神经调控正逐渐成为一种有前景的辅助治疗策略，用于处理新发难治性癫痫持续状态（NORSE）和发热感染相关癫痫综合征（FIRES）；这些疾病具有高发病率、频繁治疗抵抗以及发生慢性癫痫的显著风险等特点。
Neuromodulation is emerging as a promising adjunctive strategy for the management of new-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES), conditions characterized by high morbidity, frequent treatment resistance, and a substantial risk of chronic epilepsy.…
研究设计：系统综述与汇总分析。目的：评估胸腰椎损伤分类与严重程度评分（TLICS）推荐意见与胸腰椎创伤实际治疗决策之间的一致性。背景数据摘要：TLICS被广泛用于指导胸腰椎骨折的治疗，对评分≤3分推荐非手术治疗，对评分≥5分推荐手术干预。…
STUDY DESIGN: Systematic review and pooled analysis. OBJECTIVE: To evaluate the concordance between Thoracolumbar Injury Classification and Severity Score (TLICS) recommendations and actual treatment decisions in thoracolumbar trauma. SUMMARY OF BACKGROUND DATA: TLICS is widely used to guide management of thoracolumbar fractures, recommending nonoperative treatment for scores ≤3 and operative intervention for scores ≥5.…
《新英格兰医学杂志》，第395卷第15期，第1471-1482页，2026年10月15日。
New England Journal of Medicine, Volume 395, Issue 15, Page 1471-1482, October 15, 2026.
《新英格兰医学杂志》，第395卷第14期，第1387-1398页，2026年10月8日。
New England Journal of Medicine, Volume 395, Issue 14, Page 1387-1398, October 8, 2026.
背景：费城染色体阳性急性淋巴细胞白血病（Ph阳性 ALL）的疗效已通过使用酪氨酸激酶抑制剂和免疫治疗得到大幅改善。方法：在本试验中，我们将成人Ph阳性 ALL患者按2:1比例随机分配，分别接受帕纳替尼联合博纳吐单抗（干预组）或伊马替尼联合化疗（对照组）作为一线治疗。对照组中持续存在或再次出现可测量残留病的患者允许交叉至干预组。…
BACKGROUND: The outcome of Philadelphia-positive acute lymphoblastic leukemia (Ph-positive ALL) has greatly improved with the use of tyrosine kinase inhibitors and immunotherapy. METHODS: In this trial, we randomly assigned adult patients with Ph-positive ALL in a 2:1 ratio to receive ponatinib plus blinatumomab (intervention group) or imatinib plus chemotherapy (control group) as frontline treatment. A crossover to the intervention group was allowed for patients with persistence or reappearance of measurable residual disease in the control group.…
背景：在东部和南部非洲，约100万人类免疫缺陷病毒（HIV）感染者正在接受口服治疗，但由于依从性挑战而未实现病毒抑制。方法：我们开展了一项3b期、开放标签、随机试验，比较长效注射用卡博特韦加利匹韦林与口服多替拉韦为基础的治疗，对象为病毒载量低于200拷贝/毫升且依从性欠佳或护理参与度不足的HIV-1型病毒抑制成人。…
BACKGROUND: In eastern and southern Africa, approximately 1 million people living with human immunodeficiency virus (HIV) and receiving oral therapy do not have viral suppression because of adherence challenges. METHODS: We conducted a phase 3b, open-label, randomized trial to compare long-acting injectable cabotegravir plus rilpivirine with oral dolutegravir-based therapy among adults with virally suppressed HIV type 1 (viral load, <200 copies per milliliter) and suboptimal adherence or care engagement.…
质子治疗相比光子放疗具有独特的物理优势，通过布拉格峰将剂量集中于靶区，同时具有更低的积分剂量和有限的路径长度，以及比光子更锐利的半影，从而总体减少对周围正常组织的辐射暴露，并可能提高治疗比。然而，这一优势受到不确定性的影响，包括射程不确定性和可变的相对生物有效性。……
Proton therapy offers a distinct physical advantage over photon radiotherapy through the Bragg peak dose concentration in target with both lower integral dose and finite path length, and sharper penumbra as compared to photons, collectively reducing radiation exposure to surrounding normal tissues and potentially improving the therapeutic ratio. However, this advantage is tempered by uncertainties, including range uncertainty and variable relative biological effectiveness.…
风湿性多肌痛（PMR）是老年人中常见的炎症性风湿性疾病。糖皮质激素（GCs）仍是治疗的基石，但许多风湿性多肌痛患者在减量期间复发，并因长期糖皮质激素治疗而面临相关毒性风险。因此，需要基于证据的策略来优化疾病控制，同时最大限度地减少糖皮质激素相关损害。…
Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic condition in older adults. Glucocorticoids (GCs) remain the cornerstone of treatment, but many people with PMR relapse during tapering and are exposed to prolonged GC therapy with associated toxicity. There is therefore a need for evidence-based strategies that optimize disease control while minimizing GC-related harm.…
