元界

危重症患者中谵妄的高患病率及其不良影响使得更深入地理解其机制成为必要。本综述探讨全身性炎症与谵妄之间的关键相互作用，研究年龄、疼痛和手术等损伤性刺激如何通过小胶质细胞活化和血脑屏障破坏来协调神经炎症与谵妄。我们的综合分析识别出一系列具有预后价值的炎症和神经元损伤生物标志物，并评估了迅速发展的抗炎药物治疗领域。…

The high prevalence and adverse impact of delirium in critically ill patients necessitate a deeper understanding of its mechanisms. This review explores the pivotal interplay between systemic inflammation and delirium, examining how insults like age, pain and surgery orchestrate neuroinflammation and delirium through microglial activation and blood-brain barrier disruption. Our synthesis identifies a spectrum of inflammatory and neuronal injury biomarkers with prognostic value and evaluates the burgeoning field of anti-inflammatory pharmacotherapy.…

目的：我们评估了在患有2型糖尿病（T2DM）和代谢功能障碍相关脂肪性肝病（MASLD）的亚洲成年人中，在可比较的基础降糖治疗基础上加用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂、胰高血糖素样肽-1受体激动剂（GLP-1RAs）或吡格列酮的增量肝脏和代谢效应。方法：我们系统检索了截至2026年6月30日的PubMed、Embase、Cochrane图书馆和Web of Science。两名评审员独立筛选研究、提取数据并评估偏倚风险。…

OBJECTIVE: We evaluated the incremental hepatic and metabolic effects of adding sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), or pioglitazone to comparable background glucose-lowering therapy in Asian adults with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: We systematically searched PubMed, Embase, the Cochrane Library, and Web of Science through 30 June 2026. Two reviewers independently screened studies, extracted data, and assessed risk of bias.…

动机：人工智能（AI）正在通过机器学习、深度学习和生成式人工智能的进展重塑放射学。随着这些技术融入诊断工作流程，放射学教育必须进行调整，以使学习者准备好迎接人工智能赋能的临床实践。本综述旨在综合现有证据，确定教育优先事项，并强调实施过程中的挑战与机遇。

MOTIVATION: Artificial intelligence (AI) is reshaping radiology through advances in machine learning, deep learning, and generative AI. As these technologies become embedded in diagnostic workflows, radiology education must adapt to prepare learners for AI-enabled clinical practice. This review aimed to synthesize current evidence, identify educational priorities, and highlight challenges and opportunities for implementation.…

在这项II期试验中，子宫内膜癌（EC）患者被随机分配接受依维莫司/来曲唑联合瑞博西尼（试验组）或不联合瑞博西尼（对照组）治疗（ClinicalTrials.gov 注册号：NCT03008408）。主要终点是无进展生存期（PFS）。次要终点包括毒性、总生存期（OS）、客观缓解率（ORR）和临床获益率（CBR）。……

In this phase II trial, patients with endometrial cancer (EC) were randomized to everolimus/letrozole with (experimental arm) or without ribociclib (control arm) (ClinicalTrials.gov Identifier: NCT03008408). The primary endpoint was progression-free survival (PFS). Secondary endpoints included toxicity, overall survival (OS), objective response rate (ORR), and clinical benefit rate (CBR).…

背景：慢性肾脏病（CKD）在全球范围内是一个重大的健康问题，具有高发病率、高死亡率以及进展为终末期肾脏病（ESKD）的风险。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是一类具有潜在心肾获益的创新药物。我们开展了一项荟萃分析以评估其在慢性肾脏病管理中的疗效。方法：我们的荟萃分析按照荟萃分析首选报告条目（PRISMA）指南进行，并已在PROSPERO注册（CRD420261362785）。……

BACKGROUND: Chronic kidney disease (CKD) represents a significant health problem worldwide with high morbidity, mortality, and development of end-stage kidney disease (ESKD). Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent an innovative class of medications with possible cardiorenal advantages. We conducted a Meta-analysis to assess their efficacy in CKD management. METHODS: Our Meta-analysis was performed using the Preferred Reporting Items for Meta-analyses (PRISMA) guidelines and is registered in PROSPERO (CRD420261362785).…

背景/目标：人工智能工具已成为系统评价和卫生技术评估（HTA）有前景的方法学支持。智能输注泵互操作性因其对用药安全、护理工作流程和医院质量改进的影响，是一项相关的案例研究。目的是以智能输注泵与电子健康记录互操作性的证据综合为案例，评估人工智能作为方法学支持工具在整个系统评价中的表现。……

BACKGROUND/OBJECTIVES: Artificial intelligence tools have emerged as promising methodological support for systematic reviews and health technology assessment (HTA). Smart infusion pump interoperability represents a relevant case study due to its implications for medication safety, nursing workflow, and hospital quality improvement. The aim was to evaluate the performance of artificial intelligence as a methodological support tool across a systematic review, using the evidence synthesis on smart infusion pump-electronic health record interoperability as a case study.…

新英格兰医学杂志，第395卷，第14期，第1363-1373页，2026年10月8日。

New England Journal of Medicine, Volume 395, Issue 14, Page 1363-1373, October 8, 2026.

