This study aims to examine the longitudinal relationship between fear of disease recurrence and depressive symptoms in elderly patients who have experienced postoperative adjacent vertebral refractures, as well as in their spouses, using the actor-partner interdependence model (APIM) to assess both individual and mutual psychological influences.

A prospective longitudinal study in China.

A total of 230 osteoporotic vertebral compression fractures (OVCF) and their spouses were selected by convenience sampling method.

Simplified fear disease Progression Scale and 9-item Patient Health Questionnaire were used at admission (T1), before discharge (T2) and 1 month after discharge (T3), respectively. Equivalence test and cross-lagged analysis of APIM were used for statistical examination.

A total of 224 valid questionnaires were collected in this study, yielding an effective recovery rate of 97.31%. Across the measurement stages, both patients and their spouses exhibited a decreasing trend in scores for fear of disease recurrence and depressive symptoms. The subjective effect analysis revealed that, in elderly patients with postoperative adjacent vertebral refracture, fear of disease recurrence significantly and positively predicted depressive symptoms at the subsequent stage (T1->T2: β=0.18, T2->T3: β=0.17, pT2: β=0.16, T2->T3: β=0.17, pT2: β=0.21, T2->T3: β=0.20, pT2: β=0.20, pT3: β=0.18, pT2: β=0.21, T2->T3: β=0.20, pT2: β=0.17, T2->T3: β=0.16, all p

It is recommended that medical staff prioritise the assessment and management of fear of disease recurrence and depressive symptoms in elderly patients with OVCF and their spouses, and strategically leverage the mutual influence between them to minimise depressive symptom levels as much as possible.

This study aimed to compare the predictive performance of novel adiposity indices (a body shape index (ABSI) and visceral adiposity index (VAI)) with traditional anthropometrics (body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR)) for cardiovascular disease (CVD) risk in urban China. Secondary objectives included evaluating composite indices derived from principal component analysis (PCA) and evaluating optimised risk stratification strategies.

A community-based cross-sectional study.

Urban and rural communities in Nanjing, China, from 2020 to 2023.

38 427 adults aged 35–79 years, recruited via stratified sampling. Individuals aged 79 years, who were pregnant or had severe illness or cognitive impairment were excluded.

The primary outcome was a CVD high-risk status (defined by Chinese guidelines). Secondary outcomes included detection rates, area under the curve (AUC), ORs and multicollinearity diagnostics.

Among participants, 23.3% (n=8905) were classified as high risk for CVD. In this study, WHtR demonstrated the greatest discriminative power (AUC=0.826, 95% CI 0.819 to 0.832), followed by a PCA-derived composite obesity index (COI; AUC=0.822). ABSI showed a clear risk gradient, with a 38.5% detection rate in the high-risk group (ABSI≥0.085), and VAI exhibited a modest but statistically significant effect (OR=1.026, p=0.001). Severe multicollinearity among traditional indices (variance inflation factor >40) was mitigated by COI. Combined models (eg, COI+ABSI+ VAI) achieved comparable AUC (0.825) with improved parsimony (AIC=17 4010.34). Age, hypertension and dyslipidaemia were key covariates (ORs=1.15–3.88, p

WHtR and composite indices (eg, COI) appeared to perform better than other indicators in predicting CVD risk, whereas ABSI and VAI enhance stratification in specific subgroups. Implementing WHtR-based screening in primary care, supplemented by composite indices and novel markers for high-risk individuals, may help optimise prevention strategies in urbanising Chinese populations.

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.

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.

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.

Endometriosis, a chronic oestrogen-dependent disorder, presents significant clinical challenges including pelvic pain, dysmenorrhoea, dyspareunia and infertility. While numerous interventions exist, evidence guiding the choice among surgical, hormonal and non-hormonal therapies is fragmented. This protocol outlines a systematic review and network meta-analysis designed to comprehensively evaluate the comparative effectiveness and safety of all available treatments for endometriosis-associated pain and infertility.

We will systematically search PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and WHO International Clinical Trials Registry Platform. Randomised controlled trials evaluating any intervention for endometriosis will be identified through a two-stage independent screening process by two reviewers. Primary outcomes are overall pain reduction and live birth rate. Secondary outcomes include clinical pregnancy rate, miscarriage rate, endometriosis recurrence, relief of other endometriosis-related symptoms, adverse events, quality of life and obstetrical outcomes. Data will be synthesised using pairwise and network meta-analyses.

This systematic review of published literature does not require ethical approval. Results will be disseminated through peer-reviewed publication. The findings aim to establish a robust evidence base for clinical decision-making and to inform future research priorities in endometriosis management.

