.1%) was observed among HPs after COVID-19 policy adjustment. Key risk factors include being a nurse, long working hours (>40 hours/week), short sleep duration (
Endometriosis is a chronic condition affecting up to 11% of people presumed female at birth by the age of 44 years, characterised by the growth of tissue similar to the lining of the uterus on other organs. Endometriosis significantly impacts health-related quality of life (HRQoL) and imposes a substantial burden on both individuals and the healthcare system. International guidelines recommend the interdisciplinary management of endometriosis due to its significant biopsychosocial burden; however, research aimed at exploring psychological approaches for endometriosis is limited. This trial aims to evaluate the effectiveness of CodeEndo, an online co-designed interdisciplinary supportive care program, compared with a waitlist control (WLC), on HRQoL and biopsychosocial outcomes in people with a diagnosis of endometriosis.
A hybrid type 1 effectiveness and implementation randomised controlled trial (RCT) will be conducted. Eligible participants will be randomly allocated to either the CodeEndo program (n=176) or WLC group (n=176) for 8 weeks. The primary outcome will be HRQoL, and secondary outcomes will include psychological symptoms (anxiety, depression, stress), self-efficacy, menstrual, bladder and gastrointestinal symptoms, pain, fatigue, sleep, exercise, diet, symptom bothersomeness and physical and psychological well-being, measured at 8 weeks post-randomisation (T2) and 6-month follow-up (T3). Cost-effectiveness will also be examined. Longitudinal qualitative individual interviews (up to n=40) will be conducted with participants who complete the CodeEndo program to explore benefits, barriers and facilitators of ongoing use. Additionally, the CodeEndo program will undergo evaluation by a group of endometriosis healthcare providers, who will assess potential barriers and facilitators to its real-world implementation. Various process evaluation strategies will also be measured to inform future implementation. Data analyses will incorporate mixed-effects regression models on an intention-to-treat basis, cost-consequences and cost-utility, dietary and qualitative thematic analysis.
This protocol received ethics approval from Deakin University Research Ethics Committee (DUREC Ref: 2024-157). Dissemination is expected to include peer-reviewed journal articles, reports, conference presentations as well as websites or social media platforms of relevant chronic pain organisations. Participants will be sent a summary of trial results.
ACTRN12623000598684p.
by Xie Qiu, Shuo Hu, Shumin Dong, Haijun Sun
ObjectiveTo develop a predictive framework integrating machine learning and clinical parameters for postoperative pulmonary complications (PPCs) in non-small cell lung cancer (NSCLC) patients undergoing video-assisted thoracic surgery (VATS).
MethodsThis retrospective study analyzed 286 NSCLC patients (2022–2024), incorporating 13 demographic, metabolic-inflammatory, and surgical variables. An Improved Blood-Sucking Leech Optimizer (IBSLO) enhanced via Cubic mapping and opposition-based learning was developed. Model performance was evaluated using AUC-ROC, F1-score, and decision curve analysis (DCA). SHAP interpretation identified key predictors.
ResultsThe IBSLO demonstrated significantly superior convergence performance versus original BSLO, ant lion optimizer (ALO), Harris hawks optimization (HHO), and whale optimization algorithm (WOA) across all 12 CEC2022 test functions. Subsequently, the IBSLO-optimized automated machine learning (AutoML) model achieved ROC-AUC/PR-AUC values of 0.9038/0.8091 (training set) and 0.8775/0.8175 (testing set), significantly outperforming four baseline models: logistic regression (LR), support vector machine (SVM), XGBoost, and LightGBM. SHAP interpretability identified six key predictors: preoperative leukocyte count, body mass index (BMI), surgical approach, age, intraoperative blood loss, and C-reactive protein (CRP). Decision curve analysis demonstrated significantly higher net clinical benefit of the AutoML model compared to conventional methods across expanded threshold probability ranges (training set: 8–99%; testing set: 3–80%).
ConclusionThis study establishes an interpretable machine learning framework that improves preoperative risk stratification for NSCLC patients, offering actionable guidance for thoracic oncology practice.
This study aims to describe the knowledge, attitude and practice (KAP) regarding surgical scars among patients who had postorthopaedic surgery, and to explore correlations between these factors.
A multicentre, cross-sectional, observational study.
Conducted across multiple secondary/tertiary care hospitals between July and September 2024.
