元界

CONTEXT: Post-bariatric hypoglycemia (PBH), complicating up to 30% of Roux-en-Y (RYGB) and up to 10% of sleeve gastrectomy (SG) procedures, is characterized by recurrent severe postprandial hypoglycemia and neuroglycopenic events. Similar clinical presentations occur following total gastrectomy, esophagectomy, and Nissen fundoplication. All are characterized by postprandial hypersecretion of GLP-1. Avexitide, a first-in-class GLP-1 receptor antagonist, has shown promise in reducing hypoglycemia events in patients with PBH after RYGB.…

辅助生殖技术（ART）会增加子痫前期（PE）的风险，但目前尚无针对接受辅助生殖技术人群的特异性预测模型。本综述评估了将ART作为预测因子的预测模型，重点关注偏倚风险、性能、泛化性和临床适用性。截至2023年7月的MEDLINE系统检索确定了包含ART作为预测因子的子痫前期预测模型。排除标准包括子痫前期发生后的结局研究、单变量模型以及对既往已验证模型的验证研究。……

Assisted Reproductive Technology (ART) increases the risk of preeclampsia (PE), yet no specific prediction model tailored to the ART population exists. This review evaluates prediction models incorporating ART as a predictor, focusing on risk of bias, performance, generalizability and clinical applicability. A systematic MEDLINE search up to July 2023 identified models predicting PE that included ART as a predictor. Exclusion comprised studies on outcomes after PE onset, univariable models and validation studies of previously validated models.…

背景：接受直接口服抗凝药物（DOAC）的心房颤动（AF）患者发生胃肠（GI）黏膜损伤和出血的风险升高。质子泵抑制剂（PPI）是常规的胃保护剂，但其在下消化道的疗效有限。本研究评估了瑞巴派特单药治疗以及泮托拉唑-瑞巴派特（P+R）联合治疗与泮托拉唑单药治疗相比，在这一易感人群中的疗效和安全性。…

Background: Patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOAC) are at an elevated risk of gastrointestinal (GI) mucosal damage and bleeding. Proton pump inhibitors (PPI) are conventional gastroprotectors, but their efficacy in the lower GI tract is limited. This study evaluated the efficacy and safety of rebamipide monotherapy and combination pantoprazole-rebamipide (P + R) therapy compared to pantoprazole monotherapy in this vulnerable population.…

《新英格兰医学杂志》，第395卷，第16期，第1610-1620页，2026年10月22日。

New England Journal of Medicine, Volume 395, Issue 16, Page 1610-1620, October 22, 2026.

目的：本系统评价和荟萃分析旨在评估亚临床甲状腺功能减退（SCH）对患有多囊卵巢综合征（PCOS）的女性血清生殖激素水平的影响，包括促卵泡激素（FSH）、黄体生成素（LH）、雌二醇、催乳素和总睾酮，并为临床实践提供证据。方法：我们检索了PubMed、Web of Science、Embase和Cochrane Library，检索时间从建库至2026年4月25日，纳入相关观察性研究。使用纽卡斯尔-渥太华量表（NOS）评估研究质量。…

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effects of subclinical hypothyroidism (SCH) on serum levels of reproductive hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, and total testosterone, in women with polycystic ovary syndrome (PCOS) and to provide evidence for clinical practice. METHODS: We searched PubMed, Web of Science, Embase, and Cochrane Library from inception to 25 April 2026 for relevant observational studies. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).…

目的：评估与常规诊疗相比，在年龄≥65岁成年人中进行心房颤动（AF）机会性筛查是否能提高AF检出率和改善临床结局，并比较机会性和系统性筛查策略在AF检出率和临床结局方面的差异。方法：按照PRISMA 2020指南进行了系统评价。纳入评估在年龄≥65岁成年人中进行机会性或系统性AF筛查的随机对照试验和整群随机对照试验。…

