Perioperative psychological symptoms are prevalent among patients undergoing lung surgery and can contribute to adverse clinical outcomes. Pharmacological interventions for these symptoms have inherent limitations. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-invasive therapeutic approach. This study aims to evaluate the efficacy of taVNS in managing perioperative psychological symptoms in patients undergoing elective thoracoscopic pneumonectomy under general anaesthesia.

This single-centre, prospective, randomised, double-blind, controlled trial will enrol 176 patients scheduled for elective thoracoscopic lung resection. Participants will be randomly allocated to either the active taVNS or the sham taVNS groups in a 1:1 ratio. Both groups will receive 30 min active or sham stimulation sessions at four time points: (1) the afternoon prior to surgery, (2) the morning of the surgery, (3) following extubation and (4) the first afternoon postsurgery. The primary outcome is the incidence of perioperative anxiety, assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale. Secondary outcomes include depression scores, stress index, sleep quality, pain scores, incidence of postoperative delirium, fatigue, cough symptoms and postoperative recovery quality, all evaluated through validated assessment tools. Analyses will be conducted using intention-to-treat and per-protocol populations.

The Ethics Committee of Affiliated Hospital of Xuzhou Medical University granted approval for the study with approval number: XYFY2024-KL444-01. Dissemination will be via national anaesthesia conferences and publication in the peer-reviewed literature.

ChiCTR2400090542.

Bedaquiline (BDQ), delamanid (DLM) and pretomanid (Pa) were widely used in recent years. This study aimed to analyse adverse drug event (ADE) reports associated with them based on the Food and Drug Administration Adverse Event Reporting System (FAERS) database, to explore the signals of ADEs and provide reference for clinical use.

A retrospective pharmacovigilance study.

The FAERS database was extracted from 2015 to 2023, and the ADE reports about BDQ, DLM, and Pa were collected.

Data mining was carried out on relevant reports of BDQ, DLM, and Pa using the reporting odds ratio (ROR), proportional reporting ratio (PRR), medicines and healthcare products regulatory agency (MHRA) and the information component (IC).

A total of 4010 ADE reports were included: 2477 for BDQ, 1360 for DLM and 173 for Pa. Combined with disproportionality analysis in different backgrounds, the salient risks of three target drugs varied. In the entire dataset, prolonged ECG QT (BDQ: ROR=42.57; DLM: ROR=28.00; Pa: ROR=20.45), hepatitis toxic (BDQ: ROR=28.65; DLM: ROR=21.42; Pa: ROR=90.67), bilirubin conjugated increased (BDQ: ROR=14.40; DLM: ROR=14.56; Pa: ROR=53.95), increased aspartate aminotransferase (BDQ: ROR=9.10; DLM: ROR=8.83; Pa: ROR=7.77), increased alanine aminotransferase (BDQ: ROR=5.68; DLM: ROR=5.54; Pa: ROR=8.92), drug-induced liver injury (BDQ: ROR=6.51; DLM: ROR=6.24; Pa: ROR=3.61) and anaemia (BDQ: ROR=6.54; DLM: ROR=5.75; Pa: ROR=4.83) remained common risks for them. However, in the other two contexts, only decreased haemoglobin (tuberculosis dataset: ROR=2.15; target dataset: ROR=1.03), which was more pronounced associated with DLM and prolonged ECG QT (tuberculosis dataset: ROR=2.46; target dataset: ROR=1.23), hepatotoxicity (tuberculosis dataset: ROR=1.74; target dataset: ROR=4.03) was more pronounced associated with BDQ, while other ADEs, like pancreatitis (tuberculosis dataset: ROR=4.54; target dataset: ROR=7.36), death (tuberculosis dataset: ROR=5.71; target dataset: ROR=2.47) and multiple organ dysfunction syndrome (tuberculosis dataset: ROR=1.46; target dataset: ROR=2.76), were worthy of attention associated with Pa apart from the common ADEs. The combination of linezolid (LZD) with the target drugs elevated risk signals for hepatotoxicity, haematologic toxicity and neurotoxicity. Subgroup analyses revealed that

Our study highlights the differences in common ADEs of BDQ, DLM and Pa, as well as the differences in these ADEs among genders and age groups, providing valuable insights for clinical application.

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.

Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, with most Chinese patients diagnosed at a locally advanced stage. Neoadjuvant chemotherapy (NAC) is increasingly used to improve resectability and survival. Laparoscopy-assisted distal gastrectomy (LADG) provides short-term recovery benefits compared with open distal gastrectomy (ODG), but its safety and oncologic efficacy following NAC remain uncertain. This trial aims to determine whether LADG is non-inferior to ODG in terms of long-term survival outcomes in patients with locally advanced distal gastric cancer (LAGC) after NAC.