目标：耳鸣是在没有外部声源的情况下感知到声音。美国有超过5000万人报告曾经历过耳鸣，导致成人患病率估计为10%至15%。本指南的重点是既令人烦恼又持续存在（持续6个月或更长时间）的耳鸣，这常常对患者的生活质量产生负面影响。本指南的目标受众是任何参与管理耳鸣患者的临床医生，包括专职医疗人员。…
OBJECTIVE: Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including allied health professionals, involved in managing patients with tinnitus.…
基于T细胞的免疫疗法在血液系统恶性肿瘤中已取得显著成功，但在实体瘤中仍然受限。自然杀伤（NK）细胞能够独立于新抗原呈递和MHC I类表达识别并杀伤肿瘤细胞，因此提供了一种极具吸引力的互补方法。本研究整合多组学分析、临床试验数据和转录组学分析，以系统性地识别最有可能从基于NK细胞的疗法中获益的实体瘤适应症。…
T cell-based immunotherapies have achieved remarkable success in hematological malignancies but remain limited in solid tumors. Natural killer (NK) cells offer a compelling complementary approach, given their ability to recognize and kill tumor cells independently of neoantigen presentation and MHC class I expression. This study integrates multiomic analyses, clinical trial data, and transcriptomic analyses to systematically identify solid tumor indications most likely to benefit from NK cell-based therapies.…
目的：本“2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM非心脏手术围术期心血管管理指南”提供建议，以指导临床医生对接受非心脏手术的成年患者进行围术期心血管评估和管理。……
AIM: The "2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery.…
背景：自主循环恢复（ROSC）后的最佳氧合仍不确定，因为低氧血症和高氧血症都有继发性损伤风险。我们进行了一项更新的系统评价和荟萃分析，比较限制性氧疗目标与较高氧疗目标的疗效。方法：遵循PRISMA 2020方案，从数据库建库至2026年6月进行了系统评价和荟萃分析。仅纳入评估限制性氧疗与较高氧疗对接受有创机械通气的成人心脏骤停患者影响的随机对照试验。…
BACKGROUND: Optimal oxygenation following return of spontaneous circulation (ROSC) remains uncertain, as both hypoxemia and hyperoxemia risk secondary injury. We conducted an updated systematic review and meta-analysis comparing the efficacy of restrictive versus higher oxygenation targets. METHODS: A systematic review and meta-analysis following the PRISMA 2020 protocol was carried out from database inception through June 2026. Only RCTs examining the impact of restrictive oxygenation versus higher oxygenation for adult CA patients undergoing invasive mechanical ventilation were included.…
背景：需要更多证据来为息肉切除术后结肠镜监测间隔的建议提供依据。方法：在这项正在进行中的、在八个欧洲国家开展的非劣效性试验中，我们将高危腺瘤患者（定义为≥1个直径≥10 mm的腺瘤、伴有高级别异型增生或绒毛状生长，或3至10个任意类型的腺瘤）随机分配至在息肉切除术后5年或3年接受首次结肠镜检查；当前指南建议在3年时进行监测。3年组还在5年时接受了结肠镜检查。…
BACKGROUND: More evidence is needed to inform recommendations for intervals of colonoscopy surveillance after polyp removal. METHODS: In this ongoing noninferiority trial conducted in eight European countries, we randomly assigned patients with high-risk adenomas (defined as ≥1 adenoma with a diameter of ≥10 mm, high-grade dysplasia, or villous growth or 3 to 10 adenomas of any kind) to undergo a first colonoscopy at 5 years after polyp removal or at 3 years; surveillance at 3 years is currently recommended in guidelines. The 3-year group also underwent colonoscopy at 5 years.…
背景：经阴道自然腔道内镜手术（vNOTES）可避免腹部切口，越来越多地用于良性妇科手术，但其用于保留生育功能子宫肌瘤剔除术的证据仍有限。方法：我们检索了PubMed、MEDLINE、EMBASE和Scopus（2000年1月1日至2025年7月31日），纳入比较研究（vNOTES对比多孔或腹腔镜内镜单切口（LESS）子宫肌瘤剔除术）以及单臂vNOTES队列。两名 reviewers 独立筛选并提取数据。使用纽卡斯尔-渥太华（比较研究）和乔安娜·布里格斯研究所（JBI；病例系列）工具评估偏倚风险。…
BACKGROUND: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) avoids abdominal incisions and is increasingly used for benign gynecologic surgery, but evidence for fertility-sparing myomectomy remains limited. METHODS: We searched PubMed, MEDLINE, EMBASE and Scopus (January 1, 2000 - July 31, 2025) for comparative studies (vNOTES vs. multi-port or laparoendoscopic single-site [LESS] myomectomy) and single-arm vNOTES cohorts. Two reviewers screened/extracted data. Risk of bias was assessed using Newcastle-Ottawa (comparative) and Joanna Briggs Institute (JBI; case series).…
尿路感染（UTI）是婴幼儿中最常见的细菌感染之一，在发热婴儿中的患病率为7%。本临床实践指南（CPG）更新了2011年美国儿科学会（AAP）关于婴幼儿尿路感染诊断与管理的临床实践指南的相关文献和临床建议。……