Of 816 enrolled participants undergoing orthopaedic surgery, 54.5% were male, 43.6% were aged 31–45 years, 73.9% were urban dwellers, 31.2% had a bachelor’s degree and 65.4% were married.
None (questionnaire-based assessment).
Primary outcomes were KAP scores (knowledge: 0–22; attitude: 9–45 and practice: 7–35), analysed via correlation and regression.
Mean scores: knowledge (12.5±6.9), attitude (27.6±3.3) and practice (28.2±6.5). Knowledge was negatively correlated with attitude (r=–0.24, p
Patients who had postorthopaedic surgery demonstrated poor scar-related knowledge and negative attitudes but proactive practices. Greater knowledge correlated with better practice, suggesting targeted education could optimise scar management. Further research should explore causal relationships and the efficacy of interventions.
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.
To explore how persons with cancer construct and socially position themselves in online blogs. Clarifying the discursive practice of self-construction can deepen healthcare professionals' understanding of how persons with cancer perceive themselves and their place in society.
Mixed qualitative and quantitative design using corpus-assisted critical discourse analysis.
Online blogs active between 2015 and 2023 were evaluated. Google search with keywords: ‘Blog about cancer’ was conducted. Corpus-assisted critical discourse analysis, following Fairclough's framework, was used to analyse data from four persons with cancer living in Norway.
The analysis identified three discursive practices in which bloggers constructed themselves: a discourse of a person's existence, a discourse of norms, and a discourse of a paternalistic system. The bloggers constructed themselves as being trapped in their own bodies, changed and vulnerable individuals who should conform to the expected behaviours, and not being seen and heard by the healthcare system.
The bloggers with cancer struggled between holistic and dualistic ideology, wishing to separate their bodies from themselves and constructed themselves as changed persons. Moreover, they struggled with societal expectations and adapted themselves to a paternalistic healthcare system, despite their desire to be seen and heard as individuals.
This study investigated the experiences of patients living with cancer, offering valuable knowledge for nurses, other healthcare professionals, and the government. The study uncovered that persons with cancer constructed themselves as changed persons and felt vulnerable socially and within a paternalistic healthcare system. These results may provide a stimulus for further discussions on the patient roles in cancer treatment and how to meet their needs for care and treatment.
This study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.
No patient or public contribution.
To systematically identify, evaluate and synthesise the research literature about (a) the roles and responsibilities of advanced practice nurses (APNs) in the context of advance care planning (ACP) for older persons, (b) the characteristics of APNs' ACP practices and (c) the facilitators and barriers influencing APNs' involvement in ACP.
Mixed-methods systematic review.
Followed the mixed methods systematic review guidelines outlined by the Joanna Briggs Institute. Three researchers independently screened studies for eligibility using the Covidence Screening Application. The screening involved two stages: titles and abstracts, followed by full-text evaluation. The Mixed Methods Appraisal Tool was used for quality assessment. A convergent integrated synthesis combined quantitative and qualitative data by ‘qualitising’ quantitative findings into text, enabling integration and thematic analysis to synthesise the results.
Medline, CINAHL and Embase were searched from 2012 to 2024 for original research in English, focusing on APNs involved in ACP for individuals aged 65 or older, using qualitative, quantitative or mixed method designs.
The review included 19 studies: seven qualitative, nine quantitative and three mixed method designs. Thematic analysis revealed that APNs play a key role in ACP, aligning care with patient preferences through discussions and documentation. Studies from the United States (12), United Kingdom (4), Canada (2) and Australia (1) show varying APN roles and responsibilities.
APNs are crucial to ACP, but barriers limit their impact. Overcoming these is key to improving outcomes.
APNs clinical expertise and close patient relationships are crucial for aligning care with patient preferences and needs in ACP. However, to fully maximise their contribution, it is essential to overcome barriers such as time constraints, lack of role recognition and insufficient training. Addressing these challenges will enhance the effectiveness of APNs in providing person-centred care.
This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
No patient or public contribution.
To explore the influences of workplace bullying experiences, witnessing workplace bullying and bystander types on Speaking up for patient safety (SUPS) among hospital nurses.
Cross-sectional study.
A survey was conducted in September 2021 using a structured questionnaire about workplace bullying experiences, witnessing workplace bullying, bystander types, and SUPS. The questionnaire was administered to 200 bedside nurses from two tertiary university hospitals in South Korea.