This is a multicentre, randomised, controlled, non-inferiority trial conducted at high-volume GC centres in China. Eligible patients (aged 18–75 years; cT3–4a, N0/+, M0) with histologically confirmed distal gastric adenocarcinoma who have completed standard NAC will be randomised 1:1 to LADG or ODG with D2 lymphadenectomy. Surgical quality will be standardised through operative manuals, intraoperative video recording and central auditing. The primary endpoint is 3-year disease-free survival. Secondary endpoints are 3- and 5-year overall survival. A total of 998 patients (499 per arm) will be enrolled, providing 80% power to test non-inferiority with an absolute 8% margin, accounting for 15% attrition. Analyses will follow the intention-to-treat principle, with Cox models used for survival comparisons and subgroup analyses according to nodal status, tumour size and pathological response.

This trial has been reviewed and approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University (Approval No. 2025 (865), 16 July 2025). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed journals and international conferences, providing high-level evidence to guide the surgical management of LAGC after NAC.

Chinese Clinical Trial Registry, ChiCTR2500109677; registered on 23 September 2025. Protocol V.2.1, dated 29 June 2025.

Flexible ureteroscopy has advanced modern stone management; however, lower pole renal stones remain a challenge due to suboptimal ureteroscope deflection and navigation using conventional flexible and navigable suction ureteral access sheaths (FANS). The SCULPT trial is designed to assess whether the novel steerable FANS—which enables active controlled deflection—can improve the success rate of lower pole access during flexible ureteroscopy.

This multicentre, prospective, single-blinded, randomised controlled superiority trial will recruit 400 adult patients (aged 18–75 years) with solitary lower pole renal stones ≤2 cm diagnosed by CT from 20 high-volume urological centres in China. Participants will be randomised 1:1 to undergo flexible ureteroscopy with either steerable or conventional FANS. The primary outcome is the success rate of navigating into the lower pole calyx (defined as successful direct stone visualisation, laser lithotripsy and aspiration without adjunct use). Secondary outcomes include immediate and 1 month stone-free rates, operative time, complication profiles (graded by Clavien–Dindo), instrument damage rates, quality-of-life assessments and cost analysis. Statistical analysis will be performed using appropriate tests for continuous and categorical data, with their significance set by prespecified superiority margins.

The study protocol has been designed in accordance with the Declaration of Helsinki and ICH-GCP guidelines. Ethical approval was centrally granted by the Institutional Review Board of The First Affiliated Hospital of Guangzhou Medical University and adopted by all participating centres following local feasibility review. The trial results will be disseminated via peer-reviewed publication and presentation at international conferences.

NCT06898216.

Dexamethasone is commonly used to prevent postoperative nausea and vomiting (PONV). However, PONV is an unresolved complex problem; even with preoperative dexamethasone administration, 14.0%–26.3% of patients undergoing minimally invasive endoscopic procedures still experience PONV within 24 hours postoperatively. Compared with dexamethasone, dexamethasone palmitate has a long-lasting anti-inflammatory effect, two to five times that of traditional water-soluble dexamethasone, with fewer adverse events. This trial aims to assess the efficacy and safety of preoperative dexamethasone palmitate administration on postoperative PONV.

The INDEX trial is a multicentre, open-label, randomised, positive-controlled trial. A total of 588 patients will be recruited from three centres in China. Eligible patients are adults (aged 18–65 years) who undergo elective minimally invasive endoscopic surgery (laparoscopic or thoracoscopic surgery) under general anaesthesia. Eligible patients will be randomly assigned (1:1) to the dexamethasone palmitate or dexamethasone group. Patients in the dexamethasone palmitate group will receive intravenous injection of 8 mg of dexamethasone palmitate (containing 5 mg of dexamethasone), and those in the dexamethasone group will receive 5 mg of dexamethasone after anaesthesia induction and before surgical incision. The primary endpoint will be the incidence of PONV within the first 24 hours postoperatively. Secondary outcomes will include the incidence of PONV, postoperative nausea, postoperative vomiting, number of vomiting or retching episodes, severity of PONV, participant satisfaction, use of rescue antiemetic drugs and quality of postoperative recovery. The safety of participants will be monitored. A primary analysis will be conducted to evaluate between-group differences in the incidence of PONV in the intention-to-treat population and within the first 24 hours postoperatively. We will also perform a sensitivity analysis to evaluate the effect of missing values in the outcome parameters on the results. There is no plan to conduct an interim analysis.

