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.

China has continued to improve tuberculosis (TB) control in the past decade; however, the sudden outbreak of COVID-19 hindered this progress. As a province with a large population and frequent international exchanges, Guangdong has been seriously affected by COVID-19. This study aimed to understand the effect of COVID-19 on TB detection in Guangdong based on the autoregressive integrated moving average (ARIMA) model.

Time-series study.

Guangdong, China.

We used the ARIMA model to quantify the effect of COVID-19 by comparing reported cases during the COVID-19 pandemic with predicted cases under a counterfactual scenario of no COVID-19 pandemic. After model evaluation, we chose ARIMA (0,1,2)(0,1,1)₁₂ as the prediction model. We also highlighted that there were three emergency response periods in which the responses and public responses to COVID-19 varied.

During the pandemic period, the average annual TB notification rate was 57.95/100 000, which decreased by 27.97% compared with the pre-pandemic period. Although it decreased by 6.17% on average annually in the pre-pandemic period, it decreased by 14.92% in 2020 as compared with 2019, but only decreased by 0.34% in 2021 as compared with 2020. The results of the ARIMA model showed that the number of reported cases in 2020 decreased by 6.62% compared with that of the predicted cases, but this decreased by 0.42% only in 2021. The most seriously affected period was the second-level emergency response period in 2020, when the relative difference between reported and predicted cases reached the peak (–16.43%). The least affected period was the third-level emergency response period of 2021, the reported cases recovered and exceeded the predicted cases, with a gap of 0.77%.

TB detection in Guangdong had generally declined during the COVID-19 pandemic, which might be related to the movement restrictions, diverted resources and patients’ concerns. This decline would lead to the delay or even interruption of diagnosis and treatment, which would cause the regression of TB control. To improve TB detection, it is important for stakeholders to take consorted effort during public health emergencies.

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.

Falls are among the most common adverse events in hospitals, causing significant harm to patients and increasing healthcare costs. In 2023, over 160 000 falls were reported in China, with 62.5% of hospitalised patients suffering fall-related injuries. Falls not only prolong hospital stays but also negatively impact nursing quality and healthcare system efficiency.

This study explored the lived experiences of nurse managers in preventing and managing inpatient falls in hospital settings and examined the contextual and managerial factors influencing fall prevention practices.

We conducted a qualitative study using a phenomenological approach to explore the lived experiences of nurse managers in managing inpatient falls. Semistructured interviews were conducted with 16 participants from a tertiary hospital in Shanghai. While data collection followed phenomenological principles to elicit rich experiential narratives, thematic analysis was guided by grounded theory coding techniques to inductively identify and categorise themes. NVivo 12 software was used for data management.

Six interrelated themes emerged, reflecting nurse managers’ experiences across the stages of patient admission, hospitalisation and discharge. At admission, participants emphasised the limitations of existing fall risk assessment tools and the need for multidisciplinary collaboration and intelligent technologies to achieve precise stratification. During hospitalisation, they described ongoing challenges in conducting dynamic reassessments, implementing personalised interventions, managing limited staffing and environmental constraints and promoting patient compliance through effective education. In the discharge phase, nurse managers reflected on the emotional and ethical tensions between ensuring patient safety and respecting autonomy, underscoring the importance of cultivating a strong safety culture and reinforcing nurses’ sense of responsibility. Collectively, these findings reveal that fall prevention is not merely a procedural task but a dynamic, interpretive process shaped by professional accountability, emotional strain and systemic limitations.

Nurse managers’ experiences reflect the complex interplay between managerial responsibility, cultural caregiving norms and organisational limitations in fall prevention. Strengthening multidisciplinary collaboration, integrating intelligent technologies and promoting a proactive safety culture are crucial for improving fall management. Policymakers should also consider China’s evolving caregiver-free ward initiatives to transition towards more nurse-led and patient-centred safety systems. Future research should further explore patient and family perspectives and evaluate strategies for sustainable cultural and structural change in fall prevention.