One hundred and ninety-nine responses were analysed. A hierarchical regression model, incorporating organisational factors, workplace bullying experiences, witnessing workplace bullying, and bystander types explained approximately 44.0% of the variance in nurses' SUPS. Witnessing workplace bullying and the perpetrator-facilitating bystander negatively influenced SUPS, whereas victim-defending bystander had a positive influence on SUPS.
Findings suggest that witnessing workplace bullying and the bystander types of nurses working on patient care units are more impactful on nurses' SUPS than individual experiences of bullying. Notably, the victim-defending and perpetrator-facilitating bystander types were identified as key factors influencing SUPS.
Nurse managers should understand the roles of witnesses and bystanders working on a patient care unit, and how these roles may extend beyond traditional views of perpetrators and victims. Developing strategies to support and effectively manage witnesses and bystanders working on patient care units may promote positive SUPS behaviours among clinical nurses.
What problem did the study address?
Speaking up for patient safety (SUPS) in clinical settings is critical in maintaining and enhancing patient safety. However, a negative work environment, such as one that promotes workplace bullying may hinder nurses' willingness to engage in SUPS. Because many nurses involved in workplace bullying may be witnesses or bystanders rather than direct perpetrators or victims of such situations, this study explored the potential influences of workplace bullying, including the roles of witnesses and bystanders, on SUPS. What were the main findings?
SUPS was influenced more by witnessing workplace bullying and specific bystander types, namely victim-defending and perpetrator-facilitating bystanders, than by workplace bullying experiences. Where and on whom will the research have an impact?
These findings highlight the importance of addressing the roles of witnesses and bystanders in workplace bullying. Nurse managers should broaden their focus beyond perpetrators and victims to include the roles and views of all nursing staff within a department. By effectively managing witnesses and bystander types, they can foster an environment that enhances SUPS behaviours among nurses.
This study adhered to STROBE guidelines.
No Patient or Public Contribution.
Escape room (ER) methodology is recognised as an innovative pedagogical tool in nursing education, fostering an interactive environment that transforms students from passive observers into active participants. Current research on ER in educational contexts primarily emphasises their effectiveness and learner experiences, while neglecting the specific facilitators and barriers relevant to nursing education. This gap leads to a lack of essential frameworks for course design. Understanding these barriers and facilitators is crucial for the effective application of ERs in educational settings. Consequently, this review aims to identify factors associated with the implementation of ER in nursing education, using the Consolidated Framework for Implementation Research as a guiding framework.
The search will encompass six English databases and three Chinese databases from their inception to 1 October 2025: CINAHL, Embase, Education Resources Information Center, Scopus, Web of Science and MEDLINE, Wang Fang, China National Knowledge Infrastructure and the Chinese Biomedical Literature Database. Studies with qualitative, quantitative or mixed-methods designs will be included. Publications in English or Chinese will be considered from database inception. Two independent researchers will conduct screening and data extraction according to predefined criteria. A convergent integrated approach, including the transformation of quantitative results, will be employed, followed by thematic synthesis to analyse the findings. Discrepancies will be resolved through discussions with a third reviewer.
The ethical approval for this review is unnecessary due to the utilisation of secondary data. The outcomes are scheduled for publication in a peer-reviewed journal, with the aim of elucidating the facilitators and barriers linked to the integration of ER in nursing education.
CRD42024605953.
To evaluate the effects of diabetes mellitus (DM) and body mass index (BMI) on long-term all-cause mortality in chronic total occlusion (CTO) patients.
Retrospective, nationwide cohort study.
Swedish Coronary Angiography and Angioplasty Registry, between June 2015 and December 2021.
24 284 patients with angiographically confirmed CTO. Prior coronary artery bypass graft surgery excluded. Subgroups were defined by DM status and BMI categories (underweight, healthy weight, overweight, obesity).
Long-term all-cause mortality, assessed by Kaplan-Meier analysis and multivariable Cox proportional hazards regression.
DM was present in 30.3% of patients and conferred a 31% higher risk of mortality (HR: 1.31, 95% CI: 1.20 to 1.42; p2, lowest risk (nadir) at 32 kg/m2 and modest rise above 35 kg/m2.
In this nationwide CTO cohort, DM independently predicted higher long-term mortality, accompanied by more severe comorbidities and greater CTO complexity, and insulin therapy further elevated hazard. Overweight and obese patients had better survival, while underweight individuals had the poorest prognosis. These findings underscore the importance of individualised risk assessment and management strategies in CTO patients, particularly those with DM or low BMI.