OBJECTIVES: To evaluate whether opportunistic atrial fibrillation (AF) screening in adults aged ≥ 65 years improves AF detection and clinical outcomes compared with usual care, and to compare opportunistic and systematic screening strategies in terms of AF detection and clinical outcomes. METHODS: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Randomized and cluster-randomized controlled trials evaluating opportunistic or systematic AF screening in adults aged ≥ 65 years were included.…

BACKGROUND: Repurposing therapeutic treatments for diabetes may be a promising strategy for the treatment of neurodegenerative disorders. Intranasal insulin (INI) is shown to improve memory, attention, and cognition in Alzheimer's dementia. Associations between the etiology of Parkinson's Disease (PD), brain glucose hypometabolism, and central insulin resistance suggest INI as a promising treatment for PD. METHODS: A phase II single center, randomized, double-blind clinical trial was conducted in 30 participants with PD, aged 41-89, MoCA ≥ 16, on a stable dose of anti-PD medications.…

肌肉骨骼疾病涵盖一系列病理类型，如骨质疏松症、类风湿关节炎、骨关节炎和骨肉瘤，其特征为骨量、滑膜组织和软骨的退行性改变及异常增生。近年来，植物源性化合物在改善骨骼和肌肉老化方面显示出有前景的潜力。香豆素作为天然存在的植物化学物质，表现出多种药理特性，包括抗炎、抗病毒、抗氧化、抗肿瘤和免疫调节活性。…

Musculoskeletal diseases encompass a spectrum of pathologies such as osteoporosis, rheumatoid arthritis, osteoarthritis, and osteosarcoma, characterized by degenerative alterations and aberrant hyperplasia in bone mass, synovial tissue, and cartilage. Recently, botanical compounds have demonstrated promising potential in ameliorating skeletal and muscular aging. Coumarins, as naturally occurring phytochemicals, exhibit diverse pharmacological properties including anti-inflammatory, antiviral, antioxidant, antitumor, and immunomodulatory activities.…

目的：系统评价现有的危重症患者肠内喂养不耐受（EFI）风险预测模型，旨在为临床实践提供循证参考。方法：系统检索PubMed、Web of Science、Cochrane Library、中国知网（CNKI）、万方数据库、中国生物医学文献数据库（CBM）及维普数据库，检索时间为建库至2025年11月20日。纳入开发或验证成人危重症患者肠内喂养不耐受风险预测模型的研究。…

OBJECTIVE: To systematically evaluate existing risk prediction models for enteral feeding intolerance (EFI) in critically ill patients, with the aim of providing evidence-based references for clinical practice. METHODS: PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine Disc (CBM), and VIP Database were systematically searched from database inception to November 20, 2025. Studies that developed or validated risk prediction models for enteral feeding intolerance in adult critically ill patients were included.…

背景：红霉素、甲氧氯普胺及其联合用于危重症患者肠内营养的比较有效性和安全性仍不确定。本网络荟萃分析（NMA）综合了现有证据。方法：对七个电子数据库（Embase, PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP）从建库至2026年2月6日进行了系统检索，无语言限制。采用标准Cochrane方法进行文献选择、数据提取和偏倚风险评估。…

BACKGROUND: The comparative effectiveness and safety of erythromycin, metoclopramide, and their combination for enteral nutrition in critically ill patients remain uncertain. This network meta-analysis (NMA) synthesized available evidence. METHODS: A systematic search of seven electronic databases (Embase, PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP) from inception to February 6, 2026, was conducted with no language restrictions. Standard Cochrane methods were used for study selection, data extraction, and risk of bias assessment.…

背景：无创通气（NIV）是急性心力衰竭（AHF）相关呼吸衰竭推荐的一线呼吸支持方式。然而，其耐受性往往有限。高流量鼻导管（HFNC）已成为一种潜在的替代方案，但比较性证据仍不一致。本研究旨在评估HFNC与NIV在急性心力衰竭相关呼吸衰竭患者中的疗效和安全性。方法：我们遵循PRISMA指南进行了一项系统综述和荟萃分析。我们检索了四个主要电子数据库，检索时间从建库至2026年4月。……