Ethical approval was obtained from the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (KY 2025-041-02-01). The results will be disseminated in open-access publications and plain-language summaries.

NCT06981754

Microvascular obstruction (MVO) is a common complication following primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) and is strongly associated with adverse clinical outcomes. MVO is a dynamic, multifactorial process shaped by factors spanning the myocardial infarction–reperfusion continuum and by PPCI-related microcirculatory injury, which leaves current early risk stratification—often a static snapshot—with limited power to anticipate its evolution. Renalase, a cardioprotective enzyme, exhibits a post-reperfusion surge that parallels MVO development; periprocedural renalase release may likewise be driven by overlapping mechanisms along the ischaemia–reperfusion pathway. This hypothesis-generating observation supports evaluating the delta-Renalase (periprocedural change in serum renalase) as a candidate association-based biomarker. Accordingly, this study aims to assess whether delta-Renalase is independently associated with MVO in patients with STEMI after PPCI and to evaluate its incremental predictive value, without causal inference.

The Renalase and MicroVascular Obstruction Study (ReMVOS) is a prospective, single-centre, observational cohort study conducted at a nationally accredited chest pain centre in China. We will enrol 266 patients with consecutive STEMI with symptom onset within 12 hours who undergo PPCI. The exposure variable is delta-Renalase, calculated as the increase in serum renalase levels at 24 hours post-PPCI relative to the preprocedural baseline. The primary outcome is the presence of MVO, assessed by cardiovascular magnetic resonance (CMR) performed 2–5 days post-PPCI. Secondary outcomes include infarct size and peak global longitudinal strain quantified by CMR, major adverse cardiovascular events within 90 days and peak oxygen pulse from cardiopulmonary exercise testing (CPET) at the 90-day visit. The independent association and predictive value of delta-Renalase will be evaluated using a prespecified multivariable logistic regression model.

This protocol has been approved by the Ethics Committee of the Third Xiangya Hospital of Central South University (approval No. K24655). All patients will provide written informed consent prior to enrolment. The findings of this study will be disseminated through publications in peer-reviewed international medical journals and presentations at relevant academic conferences.

NCT06669520.

To investigate whether the triglyceride-glucose (TyG) index and the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, as clinical surrogates of insulin resistance, predict the risk of anxiety, and to examine the potential mediating role of plasma proteins.

Prospective cohort study.

Community-based population cohort in the United Kingdom.

A total of 412 767 participants aged 40–69 years without anxiety at baseline and with available data on TyG index and TG/HDL-C ratio were included. Among them, 43 991 participants had proteomic data with 2923 unique plasma proteins measured.

The primary outcome was the incidence of first-episode anxiety. The main exposures were TyG index and TG/HDL-C ratio. Mediation analysis was conducted to assess the contribution of plasma proteins.

During a median follow-up of 13.8 years, 21 616 cases of first-episode anxiety were identified. Higher quintiles of TyG index and TG/HDL-C ratio were significantly associated with increased anxiety risk (p trend

Elevated baseline TyG index and TG/HDL-C ratio are associated with an increased risk of anxiety, and this association may be mediated by ASGR1 and PRSS8.

Herpes zoster (HZ) vaccinations effectively prevent HZ and may decrease dementia, but HZ vaccine uptake remains poor in China. Rapid verbal persuasion is an innovative intervention, in which physicians offered brief advice to encourage individuals to accept vaccination. This study aims to tailor this intervention to promote HZ vaccination among older adults.

The proposed study will be a two-arm randomised controlled trial and conducted across four community health centres in Shenzhen, China. A total of 388 participants aged 50 and above will be recruited and assigned to either the intervention arm or the standard-care arm. The primary outcome will be first-dose uptake, recorded within 3 weeks after intervention. The primary outcome will be calculated for each arm and compared using ² test.

This trial has been approved by the Ethics Committee of Southern Medical University (Ethical Approval (2024) No. 90). Our findings will be disseminated to patients, healthcare providers and stakeholders through outreach activities and published in peer-reviewed journals, as well as presented in scientific conferences to inform future research or evidence-based practices for public health promotion.

Chinese Clinical Trial Registry (No. ChiCTR2500100798). Registered on 15 April 2025.

Secondary prevention strategies for coronary heart disease (CHD) can play a crucial role in averting acute coronary events and enhancing the overall well-being of CHD patients. This study aimed to investigate the knowledge, attitude and practice (KAP) of CHD patients in Shandong Province, China, toward secondary prevention medication regimens for CHD.