《新英格兰医学杂志》，第395卷，第16期，第1575-1584页，2026年10月22日。

New England Journal of Medicine, Volume 395, Issue 16, Page 1575-1584, October 22, 2026.

BACKGROUND: Optimization of renal drug dosing to avoid drug toxicity is essential in Chronic Kidney Disease (CKD), yet prescribing errors are common. CDSS with rule-based and AI/ML based tools are used to address this safety gap; however, their impact remains uncertain. METHODS: We performed a PRISMA-guided systematic review and meta-analysis of RCTs comparing rule-based or AI/ML CDSS with usual care comparators among adults with CKD or at risk of CKD-related prescribing errors.…

《新英格兰医学杂志》，第395卷，第16期，第1600-1609页，2026年10月22日。

New England Journal of Medicine, Volume 395, Issue 16, Page 1600-1609, October 22, 2026.

背景：在肺栓塞患者中，鞍状栓塞被认为与疾病严重程度相关。尽管在急性中高危肺栓塞患者中经常观察到，但其预后意义仍不明确。目的：在本研究中，我们评估了该风险亚组中鞍状栓塞与短期不良结局之间的关联。…

BACKGROUND: In patients with pulmonary embolism, a saddle-shaped embolus is perceived to be associated with disease severity. Although frequently observed in patients with acute intermediate-high-risk pulmonary embolism, its prognostic significance remains unclear. OBJECTIVES: In this study, we assessed the association between saddle embolism and short-term adverse outcomes in this risk subgroup.…

HER2阳性伴肝转移的晚期乳腺癌（BCLM）患者预后不良。RC48-C006研究是一项前瞻性、开放标签、多中心、随机2/3期试验（ClinicalTrials.gov注册号，NCT03500380）。基于2期结果，启动了3期阶段，以评估维迪西妥单抗（DV）对比拉帕替尼联合卡培他滨（L + C）用于既往接受过曲妥珠单抗和紫杉类药物治疗的HER2阳性BCLM患者。本文报告3期阶段的结果。

Patients with HER2-positive advanced breast cancer with liver metastases (BCLM) have poor prognosis. Study RC48-C006 is a prospective, open-label, multi-center, randomized phase 2/3 trial (ClinicalTrials.gov identifier, NCT03500380). Based on the phase 2 results, the phase 3 stage was initiated to evaluate disitamab vedotin (DV) versus lapatinib plus capecitabine (L + C) in patients with HER2-positive BCLM who were previously treated with trastuzumab and taxanes. The results from the phase 3 stage are reported in this article.…

背景：体弱使老年心房颤动（AF）患者的抗凝管理复杂化，尤其是在已长期使用维生素K拮抗剂（VKA）治疗的情况下。在此类情况下，转换为直接口服抗凝药（DOAC）是否能改善结局仍不确定，指南推荐也有限。我们开展了一项系统评价和荟萃分析，比较体弱老年AF患者中由VKA转换为DOAC与继续使用VKA的结局。

Background: Frailty complicates anticoagulation management in older patients with atrial fibrillation (AF), particularly when long-term vitamin K antagonist (VKA) therapy is already established. Whether switching to a direct oral anticoagulant (DOAC) improves outcomes in this setting remains uncertain, and guideline recommendations are limited. We performed a systematic review and meta-analysis comparing outcomes of VKA-to-DOAC switching versus VKA continuation in frail elderly patients with AF.…

背景：感染性胰腺坏死（IPN）是急性胰腺炎（AP）最严重的局部并发症之一，并在导致AP相关死亡中起核心作用。降钙素原（PCT）是一种优先对细菌感染产生反应的血清生物标志物，在理论上具有区分感染性与无菌性坏死的潜力。然而，此前的系统评价受限于样本量小、亚组分析浅显以及缺乏正式的证据分级。目前尚缺少以IPN作为临床终点进行专门更新的综合研究。…

BACKGROUND: Infected pancreatic necrosis (IPN) ranks among the most severe local complications of acute pancreatitis (AP) and plays a central role in driving AP-related death. Procalcitonin (PCT), a serum biomarker that responds preferentially to bacterial infection, has theoretical promise for differentiating infected from sterile necrosis. Earlier systematic reviews, though, are limited by small sample sizes, shallow subgroup analysis, and a lack of formal evidence grading. An updated synthesis that focuses specifically on IPN as the clinical endpoint is missing.…

本研究旨在评估混合闭环系统对年龄<7岁的1型糖尿病儿童血糖控制的临床有效性和安全性。通过电子检索PubMed、Cochrane Library、Embase和Web of Science数据库中截至2025年7月30日发表的相关研究。两名研究者独立筛选文献、提取有效数据并评估纳入研究的偏倚风险，采用RevMan 5.4软件进行荟萃分析。共纳入3项随机对照试验，涉及274名儿童。…