BACKGROUND: Noninvasive ventilation (NIV) is the recommended first-line respiratory support for acute heart failure (AHF)-related respiratory failure. However, its tolerance is often limited. High-flow nasal cannula (HFNC) has emerged as a potential alternative, but comparative evidence remains inconsistent. This study aimed to evaluate the efficacy and safety of HFNC versus NIV in patients with AHF-related respiratory failure. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched four major electronic databases from inception to April 2026.…

目的：采用网络荟萃分析比较GLP-1RAs、SGLT2is和nsMRAs在2型糖尿病合并慢性肾脏病（T2D-CKD）中的心血管和肾脏获益及安全性。方法：系统检索截至2026年8月7日发表的随机对照试验（RCTs）。采用频率学派随机效应网络荟萃分析。使用CINeMA评估证据可信度。结果：共纳入21项RCT，涉及51,899例患者。…

OBJECTIVE: To compare cardiovascular and renal benefits and safety of GLP-1RAs, SGLT2is, and nsMRAs in T2D-CKD using network meta-analysis. METHODS: RCTs published through 7 August 2026 were systematically identified. A frequentist random-effects network meta-analysis was performed. Evidence certainty was assessed with CINeMA. RESULTS: A total of 21 RCTs involving 51,899 patients were included.…

前列腺癌是全球男性中第二常见的癌症。诊断技术的进步，尤其是多参数磁共振成像和前列腺影像报告与数据系统，提高了检测的精确性。然而，对于前列腺影像报告与数据系统评分为3-5分的病灶，最佳活检策略仍不确定。…

Prostate cancer is the second most common cancer in men globally. Advances in diagnostic techniques, particularly multiparametric magnetic resonance imaging and the Prostate Imaging Reporting and Data System, have enhanced detection precision. However, optimal biopsy strategies for lesions with Prostate Imaging Reporting and Data System scores of 3-5 remain uncertain.…

目的：分析含胺碘酮方案治疗胎儿快速性心律失常的疗效及胺碘酮的安全性。方法：检索PubMed、Web of Science、Medline和Embase。纳入关于基于胺碘酮治疗胎儿心动过速的疗效及胺碘酮相关安全性的随机对照试验、队列研究、病例系列和病例报告。病例报告单独呈列并进行描述性综合，病例系列和队列研究则纳入荟萃分析。…

OBJECTIVE: To analyze the efficacy of amiodarone-inclusive protocol and the safety of amiodarone in fetal tachyarrhythmia treatment. METHODS: PubMed, Web of Science, Medline and Embase were searched. Randomized controlled trials, cohort studies, case series and case reports on the efficacy of amiodarone-based therapy and the amiodarone-related safety in fetal tachycardia were included. Case reports were presented separately and descriptively synthesized, while case series and cohort studies were included in the meta-analysis.…

背景：社区获得性肺炎对儿童健康构成重大威胁。传统的呼吸康复因儿童认知能力有限而常存在依从性差的问题。本研究旨在评估基于趣味游戏的干预措施对肺炎儿童呼吸功能、运动能力和康复依从性的影响。方法：开展了一项单中心、双组、平行分组随机对照试验。…

BACKGROUND: Community-acquired pneumonia poses a significant threat to children's health. Traditional respiratory rehabilitation often suffers from poor adherence due to children's limited cognitive abilities. This study aimed to evaluate the effects of a fun game-based intervention on respiratory function, exercise capacity, and rehabilitation compliance in children with pneumonia. METHODS: A single-center, two-arm, parallel-group randomized controlled trial was conducted.…

背景：卒中后认知障碍（PSCI）是卒中后常见的并发症，显著影响患者的生活质量和长期预后。尽管PSCI已被广泛研究，但大多数研究将缺血性卒中和出血性卒中合并在一起。从文献计量学的角度来看，缺血性卒中特异性认知功能障碍（ISCD）背后的独特炎症机制和血管损伤是否遵循了一条独立的研究轨迹仍属未知。……