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.

Coronary artery involvement remains the primary focus in the long-term management of Kawasaki disease (KD). However, previous studies suggest that myocardial abnormalities frequently persist beyond coronary artery involvement in KD patients. Yet, their temporal evolution and clinical implications remain poorly characterised. To address this gap, we established the Kawasaki disease cardiac imaging (KDCI) cohort, integrating cardiac magnetic resonance (CMR) with echocardiography, coronary CT angiography (CCTA) and invasive angiography. These multimodal imaging approaches enable comprehensive assessment of cardiac abnormalities and elucidate the role of cardiac imaging in optimising long-term KD management.

The KDCI cohort is a prospective study aiming to enrol 400–500 KD patients diagnosed at West China Second University Hospital from September 2018 to September 2035. To date, 207 participants have been recruited. Participants will perform the multimodal cardiac imaging including echocardiography, CMR, CCTA, invasive angiography and comprehensive laboratory testing under a scheduled protocol in the follow-up.

The KDCI cohort has established baseline characteristics for 207 KD patients. Of those included to date, 72.0% (149/207) received intravenous immunoglobulin (IVIG) treatment, with 26.1% (54/207) demonstrating IVIG resistance, and 37.7% (78/207) exhibiting coronary artery dilatation. Longitudinal follow-up data are available for 80.7% (167/207) of participants, with a median follow-up duration of 2.7 years and a follow-up patient-years of 594 patient-years. Of the 207 patients, 16.9% (35/207) patients experienced endpoint events, encompassing coronary artery thrombosis (8.2%, 17/207), coronary stenosis/obstruction (5.3% 11/207) and clinical myocardial infarction (1.9%, 4/207). Based on the data collected, we have demonstrated the cardiac abnormalities beyond coronary artery involvement in KD by CMR and CCTA.

The KDCI cohort will maintain ongoing recruitment and longitudinal follow-up, with a projected enrolment exceeding 400 participants by 2035. This expansion will yield a median follow-up duration of 10 years, providing robust long-term outcome data. We have implemented standardised protocols for scheduled follow-up assessments and data collection in newly enrolled patients. Furthermore, planned genomic analyses will be incorporated to investigate the molecular pathogenesis and prognostic determinants of KD.

Myoglobin (Mb) exerts both direct and indirect nephrotoxic effects, contributing to the progression of kidney injury. For patients with rhabdomyolysis (RM) and acute kidney injury (AKI) requiring renal replacement therapy (RRT), Mb clearance is a critical therapeutic goal. Recent studies have indicated that haemoadsorption (HA) combined with continuous renal replacement therapy (CRRT) is an effective strategy for removing circulating Mb. However, clinical data regarding the efficiency of Mb clearance and long-term patient outcomes with this approach remain limited. This study aims to evaluate the efficacy and safety of HA combined with CRRT in treating severe RM and AKI.

This single-center, open-label, randomised controlled trial will be conducted at West China Hospital of Sichuan University. A total of 60 patients with severe RM and AKI will be enrolled and randomly assigned in a 1:1 ratio to either the CRRT group or the CRRT+HA group. Randomisation will be conducted by drawing lots, performed by the patient’s legal representative (with ‘0’ indicating the CRRT group and ‘1’ indicating the CRRT+HA group).

The primary outcome of the study is the plasma clearance of Mb. Secondary outcomes include the plasma clearance of creatine kinase, haemodynamic changes, changes in acute physiology and chronic health II (APACHE) II score and sequential organ failure assessment (SOFA) score, renal function recovery, length of hospital stay, all-cause mortality, and pre- and post-treatment changes in albumin, platelet and haemoglobin counts. Data will be analysed using both intention-to-treat and per-protocol analysis methods.

The study will comply with the Declaration of Helsinki and the Chinese Clinical Trials Act. The study protocol has been approved by the Biomedical Research Ethics Committee of West China Hospital of Sichuan University (2024.1914). Written informed consent will be obtained from all participants. The study results will be presented at academic meetings and in peer-reviewed academic journals.