CRD420251051917.

To explore the associations between arterial stiffness (AS) onset age and type 2 diabetes mellitus (T2DM) risk.

Large-scale cohort study.

The largest medical centre in central China.

This study enrolled 22 588 participants free of T2DM at baseline. All participants took an annual physical examination from 2012 to 2016, with fasting blood glucose and brachial–ankle pulse wave velocity measurements.

Cox proportional model was used to investigate the association between AS onset age and T2DM risk. Sex-specific analysis was also performed, and the association between early vascular ageing (EVA), normal vascular ageing (NVA), supernormal vascular ageing (SUPERNOVA) onset age and diabetes risk was also examined.

A total of 757 (3.4%) participants were diagnosed with T2DM. Compared with participants free of AS in each specific age group, the earlier AS onset age was more strongly associated with T2DM risk, especially for middle age, with the fully adjusted hazard risk (HR) and 95% CI of 4.63 (2.79–7.67) for AS onset age at 50. Similar results were observed both in males and females, with the fully adjusted HR and 95% CI of 4.54 (2.60 to 7.93) for males and 4.86 (1.48 to 16.01) for females, with AS onset age at 50. Such an association was also observed in the exploration of EVA, NVA and SUPERNOVA onset age and incident T2DM risk.

This study revealed that the middle-aged onset of AS was more significantly associated with a higher T2DM risk. Early screening of AS, especially in middle age, may assist in T2DM detection and postpone diabetic vascular complications.

Data on health inequalities in inflammatory bowel disease (IBD) among women of childbearing age (WCBA, 15–49 years) across different countries are lacking. We aimed to assess the global incidence, disability-adjusted life year (DALY) burden and cross-country inequalities of IBD in WCBA from 1990 to 2021.

Observational study.

Data were extracted from the Global Burden of Disease Study 2021.

Women aged 15–49 years diagnosed with IBD.

The primary outcomes were the total numbers and age-standardised rates of incidence and DALYs. Secondary outcomes included (1) temporal trends, assessed using estimated annual percentage change (EAPC); (2) periods of significant change identified through joinpoint regression analysis and (3) health inequalities by sociodemographic index (SDI), assessed using the slope index of inequality (SII) and the concentration index.

Globally, from 1990 to 2021, the number of incident IBD cases among WCBA increased from 60 926 (95% uncertainty interval (UI) 50 342 to 74 910) to 98 975 (95% UI 80 568 to 124 089), and DALYs increased from 193 091 (95% UI 145 850 to 245 244) to 281 580 (95% UI 223 989 to 349 966). During the same period, the age-standardised incidence rate (ASIR) increased significantly (EAPC 0.22, 95% UI 0.1 to 0.34), whereas the age-standardised DALY rate (ASDR) decreased significantly (EAPC –0.28, 95% UI –0.35 to –0.21). In 2021, the highest ASIR (14.93 per 100 000, 95% UI 11.52 to 18.97) and ASDR (27.94 per 100 000, 95% UI 19.97 to 37.87) were observed in high-SDI regions. In contrast, the fastest increase in ASIR (EAPC 1.69, 95% UI 1.48 to 1.90) occurred in middle-SDI regions. High-middle-SDI regions exhibited the most pronounced decrease in ASDR (EAPC –0.8, 95% UI –0.92 to –0.67), whereas a notable upward trend in ASDR was found solely in low-SDI regions (EAPC 0.14, 95% UI 0.07 to 0.21). The SII for ASIR increased from 4.83 (95% CI 3.63 to 6.03) in 1990 to 6.26 (95% CI 4.90 to 7.63) in 2021, whereas the concentration index decreased from 0.35 (95% CI 0.25 to 0.44) to 0.24 (95% CI 0.16 to 0.33). The SII for ASDR decreased from 7.37 (95% CI 2.07 to 12.67) in 1990 to 5.97 (95% CI 1.38 to 10.56) in 2021, and the concentration index shifted from 0.13 (95% CI 0.06 to 0.2) in 1990 to –0.03 (95% CI –0.1 to 0.05) in 2021.

In 2021, the global incidence and ASDR burden remained concentrated in high-SDI countries, with significant regional disparities. From 1990 to 2021, health inequality in DALYs gradually shifted from high-income to low-income countries.