This study aimed to evaluate the clinical efficacy and safety of hybrid closed-loop systems for glycemic control in children aged < 7 years with Type 1 diabetes. Relevant studies published up to July 30, 2025 were electronically retrieved from the PubMed, Cochrane Library, Embase, and Web of Science databases. Two investigators independently screened the literature, extracted valid data, and assessed the risk of bias of included studies, with a meta-analysis conducted via RevMan 5.4 software. Three randomized controlled trials, with 274 children enrolled, were incorporated into the analysis.…

通过荟萃分析，探讨细胞毒性T淋巴细胞相关抗原4（CTLA-4）+49A/G 位点单核苷酸多态性（SNP）与儿童哮喘风险之间的关联。检索了六个数据库，以获取关于 CTLA-4 +49A/G 位点多态性与儿童哮喘关联的文献。检索时间为各数据库建库至 2024 年 7 月。应用 Stata 15.0 软件，计算合并比值比（OR）和 95% 置信区间（CI）。分析了五种遗传模型（G/A、GA+AA/AA、G/GA+AA、GG/AA 和 GA/AA）。…

To investigate the association between single nucleotide polymorphism (SNP) of cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) +49A/G locus and the risk of asthma in children by meta-analysis. Six databases were searched for records on the association between CTLA-4 +49A/G locus polymorphism and pediatric asthma. The retrieval time was from the establishment of each database to July 2024. Stata 15.0 software was applied, with the pooled OR and 95% CI calculated. Five genetic models (G/A, GA+AA/AA, G/GA+AA, GG/AA, and GA/AA) were analyzed.…

病态肥胖患者合并抑郁和焦虑症状的风险较高。虽然减重手术是一种有效的治疗方法，但传统的基于阿片类药物的麻醉具有显著的围手术期风险。无阿片麻醉（OFA）提供了一种更安全的替代方案。艾司氯胺酮以其双重镇痛和快速抗抑郁作用而闻名，是OFA中一个有前景的组成部分。然而，支持其在减重手术患者中同时促进身体和心理恢复的临床证据仍然有限。…

Patients with morbid obesity are at a high risk of comorbid depressive and anxiety symptoms. While bariatric surgery is an effective treatment, conventional opioid-based anesthesia carries significant perioperative risks. Opioid-free anesthesia (OFA) presents a safer alternative. Esketamine, known for its dual analgesic and rapid antidepressant effects, is a promising component of OFA. However, clinical evidence supporting its simultaneous benefits for both physical and psychological recovery in bariatric patients remains limited.…

背景：妊娠期使用他汀类药物的安全性仍存在争议。我们旨在评估亚洲女性产前他汀类药物暴露与妊娠结局之间的关联，包括低出生体重、早产和先天性异常。方法：我们按照PRISMA规范对评估亚洲人群产前他汀类药物暴露的研究进行了系统综述和荟萃分析。检索了PubMed、Embase、Cochrane图书馆、Web of Science和试验注册库，检索截止日期为2026年1月31日。…

BACKGROUND: The safety of statin use during pregnancy remains controversial. We aimed to evaluate the association between prenatal statin exposure and pregnancy outcomes in Asian women, including low birth weight, preterm birth, and congenital anomalies. METHODS: We conducted a PRISMA-compliant systematic review and meta-analysis of studies in Asian populations evaluating prenatal statin exposure. PubMed, Embase, the Cochrane Library, Web of Science, and trial registries were searched through January 31, 2026.…

背景：闭孔神经阻滞（ONB）常用于在涉及侧壁病变的经尿道膀胱肿瘤切除术（TURBT）中预防内收肌痉挛。本研究旨在比较超声引导下耻骨肌下（近端）与筋膜间（远端）ONB技术的临床有效性和安全性，并采用根据靶筋膜间室调整的解剖学定制给药方案。方法：这项前瞻性随机对照试验纳入了60例计划在蛛网膜下腔麻醉下择期行TURBT的患者。…

BACKGROUND: Obturator nerve block (ONB) is commonly used to prevent adductor muscle spasm during transurethral resection of bladder tumors (TURBT) involving lateral wall lesions. This study aimed to compare the clinical effectiveness and safety of ultrasound-guided subpectineal (proximal) and interfascial (distal) ONB techniques, utilizing an anatomically tailored dosing regimen adapted to the targeted fascial compartments. METHODS: This prospective randomized controlled trial included 60 patients scheduled for elective TURBT under spinal anesthesia.…

背景：人工智能（AI）在提高牙科X线片上邻面龋的检测方面已显示出前景；然而，其在提升本科生独立影像判读能力方面的教育价值仍不清楚。因此，本研究旨在评估与常规放射学培训相比，AI辅助放射学培训对口腔医学本科生评估邻面龋扩展范围诊断能力的影响。方法：本项随机实验研究纳入了82名口腔医学本科生。…

BACKGROUND: Artificial intelligence (AI) has shown promise in improving the detection of proximal caries on dental radiographs; however, its educational value in enhancing undergraduate students' independent radiographic interpretation remains unclear. Therefore, this study aimed to evaluate the effect of AI-assisted radiology training on undergraduate dental students' diagnostic competence in assessing proximal caries extension when compared with conventional radiology training. METHODS: This randomized experimental study included 82 undergraduate dental students.…