BACKGROUND: Post-Stroke Cognitive Impairment (PSCI) is a common complication after stroke, significantly affecting patients' quality of life and long-term prognosis. Although PSCI has been extensively studied, most research combines ischemic and hemorrhagic strokes. Whether the distinct inflammatory mechanisms and vascular injury underlying ischemic stroke-specific cognitive dysfunction (ISCD) have followed an independent research trajectory remains unknown from a bibliometric perspective.…

背景：免疫检查点抑制剂（ICIs）联合化疗已成为治疗早期和局部晚期三阴性乳腺癌（TNBC）的基石。然而，关于不同PD-1/PD-L1药物和治疗策略——尤其是仅新辅助治疗与围手术期“全程”治疗策略——的相对疗效和安全性的直接比较证据仍然有限。为指导临床决策，我们进行了一项贝叶斯网络荟萃分析（NMA），比较了六种特定的基于ICI的化疗方案和四种总体治疗策略。…

BACKGROUND: Immune checkpoint inhibitors (ICIs) combined with chemotherapy have become a cornerstone in managing early and locally advanced triple-negative breast cancer (TNBC). Yet direct comparative evidence on the relative efficacy and safety of different PD-1/PD-L1 agents and treatment strategies-particularly neoadjuvant-only versus perioperative, "full-course" approaches-remains limited. To guide clinical decision-making, we performed a Bayesian network meta-analysis (NMA) comparing six specific ICI-based regimens and four overarching treatment strategies.…

背景：有效的术后镇痛对心脏手术后的恢复至关重要。局部麻醉药（LAs）的连续伤口浸润（CWI）已被提议作为一种减少阿片类药物的辅助手段，但其在疼痛控制之外的疗效和安全性特征尚未完全明确。方法：我们开展了一项符合PRISMA的系统评价和荟萃分析，纳入比较成人心脏手术中CWI与对照组的随机对照试验（RCTs）。检索了PubMed、Embase和Cochrane CENTRAL数据库，时间从建库至2025年8月30日，并于2026年4月2日更新。…

BACKGROUND: Effective postoperative analgesia is critical to recovery after cardiac surgery. Continuous wound infiltration (CWI) with local anesthetics (LAs) has been proposed as an opioid-sparing adjunct, but its efficacy beyond pain control and its safety profile remain incompletely defined. METHODS: We conducted a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CWI with control in adult cardiac surgery. PubMed, Embase, and Cochrane CENTRAL were searched from inception to August 30, 2025, and updated on April 2, 2026.…

目的：维生素C在脓毒症或脓毒性休克患者中的辅助治疗价值仍存在争议。本研究旨在通过Meta分析评估静脉注射维生素C对脓毒症或脓毒性休克患者的治疗效果与安全性。方法：在PubMed、Embase和Scopus数据库及其他相关数据库中检索相关文献。主要结局指标为28天死亡率。……

OBJECTIVE: The adjunctive therapeutic value of vitamin C in sepsis or septic shock patients remains controversial. This study aimed to evaluate the therapeutic efficacy and safety of intravenous administration of vitamin C in sepsis or septic shock patients through meta-analysis. METHODS: Relevant literature was searched in PubMed, Embase, and Scopus databases and other related databases. The primary outcome was 28-day mortality.…

背景：精神障碍占全球疾病负担的相当大比例，许多人在获得适当照护方面经历显著延误。早期干预已成为改善整个精神卫生连续谱中临床、功能和经济结局的关键策略。尽管围绕早期干预的证据已很充分，但涵盖不同诊断、年龄组和服务环境的早期干预模型的更广泛综合仍有所缺乏。…

BACKGROUND: Mental health disorders account for a substantial global burden of disease, with many individuals experiencing significant delays in receiving appropriate care. Early intervention has emerged as a key strategy to improve clinical, functional, and economic outcomes across the mental health continuum. Although evidence surrounding early intervention is well established, a broader synthesis of early intervention models across diagnoses, age groups, and service settings has been lacking.…