Video-assisted thoracoscopic surgery (VATS) has become the predominant method for lung cancer diagnosis and resection, with over 80% adoption in relevant surgeries. With technological advancements, uniportal VATS is now widely employed. However, it still poses a significant risk of moderate to severe acute postoperative pain, potentially leading to chronic post-thoracotomy pain syndrome (PTPS). Therefore, effective postoperative analgesia is crucial. Regional block techniques have gradually gained wide attention. Specifically, paravertebral block (PVB) has been considered the ‘gold standard’ for thoracic analgesia, but its application involves risks due to the challenging anatomy. The erector spinae plane block (ESPB) and intertransverse process block (ITPB) have emerged as alternatives. ESPB showed non-inferiority to PVB in pain management and recovery quality. However, the mechanism of ESPB and its consistency in providing analgesia are not fully understood. ITPB, targeting the ‘posterior space of the superior costotransverse ligament’, offers theoretical advantages in drug diffusion due to its closer proximity to the paravertebral space than ESPB. Despite these advancements, there is a lack of randomised controlled trials (RCTs) assessing the comparative efficacy of continuous ESPB and ITPB. This study aims to address these gaps by comparing the analgesic effects and recovery quality of continuous ESPB and ITPB in patients undergoing single-port VATS.

A double-blind RCT will be conducted, enrolling 96 patients electively undergoing single-port thoracoscopic surgery, randomly assigned to either the experimental group (ITPB group) or the control group (ESPB group). After routine surgery, block intervention and continuous pump catheterisation will be performed. The primary assessment will be the numeric rating scale (NRS) scores at 24 hours. Secondary outcomes include NRS at other time points, block effectiveness, Quality of Recovery-15 scores and chronic pain-related scores. Evaluations will be conducted at 0, 2, 6, 12, 24 and 48 hours. Additional assessment indicators include time to first self-administration of pulse analgesia pump, number of self-administrations within 48 hours, use of non-steroidal anti-inflammatory drugs and opioids postoperatively, Comprehensive Complication Index (CCI) score, length of hospital stay, incidence of adverse events and complications, patient satisfaction score and assessment of PTPS incidence at 3 months postoperatively using the Brief Pain Inventory short form and the Short-Form McGill Pain Questionnaire.

The study was reviewed and approved by the Medical Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University (No. K44-1, 2024). The results of the study will be submitted for publication in a peer-reviewed journal with online accessibility.

ChiCTR2400082856.

Mediastinal and/or hilar lymphadenopathy (MHL) is increasingly identified owing to various underlying conditions. Minimally invasive biopsy techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), transbronchial mediastinal cryobiopsy (TBMC) and transbronchial forceps biopsy (TBFB), are common diagnosis tools. However, their safety and diagnostic efficiency remain unclear. This trial aims to compare the diagnostic yield and safety of these three techniques.

This study is a three-arm, parallel-design, randomised controlled trial involving 972 adult patients with MHL recruited from multiple medical centres. Participants will be randomly assigned to the EBUS-TBNA, TBMC via a tunnel or TBFB via a tunnel group. The primary outcome is diagnostic yield, and the secondary outcomes include diagnostic sensitivity, sample quality and procedure-related complications. Statistical analyses will be conducted using the appropriate methods. An independent sample ² test will be used to test the differences in the diagnostic yield and incidence of procedure-related complications.

Ethics approval was obtained from the China-Japan Friendship Hospital Ethics Committee (2022-KY-194).

Written informed consent will be obtained from all patients or their guardians before their enrolment in the study. This study will be conducted per the principles established in the Declaration of Helsinki and the International Council for Harmonisation Guidelines for Good Clinical Practice.

www.clinicaltrials.gov (NCT06262620).

This study assessed the knowledge, attitude and practice (KAP) of pregnant women in Chongqing, China, regarding pre-eclampsia and examined their inter-relationships.

A cross-sectional survey was conducted using validated questionnaires.

The study was conducted between May 2023 and August 2023 in Chongqing, China.

A total of 427 pregnant women were included, with 68.15% aged ≤30 years and a mean pregnancy duration of 238.18±45.01 days.

This was an observational study, and interventions were applied.

The primary outcomes were the KAP scores (knowledge: 0–40; attitude: 12–60 and practice: 10–50). The correlations and structural equation modelling (SEM) analyses were conducted to explore the relationships among KAP.

Mean scores were 22.19±12.17 (knowledge), 46.38±6.14 (attitude) and 41.96±5.96 (practice). Knowledge positively correlated with attitude (r=0.586, p

Pregnant women exhibited inadequate knowledge and a suboptimal attitude but a proactive practice. Targeted interventions to improve knowledge and attitudes are recommended for better clinical outcomes, particularly in regions where few such studies have been conducted.