Urinary tract infection (UTI) is one of the most common bacterial infections in infants and young children, with a prevalence of 7% in infants with fever. This clinical practice guideline (CPG) provides an update of the literature and clinical recommendations of the 2011 American Academy of Pediatrics (AAP) CPG on diagnosing and managing UTI in infants and children.…
背景：Giredestrant和everolimus分别靶向雌激素受体（ER）通路和磷脂酰肌醇3-激酶（PI3K）-蛋白激酶B（AKT）-哺乳动物雷帕霉素靶蛋白（mTOR）通路，这些通路与内分泌治疗耐药有关。方法：在这项3期、开放标签、随机试验中，我们纳入了接受细胞周期蛋白依赖性激酶4和6（CDK4/6）抑制剂联合内分泌治疗后发生疾病进展或复发的ER阳性、人表皮生长因子受体2（HER2）阴性局部晚期或转移性乳腺癌患者。……
BACKGROUND: Giredestrant and everolimus target the estrogen receptor (ER) pathway and the phosphatidylinositol 3-kinase (PI3K)-protein kinase B (AKT)-mammalian target of rapamycin (mTOR) pathway, respectively, which are implicated in endocrine-therapy resistance. METHODS: In this phase 3, open-label, randomized trial, we enrolled patients with ER-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer who had disease progression or recurrence after receipt of a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor plus endocrine therapy.…
背景：导致食物过敏的免疫反应可能在生命早期形成，可能早在引入固体食物之前。通过子宫内和母乳接触食物过敏原已被提议作为预防婴儿食物过敏的策略，但缺乏来自随机试验的证据。方法：在这项多中心随机试验中，未出生子女至少有两名经医学诊断患有过敏性疾病的生物学家庭成员孕妇有资格参加。…
BACKGROUND: Immune responses leading to food allergy may develop early in life, potentially before the introduction of solid foods. Exposures to food allergens in utero and through breast milk have been proposed as a strategy to prevent food allergies in infants, but evidence from randomized trials is lacking. METHODS: In this multisite, randomized trial, pregnant women whose unborn child had at least two biologic family members with medically diagnosed allergic disease were eligible to participate.…
背景：单独甲状腺内注射地塞米松（Dex）（单药治疗）或地塞米松联合利多卡因（联合治疗）已用于治疗亚急性甲状腺炎（SAT）。我们开展本研究旨在同时判断甲状腺内注射地塞米松是否优于口服泼尼松，以及联合治疗是否优于单药治疗。方法：我们检索了截至2021年12月31日PubMed、Embase、Cochrane图书馆、中国知网（CNKI）和万方数据库中的研究。…
BACKGROUND: Intrathyroidal injection of dexamethasone (Dex) alone (monotherapy) or combined Dex with lidocaine (combination therapy) has been used for treating subacute thyroiditis (SAT). We performed this study to simultaneously determine whether intrathyroidal injection of Dex was better than oral prednisone and whether combination therapy was superior to monotherapy. METHODS: We identified studies from PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), and Wanfang databases through December 31, 2021.…
引言：机器人辅助全膝关节置换术（RTKA）是传统全膝关节置换术（CTKA）的一种新兴替代方案，其有效性尚不确定。本系统评价与Meta分析旨在比较RTKA与CTKA的临床和影像学结局。方法：共纳入52项研究（随机对照试验和观察性队列研究）。比较的结局包括力线（髋-膝-踝角度、股骨/胫骨组件角度）、患者报告结局指标（PROMs）、手术时间、住院时间（LOS）、失血量及并发症。…
INTRODUCTION: Robotic-assisted total knee arthroplasty (RTKA) is an emerging alternative to conventional total knee arthroplasty (CTKA) with uncertain effectiveness. This systematic and meta-analysis aims to compare clinical and radiological outcomes between RTKA and CTKA. METHODS: 52 studies were included (randomised controlled trials and observational cohorts). Outcomes compared were alignment (Hip-Knee-Ankle angle, femoral/tibial component angles), Patient Reported Outcome Measures (PROMs), operative time, length of stay (LOS), blood loss, and complications.…
目的：评估正念干预在护士中的有效性。背景：护理实践本身所固有的繁重工作负荷和高情感投入使护士容易发生共情疲劳、职业倦怠和创伤性应激。方法：对主要英文和中文电子数据库进行了系统性文献检索。纳入标准仅限于检验正念干预对护士共情疲劳、职业倦怠或创伤性应激影响的随机对照试验。…
AIM: To evaluate the effectiveness of mindfulness-based interventions among nurses. BACKGROUND: The demanding workload and high emotional investment inherent in nursing practice render nurses vulnerable to compassion fatigue, job burnout, and traumatic stress. METHODS: A systematic literature search was conducted across major English and Chinese electronic databases. Eligibility criteria were restricted to randomized controlled trials examining the effects of mindfulness-based interventions on compassion fatigue, job burnout, or traumatic stress among nurses.…