A multi-centre cross-sectional study.

Using a self-administered questionnaire.

This survey was conducted between October 2023 and February 2024 across four tertiary hospitals in Shandong Province, including the Provincial Hospital Affiliated with Shandong First Medical University, Qilu Hospital of Shandong University, Jinan Central Hospital and Jinan Fourth People’s Hospital.

The KAP of CHD patients toward secondary prevention medication regimens.

A total of 495 participants were finally enrolled, 347 (70.1%) were male and 248 (50.1%) were aged greater than or equal to 65 years. The mean score of KAP was 6.73 (5.19) (range: 0–20), 29.15 (3.81) (range: 7–35) and 28.61 (3.90) (range: 7–35), respectively. The structural equation model demonstrated that knowledge had a direct effect on attitude (β=0.427, p

CHD patients demonstrated insufficient knowledge, positive attitude and proactive practice toward secondary prevention medication regimens for CHD. It is recommended that healthcare providers implement targeted educational interventions to enhance patients’ knowledge levels regarding secondary prevention medication regimens for CHD.

The decline in intrinsic capacity (IC) among older adults poses significant challenges to healthy ageing. Despite the importance of self-management in enhancing IC, research on self-management patterns and their predictors among older adults with declined IC remains limited.

This study aimed to explore clusters of self-management behaviours and their predictors among older adults with declined IC using an integrated theoretical framework combining the Theory of Planned Behaviour (TPB) and the Health Action Process Approach (HAPA).

This cross-sectional study was conducted in two community health centres in China from December 2022 to June 2023. A convenience sample of 308 older adults with declined intrinsic capacity was recruited based on WHO-recommended criteria. Self-management behaviours were assessed using the Chronic Disease Self-Management Behaviour Scale. HAPA constructs (self-efficacy, outcome expectancy, risk perception, planning) and TPB constructs (subjective norms, behavioural attitudes, perceived behavioural control, behavioural intention) were measured via validated questionnaires refined through expert consultation. Unsupervised k-means clustering was applied to identify behavioural subgroups, validated by principal component analysis. Inter-subgroup differences were examined using Analysis of Variance (ANOVA) or rank-sum tests for continuous variables and chi-square tests for categorical variables.

Three distinct self-management behaviour subgroups were identified among older adults with declined intrinsic capacity: Hesitant to Act (n=196), Norm-Dependent (n=42) and Assertive Decisiveness (n=70). Significant differences were observed across subgroups in demographic characteristics, including gender (p=0.017) and education (p=0.005), as well as in HAPA/TPB construct scores, including perceived behavioural control and planning (all p

This study identifies three distinct patterns of self-management behaviours among older adults with declined IC. The findings highlight the need for tailored interventions targeting the specific challenges faced by each subgroup. Future research should validate these findings in larger samples and explore causal relationships between variables.

Tobacco use causes approximately 8 million deaths worldwide each year. Against the backdrop of a rapidly expanding game market, there is growing potential to develop tailored gaming interventions for smoking cessation. This study protocol describes the development of a personalised Serious Game Applet based on an integrated TTM–PMT–HAPA framework (Transtheoretical Model, Protection Motivation Theory, Health Action Process Approach) and evaluates its effectiveness compared with conventionalShort Messaging Service (SMS) -based smoking cessation interventions.

Design: The study comprises two phases. The first involves developing the Serious Game Applet using the TTM–PMT–HAPA theoretical framework. The second phase consists of a multicentre, two-arm, single-blind cluster randomised controlled trial, which will enrol 1320 eligible smokers from various enterprises. Enterprises will be randomised to either the Serious Game Applet group or the SMS push control group. Eligible participants include daily smokers aged 18–45 years, working in non-tobacco-related enterprises, with exhaled carbon monoxide levels ≥6 ppm.

Outcomes: Primary outcomes are smoking abstinence rates at 3 and 6 months. Secondary outcomes include abstinence rates at 1, 2 and 9 months; point-prevalence cessation rates at 1, 2, 3, 6 and 9 months; changes in cigarette consumption; stage transitions in smoking cessation; nicotine dependence scores and withdrawal symptoms. The trial will be conducted as a field study targeting smartphone users across three cities in Fujian Province, China.

This study has been approved by the Biomedical Research Ethics Committee of Fujian Medical University (Approval No. 127, 2024). Results will be disseminated through peer-reviewed journals and academic conferences.

ChiCTR2400088105.