To investigate the association between longitudinal trajectories of metabolic risk clusters and the risk of progression to end-stage kidney disease (ESKD) and major adverse kidney events (MAKEs) in patients with chronic kidney disease (CKD).

Prospective registry-based cohort study.

Secondary and tertiary care settings in Taiwan, using data from a multidisciplinary pre-ESKD care programme.

A total of 1494 adult patients with CKD stages 3b–5 enrolled in a structured pre-ESKD care programme.

Time to initiation of dialysis (primary outcome) and time to MAKE, defined as a composite of dialysis initiation or all-cause mortality (secondary outcome). Group-based multitrajectory modelling was used to categorise longitudinal trajectories of metabolic risk clusters, including systolic blood pressure, fasting blood glucose and low-density lipoprotein (LDL) cholesterol.

Four trajectory groups were identified: Group I had controlled blood pressure and glucose but elevated LDL (dialysis incidence: 19.5 per 1000 person-years); Group II had borderline-high blood pressure and elevated glucose (33.6 per 1000 person-years); Group III had controlled glucose and low LDL but borderline-high blood pressure (38.8 per 1000 person-years) and Group IV had controlled glucose but elevated blood pressure and LDL (46.7 per 1000 person-years). Compared with the other groups, Group I exhibited significantly longer dialysis-free and MAKE-free survival (log-rank test, p

Longitudinal trajectories of metabolic risk cluster are associated with differential risks of CKD progression to ESKD and death. Our findings provide valuable insights into the monitoring of metabolic risk profiles over time in patients with CKD.

To assess the incidence and risk of major adverse cardiovascular events (MACE) in patients with different stages of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in Taiwan.

Retrospective cohort study.

Secondary and tertiary care; data were collected from three affiliated hospitals in northern Taiwan.

A total of 7038 adult patients with clinically confirmed CKD stages 3–5 were included, of whom 14.09% had progressed to ESKD. Patients were identified from a multicentre database in northern Taiwan. Key exclusion criteria included age under 20 years, prior MACE, cancer or renal transplantation.

The primary outcome was the incidence of MACE during follow-up. Secondary analyses included time to MACE and subgroup comparisons by CKD stage and comorbid conditions (eg, diabetes, cardiovascular disease).

MACE occurred in 49.8% of patients with CKD and 64.1% of those with ESKD. After adjustment for covariates, the ESKD group had a significantly higher risk of MACE (HR=1.52; 95% CI 1.08 to 2.16) compared with the non-ESKD group. Relative to stage 3a, the adjusted HRs for MACE were 1.13 (95% CI 0.74 to 1.73) for stage 3b, 1.13 (95% CI 0.74 to 1.70) for stage 4, 1.82 (95% CI 1.18 to 2.81) for stage 5 (non-ESKD) and 2.32 (95% CI 1.51 to 3.57) for stage 5D (ESKD). Diabetes and cardiovascular comorbidities were associated with increased MACE incidence and shorter time to MACE, but their associations became non-significant after adjustment.

Based on a multicentre cohort from Taiwan, our findings provide insights into the prognosis of patients with CKD across disease stages and highlight the importance of targeted interventions and integrated care to improve cardiovascular outcomes.

Effective community-based disease management is essential for public health. In low- and middle-income countries, sustainable strategies for timely diagnosis and treatment are a research priority. This study aims to assess the feasibility of a non-invasive saliva self-sampling method, paired with digitally linked molecular point-of-care diagnostics, for detecting respiratory infections among paediatric patients in the Tshwane District, South Africa.

A field study will be conducted at Steve Biko Academic Hospital to compare saliva collection using the CandyCollect lollipop device and standard mouth swabs. The spiral groove of the lollipop device captures pathogens, which are stored in DNA/RNA preservation media and later analysed using quantitative PCR and commercially available rapid antigen tests. The multiplex respiratory pathogen panel, based on TaqMan real-time PCR technology, targets key paediatric pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, respiratory syncytial virus (RSV) and influenza A/B. Nucleic acids will be extracted using standard viral extraction kits and analysed following manufacturer protocols. Internal controls will be included in each qPCR run, and samples with CT values below defined thresholds will be considered positive. Rapid antigen tests will detect common pathogens such as influenza A/B, RSV and SARS-CoV-2 for comparative analysis. User experience and acceptability will be assessed via child-friendly and caregiver surveys following sample collection. The study will be implemented in two phases: diagnostic performance evaluation and user feedback assessment. The protocol is aligned with the Standard Protocol Items: Recommendations for Interventional Trials 2013 checklist.

Ethical approval has been granted by the University of Pretoria (509/2023) and the Gauteng Department of Health (GP_202406_032). The study is registered in the Pan African Clinical Trial Registry (PACTR202411743094783). Findings will be disseminated through peer-reviewed journals, conferences and stakeholder briefings. The study complies with South Africa’s Protection of Personal Information Act. Data collection is scheduled from November 2024 to February 2025, with project completion expected within 1 year.

Pan African Clinical Trial Registry (PACTR202411743094783).

Temporomandibular disorders (TMDs) are a group of conditions affecting the temporomandibular joint (TMJ), masticatory muscles and associated structures, often leading to pain, dysfunction and a significant impact on quality of life. Epidemiological studies have estimated that up to 75% of the population in the USA exhibits at least one sign of TMD. Although conservative treatments, such as acupuncture and occlusal splints, have been recommended, evidence for their effectiveness remains inconclusive, and the combined effects of these interventions are not well understood.

This study aims to evaluate the efficacy of an intraoral balance appliance (IBA) combined with standard Korean medicine care, compared to Korean medicine care alone, in patients with chronic, painful TMD with myalgia.

A single-centre, two-arm, parallel, practitioner-blinded and evaluator-blinded, randomised controlled trial with a 1:1 allocation ratio will be designed to test the interventions. 76 patients with TMD with myalgia will be recruited and randomised. The interventions will include manual acupuncture and physical therapy for both groups, with the addition of IBA in the treatment group for 3 weeks. The primary outcomes of the study will be the Numeric Rating Scale (NRS) for pain and discomfort at the final visit at week 4. Secondary outcomes will include overall functional assessment of the TMJ using several scales, as well as evaluations of quality of life, patient satisfaction and AEs.

The recruitment started on 18 July 2024, and 37 patients were included as of 8 July 2025.

Ethical approval is obtained from the Kyung Hee University Korean Medicine Hospital Institutional Review Board (IRB number: KOMCIRB 2023-06-001). The result from this study will be actively disseminated through manuscript publications and conference presentations.

The protocol was registered with the Clinical Research Information Service (CRiS), Republic of Korea, on 30 October 2023, CRiS number KCT0008906 prior to the initiation of the study, and was revised on 7 July 2025 (https://cris.nih.go.kr/cris/search/detailSearch.do?seq=30270&search_page=M&search_lang=&class_yn=).