ChiCTR2400092176.

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.

This study aimed to investigate the knowledge, attitude and practice (KAP) of patients living with functional gastrointestinal disorders (FGIDs) toward their diseases.

A web-based cross-sectional study was conducted.

The gastroenterology outpatient department of Zhejiang Hospital of Traditional Chinese Medicine, Zhejiang, China.

The study enrolled 503 patients with FGIDs from the Gastroenterology Outpatient Department of our hospital between September and October 2023.

Not applicable for cross-sectional study.

Participants completed a self-designed questionnaire that collected sociodemographic information and assessed KAP scores. The primary outcome measures were KAP scores.

The mean KAP scores were 6.57±2.76 (possible range: 0–10) for knowledge, 30.00±4.08 (possible range: 7–35) for attitude and 30.16±4.92 (possible range: 8–40) for practice. Pearson’s correlation analysis indicated a positive and moderate correlation between knowledge and attitude (r=0.330, p

Patients with FGIDs demonstrated moderate knowledge, positive attitudes and moderate practices regarding their disease. Drinking habits and household income reportedly influenced their KAP outcomes. Targeted educational interventions are warranted to enhance practice behaviours among patients with FGIDs.

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.

Total mesorectal excision has been adopted as standard procedure for resectable rectal cancer. However, there is no regulation in the current guidelines on the sequence of ligation of the inferior mesenteric artery and vein during rectal cancer surgery owing to a lack of sufficient evidence. Circulating tumour cells (CTCs) in peripheral blood can be used as potential indicators for predicting postoperative recurrence and prognosis in patients with colorectal cancer. The aim of the study is to investigate whether vascular ligation sequence affects the dissemination of CTCs into the bloodstream and survival during minimally invasive rectal cancer surgery.

This study is a prospective, multicentre, randomised controlled trial investigating the effect of ligation sequence (inferior mesenteric artery vs vein priority) on CTC levels and survival outcomes in minimally invasive rectal cancer surgery. 268 eligible patients with rectal cancer will be randomly assigned to the priority ligation of the inferior mesenteric vein group or priority ligation of the inferior mesenteric artery group during minimally invasive rectal cancer surgery. The primary endpoint of this study is the change of peripheral blood CTC levels before and after surgery, analysed using the Wilcoxon rank sum test. Secondary endpoints are 3-year disease-free survival, 3-year overall survival, 3-year recurrence pattern, intraoperative blood loss, operation duration, conversion rate, number of lymph nodes collected, intraoperative morbidity and mortality, postoperative morbidity and mortality and postoperative recovery course.

The study has been approved by the ethics committee of Sichuan Cancer Hospital (Approval number: SCCHEC-02-2024-102), all participants of the study will be well informed and written informed consent will be obtained from all participants. Findings from this trial will be published in peer-reviewed publications.

NCT05807646.

The under-5 mortality rate (U5MR) is a crucial global health metric for evaluating public health interventions, and further reductions in U5MR are essential for achieving the Sustainable Development Goals (SDGs). This study analyses the trends of U5MR globally from 2000 to 2021 and explores the quantitative impact of health resources on U5MR reduction.

This study used WHO public data from 2000 to 2021 to investigate the temporal trend of U5MR through Joinpoint regression analysis. A two-way fixed-effect model was used to investigate the relationship between U5MR and health resources.

Data on U5MR and health resources (including six vaccine-related indicators and eight health expenditure-related indicators) were obtained from the WHO Global Health Observatory, encompassing 200 countries and regions from 2000 to 2021.

Globally, U5MR declined, though at a slower pace (annual average percentage change: –3.259, p

Global U5MR has declined from 2000 to 2021, but progress remains insufficient to fully achieve the SDGs. Immunisation played a dominant role in the global reduction of U5MR, underscoring the critical need to prioritise vaccination in health resource allocation strategies.