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.

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.

Research investigating the efficacy of spinal muscular atrophy type II rehabilitation has yielded conflicting conclusions, underscoring the need for high-quality research to validate the role of physical therapy. Furthermore, exercise training should be considered as a potential non-pharmacological strategy to enhance motor function in SMA type III patients. Hence, this study is designed to explore the effectiveness of physical therapy for improving motor function in individuals with SMA type III.

This study is an open-label, randomised controlled trial. We will first stratify patients by disease severity (mild=independent walking, severe=non-ambulatory) and then randomly assign 428 participants to either the treatment group or the control group for a period of 12 weeks using a computer-generated randomisation schedule with a 1:1 allocation ratio. The intervention group will undergo a combination of cycling, resistance training, balance exercises, postural control training and locomotion exercises, while the control group will receive education sessions and a standard home exercise programme consisting of stretching and relaxation exercises. Outcome measurements will be assessed at baseline, immediately postintervention and at 3-month and 6-month follow-up assessments. The primary outcome will be assessed using the Hammersmith Functional Motor Scale Expanded, while secondary outcomes will include: Manual Muscle Test, Six-Minute Walk Test, 10 Metre Walk/Run Test, adverse events monitoring, Paediatric Quality of Life Inventory Multidimensional Fatigue Score and active and passive range of motion measurements.

The study protocol and consent form have been approved by the Ethics Committee on Biomedical Research of West China Hospital of Sichuan University (#2025-56) on 19 February 2025. Results will be published in peer-reviewed journals, presented at national and/or international conferences and disseminated to Chinese rare disease support groups.

ChiCTR2500101177.

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.

Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder. Parents of children with ASD often have a higher level of affiliate stigma, which impacts their physical and mental health, family relationships and social functions. Nowadays, a variety of assessment tools are available for measuring this stigma, but they have many limitations. This systematic review aims to critically appraise the measurement properties of instruments used to assess affiliate stigma in parents of children with autism and help researchers and healthcare professionals make more appropriate choices when using these tools.

This protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search five English databases (ie, PubMed, Web of Science, ScienceDirect Online, Embase and Cochrane Library) and four Chinese databases (ie, SinoMed, China National Knowledge Infrastructure, Wanfang Database and VIP information) from the databases’ inception to 30 September 2025. Eligible studies will evaluate instruments measuring affiliate stigma in parents of children with autism, including self-report and observer ratings. The psychometric properties assessed will include reliability, validity, responsiveness, interpretability and clinical utility. Only primary quantitative studies published in peer-reviewed journals will be included. The search will have no limitations on language or time. Two researchers will independently carry out data extraction and quality assessment, with disagreements resolved through consensus or a third researcher. The consensus-based standards for the selection of health measurement instruments risk of bias checklist and the Grading of Recommendations Assessment, Development and Evaluation approach will be used to evaluate each measure’s methodological quality and overall strength of evidence.

As this research constitutes a systematic review of pre-existing published data, formal ethics committee approval is deemed unnecessary in accordance with international research ethics guidelines. The synthesised findings will be submitted for publication in a rigorously peer-reviewed academic journal and presented at pertinent scientific conferences to ensure transparent knowledge dissemination within the academic community.

CRD420251043478.

This study aimed to investigate the knowledge, attitudes and practices (KAP) regarding dysphagia and its care among patients with dysphagia and their caregivers.

A cross-sectional survey.

This multicentre cross-sectional study was conducted between May and September 2024. It was led by the China-Japan Friendship Hospital and involved multiple institutions, including nursing communities, nursing homes and community hospitals, located in both Beijing and Shandong Province.

Patients with clinically diagnosed dysphagia and their caregivers recruited from the China-Japan Friendship Hospital, nursing communities, nursing homes and community hospitals.

Data were collected through a self-designed questionnaire encompassing sociodemographic characteristics and three dimensions of KAP. The primary outcome was the KAP scores. Secondary outcomes included the interaction between the three KAP dimensions.

A total of 416 participants were included in the final analysis, of whom 317 (76.2%) were female. The mean scores for KAP were 12.02±8.12 (possible range: 0–24), 31.38±4.77 (possible range: 8–40) and 29.29±9.03 (possible range: 8–40), respectively. Correlation analysis indicated significant positive relationships between knowledge and attitudes (r=0.416, p=0.002), knowledge and practices (r=0.412, p

Patients with dysphagia and their caregivers demonstrated inadequate knowledge but generally positive attitudes and proactive practices towards dysphagia and its care. Adequate knowledge might be correlated with better attitudes and practices.

Children’s medical fear refers to the negative emotional experiences, including fear, anxiety and nervousness, that arise when children are confronted with medical procedures and related events during healthcare encounters. This phenomenon exerts substantial negative impacts on treatment adherence, procedural cooperation and therapeutic outcomes, thereby emerging as a critical focus in modern paediatric medicine and psychiatric care. The establishment of precise assessment protocols serves as the cornerstone for developing effective intervention strategies. Despite the proliferation of assessment instruments targeting paediatric medical anxiety, there remains a notable paucity of rigorous methodological evaluation regarding their psychometric properties and clinical utility. This systematic review aims to bridge the existing gap between theoretical frameworks and clinical application by conducting a comprehensive evaluation of measurement properties of instruments designed to assess children’s medical fear, with particular attention to their reliability, validity and clinical applicability across diverse patient populations and healthcare settings.