Ultrasound-guided serratus anterior plane block (SAPB) is commonly used for postoperative pain management in video-assisted thoracoscopic surgery (VATS). However, the choice of local anaesthetics for SAPB remains controversial. This study aims to compare the efficacy and safety of liposomal bupivacaine versus ropivacaine combined with two local anaesthetic adjuncts (dexamethasone and dexmedetomidine) for postoperative pain relief in VATS patients.
This is a single-centre, double-blinded, randomised controlled trial conducted at the Hangzhou First People’s Hospital Affiliated to Westlake University School of Medicine in Hangzhou, China. A total of 120 adult patients scheduled for VATS will be randomly assigned in a 1:1:1 ratio to one of the following three groups: liposomal bupivacaine (group L), ropivacaine combined with dexamethasone (group D) and ropivacaine combined with dexmedetomidine (group R). The primary outcome is the Numeric Rating Scale pain score at rest at 24, 48 and 72 hours postoperatively. Secondary outcomes include opioid consumption, adverse events, Quality of Recovery-15 scores, patient satisfaction and length of hospital stay.
The study was approved by the Ethics Committee of the Hangzhou First People’s Hospital Affiliated to Westlake University School of Medicine (approval number IIT-2024405-01) on 6 November 2024. The protocol was registered in the Chinese Clinical Trial Registry on 9 January 2025. The planned study period is from 1 January 2025 to 31 December 2027, with participant recruitment scheduled from 1 March 2025 to 31 December 2026. Recruitment has not yet started. All participants will provide written informed consent. The results will be disseminated through peer-reviewed journals and academic conferences.
ChiCTR2500095609.
Accidental hypothermia (AH) can occur in mild-to-severe cases; however, its management is crucial in severe cases as it can cause ventricular fibrillation and lead to death. Among various rewarming therapies for AH, endovascular catheter rewarming has been the focus of recent studies as a minimally invasive alternative to invasive internal rewarming, such as extracorporeal membrane oxygenation (ECMO). However, no study has demonstrated the efficacy and safety of endovascular catheter rewarming therapy. This study aimed to validate the efficacy and safety of endovascular catheter rewarming for patients with AH.
The intensive care with endovascular catheter rewarming in accidental severe hypothermia (ICE-CRASH II) study is a multicentre, randomised study of patients with AH. This study will include patients with AH (age ≥65 years, core temperature
This study was approved by the Hokkaido University Certified Review Board (approval number: 024-00013). Written informed consent will be obtained from all the participants or their legally acceptable representatives. The results will be disseminated through publications and presentations.
Japan Registry of Clinical Trials (jRCT1012240051).
Although lung cancer in never smokers (LCNSs) accounts for an estimated 25% of all lung cancer cases, the temporal trends in LCNS incidence and its broader epidemiological patterns remain poorly understood. Our study examines the temporal trends in LCNS incidence and analyses key epidemiological characteristics, specifically, the trends in mortality rates, survival rates and changes in age at onset to illuminate the reasons for temporal trends in LCNS incidence.
Retrospective population-based cohort study.
Regional electronic health record (EHR) database linked to the cancer registry in eastern China.
A total of 1 080 317 adults who have never smoked were included, among whom 4061 incident lung cancer cases were identified between 1 January 2009 and 31 December 2020.
The temporal trends in LCNS incidence in a large population-based dynamic cohort were estimated, overall and separately by sex, age group and histological types. The broader epidemiological patterns of LCNS, such as trends in mortality rates, survival rates and changes in age at onset, were analysed.
From 2009 through 2020, the incidence of LCNS among men increased significantly from 9.51 to 43.4 per 100 000 (average annual percentage change (AAPC) 10.51%; 95% CI (6.88% to 14.26%)) whereas a sharper increase was observed among women from 3.57 to 51.68 per 100 000 (AAPC 22.39%; 95% CI (18.36% to 26.55%)). The 2-year survival of LCNS improved from 39% in 2010 to 64% in 2018 for men, and from 57% in 2009 to 86% in 2020 for women, while the mortality from LCNS remained stable from 2014 through 2020 (men: AAPC –1.77%; 95% CI (–8.95% to 5.97%); women: AAPC 2.19%; 95% CI (–4.09% to 8.89%)). The increasing trend in LCNS incidence was observed across most of the age groups except the elderly population aged ≥85 years in both sexes and the men aged 45–54 years, but the increase was most evident in the younger population aged
There is a substantial increase in LCNS incidence, especially among women and young populations. However, the reason for these observed trends remains unclear and warrants investigation.