This study protocol has been developed in strict accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines, ensuring methodological rigour and transparency. A comprehensive search of literature will be conducted across four English databases (PubMed, Web of Science, CINAHL via EBSCOhost and PsycINFO via ProQuest) and three Chinese databases (China National Knowledge Infrastructure, WanFang Data and SinoMed) from inception to 30 September 2025. The systematic review will incorporate comprehensive evaluation of measurement instruments assessing children’s medical fear across multiple modalities, including self-report measures, observer-rated scales, behavioural observation protocols and semi-structured clinical interviews. The psychometric evaluation framework will encompass five critical domains: reliability, validity, responsiveness to clinical change, interpretability of scores and clinical utility in diverse healthcare settings. We will include primary quantitative studies published in English or Chinese.

Ethics approval will not be required. The results of this systematic review will be submitted for publication in a peer-reviewed journal.

CRD420250656564.

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.

Delayed antibiotic prescribing (DAP) has demonstrated efficacy in reducing inappropriate antibiotic use for uncomplicated respiratory tract infections (uRTIs) in primary care across high-income countries. However, evidence regarding its effectiveness in low-income and middle-income countries remains limited. This cluster-randomised controlled trial (cRCT) aims to evaluate the effectiveness of DAP for optimising antibiotic use in primary healthcare institutions (PHIs) in China.

We designed a pragmatic, multicentre, open-label, three-arm cRCT in adult patients with uRTIs. The study will involve 12 PHIs in Korla City of China. Participating institutions will be randomised at a 1:1:1 ratio to three parallel arms: (1) DAP-intervention arm, (2) Immediate antibiotic prescribing comparator arm and (3) Usual care (observational arm). The primary outcome is symptom duration. Secondary outcomes include symptom severity, antibiotic use, adverse events, patient satisfaction and patient belief regarding antibiotic efficacy.

Ethics committee approval of this study was obtained from Peking University Institution Review Board (IRB00001052-24169). The findings will be disseminated through peer-reviewed publications and presentations at scientific conferences.

ChiCTR2500097330.

To construct a nursing diagnosis index system for burn patients under prolonged field care (PFC).

A modified Delphi study.

13 class A tertiary hospitals and 2 universities.

Nine experts were selected for expert interview: (1) bachelor’s degree or higher; (2) ≥10 years’ experience in burn care, nursing quality management or health service management, including participation in ≥3 PFC operations; (3) intermediate or higher professional title; (4) willingness to participate. 22 experts were selected for expert consultation: (1) bachelor’s degree or higher; (2) ≥3 years’ nurse management experience with theoretical expertise in burn nursing diagnosis; participation in ≥3 major non-combat military operations; (3) intermediate or higher professional title; (4) commitment to complete consultations.

Including a two-stage process: (1) system construction: developed a preliminary index system using The North American Nursing Diagnosis Association international’s framework, guided by US military ‘10 PFC Core Competencies’ and UK military SHEEP VOMIT standards, via literature analysis and expert interviews. (2) Delphi refinement: conducted three Delphi rounds with 22 experts. Finalised indicators using Analytical Hierarchy Process to assign weights.

The burn PFC nursing diagnosis index system established in this study comprises 7 primary indicators, 18 secondary indicators and 44 tertiary indicators. The valid questionnaire response rate for the expert consultation reached 100%, with an expert authority coefficient of 0.85. After three rounds of the Delphi expert consultation, Kendall’s coefficient of concordance (Kendall’s W) for indicators at all levels ranged from 0.104 to 0.305 (p

This systematic, scientific and rational index system provides a foundation for standardising burn PFC nursing plans, potentially enhancing care quality and efficiency in PFC settings.

This quasi-experimental study aimed to evaluate the impact of a flipped classroom (FC) combined with case-based learning (CBL) on the academic performance of first-year clinical medicine students in a human anatomy course in China, with a specific focus on higher-order cognitive skills and self-efficacy.

A quasi-experimental design was implemented, with participants randomly assigned to an intervention group (flipped classroom case learning (FCCL), n=64) or a control group (traditional lecture-based instruction, n=64). Learning outcomes and cognitive levels were compared between the two groups.

The study was conducted at a medical school in Meizhou, China, over an 18-week period. The curriculum covered the anatomy of nine major organ systems (excluding the nervous system).

A total of 128 first-year clinical medicine students participated. The FCCL group (63.5% male) had a mean age of 19.13±1.351 years, and the traditional group (67.1% male) had a mean age of 19.33±1.481 years. No significant differences were found in gender (p=0.580) or age (p=0.414) between the groups.

The FCCL group engaged in pre-class activities via the ChaoXing platform, which included instructional videos, key concept outlines and clinical cases. In-class sessions were dedicated to group discussions, specimen practice and case analysis. The control group received traditional PowerPoint-based lectures and completed post-class assignments. Both groups were taught by the same instructors, shared identical learning objectives and used the same laboratory materials.

Outcomes included scores on a theoretical examination (TCE) and a laboratory examination (LCE), both designed based on Bloom’s taxonomy; responses on a self-efficacy questionnaire (incorporating Likert-scale and open-ended items); and qualitative analysis of reflective journals from the FCCL group.

No significant difference was observed in TCE scores between the FCCL and traditional groups (59.52%±15.67% vs 55.5%±14.31%, p=0.136). However, the FCCL group scored significantly higher on the LCE (65.94%±13.71% vs 57.27%±16.95%, p=0.004). Furthermore, the intervention group demonstrated superior performance on higher-order cognitive questions (application-type: +8%, p=0.036; analysis-type: +11%, p=0.009). Questionnaire results indicated that the FCCL approach enhanced students’ learning motivation, critical thinking and collaborative skills (mean Likert scores >4.5).

The integration of FC with CBL effectively enhanced medical students’ higher-order cognitive abilities in anatomy, particularly in practical application and analytical skills, although its effect on the short-term retention of theoretical knowledge was limited. This approach offers a viable pathway for reforming anatomy education, though future studies with larger samples and longer follow-up are warranted.