Intracranial atherosclerosis is the main cause of stroke globally, with acute large vessel occlusive (LVO) stroke being a predominant contributor to stroke-related mortality. In recent years, aspiration thrombectomy (AT) has emerged as a novel therapeutic method for treating acute LVO stroke. The purpose of this study aims to investigate the safety and efficacy of AT alone or combined with stent retriever thrombectomy (SRT) in the treatment of acute LVO stroke
This is a multicentre and observational real-world study involving patients diagnosed with acute LVO stroke. Participants will be treated with AT alone or combined with SRT. According to the actual annual number of embolectomy in the sub-centre and the research years, the sample size of this study is estimated to be 400 patients, of which 300 patients of anterior circulation lesions and 100 patients of posterior circulation lesions are planned to be recruited, being considered that the incidence of posterior circulation is about 20–25%. Clinical data, including baseline characteristics, intraoperative details, postoperative outcomes and follow-up results, will be systematically collected using an Electronic Data Capture system over a follow-up period of 3 months. The primary efficacy endpoint is the rate of excellent functional outcome (modified Rankin Scale score range 0–3) after 90 days, and the successful recanalisation confirmed by digital subtraction angiography. The primary safety outcome is symptomatic intracranial haemorrhage within 48 hours (National Institutes of Health Stroke Scale score increase ≥4). This study will provide us with powerful guidance for the treatment of acute LVO stroke with different aetiologies.
This study protocol was approved by the Ethics Committee on Human Experimentation at Shandong Provincial Hospital Affiliated to Shandong First Medical University (approval number: SWYX:2022–1025). All the participating sites have received the ethics approval. The outcomes will be disseminated through national and international presentations and peer-reviewed publications.
ChiCTR2200065172.
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.
by Dong Min Jung, Yong Jae Kwon, Yong Wan Cho, Jong Geol Baek, Dong Jae Jang, Yongdo Yun, Seok-Ho Lee, Gahee Son, Hyunjong Yoo, Min Cheol Han, Jin Sung Kim
Volumetric modulated arc therapy (VMAT) for lung cancer involves complex multileaf collimator (MLC) motion, which increases sensitivity to interplay effects with tumour motion. Current dynamic conformal arc methods address this issue but may limit the achievable dose distribution optimisation compared with standard VMAT. This study examined the clinical utility of a VMAT technique with monitor unit limits (VMATliMU) to mimic conformal arc delivery and reduce interplay effects while maintaining plan quality. VMATliMU was implemented by applying monitor unit limitations during VMAT reoptimisation to minimise MLC encroachment into target volumes. Using mesh-type reference computational phantom CT images, treatment plans were generated for a simulated stage I lung cancer case prescribed to 45 Gy in three fractions. VMATliMU, conventional VMAT, VMAT with leaf speed limitations, dynamic conformal arc therapy, and constant dynamic conformal arc therapy were compared. Plans were optimised for multiple isodose line prescriptions (50%, 60%, 70%, 80%, and 90%) to investigate the impact of dose distribution. Evaluation parameters included MLC positional accuracy using area difference ratios, dosimetric indices, gradient metrics, and organ-at-risk doses. VMATliMU prevented MLC encroachment into the internal target volume across 60%–90% isodose lines, showing superior MLC accuracy compared with other methods. At the challenging 50% isodose line, VMATliMU had 4.5 times less intrusion than VMAT with leaf speed limits. VMAT plans had better dosimetric indices than dynamic conformal arc plans. VMATliMU reduced monitor units by 5.1%–19.2% across prescriptions. All plans met the clinical dose constraints, with the aortic arch below tolerance and acceptable lung doses. VMATliMU combines VMAT’s dosimetric benefits with the dynamic conformal arcs’s simplicity, minimising MLC encroachment while maintaining plan quality. Reduced monitor units lower low-dose exposure, treatment time, and interplay effects. VMATliMU is usable in existing planners with monitor unit limits, offering a practical solution for lung stereotactic body radiation therapy.
FreshRSS 