元界

引言：检测代谢变化中的毒性模式是潜在威胁的关键指标。代谢组学可能为寻找药物过量和毒性生物标志物提供一种替代方法。在对乙酰氨基酚过量时，谷胱甘肽清除导致线粒体功能障碍和肝细胞死亡。代谢组学方法已使发现对乙酰氨基酚（APAP）过量所致肝损伤的新机制成为可能。方法：我们进行了一项同行评审的科学综述，以评估代谢组学在APAP中毒中应用的研究。…

INTRODUCTION: Detecting toxicity patterns in metabolic changes is a key indicator of potential threats. Metabolomics may provide an alternative way to find biomarkers for drug overdose and toxicity. In an acetaminophen overdose, glutathione scavenging causes mitochondrial malfunction and hepatocyte death. Metabolomics methods have enabled the discovery of novel mechanisms of liver injury in acetaminophen (APAP) overdose. METHODS: We conducted a peer-reviewed scientific review to assess the studies on the application of metabolomics in APAP poisoning.…

背景：无家可归与无家可归经历类型同全因及特定原因死亡率之间的关联尚不确定。方法：通过系统检索MEDLINE、Embase PsycINFO和Scopus，自建库至2024年12月收录已发表研究，并从开放获取数据档案中识别未发表数据。我们采用随机效应荟萃分析合并来自116项研究的已发表和未发表数据，共包含2 563 633名无家可归者和129 292 553名人群对照。……

BACKGROUND: The association between homelessness and the type of homeless experience with all-cause and cause-specific mortality is uncertain. METHODS: Published studies were retrieved through a systematic search of MEDLINE, Embase PsycINFO, and Scopus from inception to December 2024. Unpublished data were identified from open-access data archives. We used random-effects meta-analysis to combine the effect estimates from published and unpublished data from 116 studies comprising 2 563 633 homeless people and 129 292 553 population controls.…

长链脂肪酸氧化障碍（LC-FAOD）是线粒体β氧化的罕见遗传性缺陷，可损害禁食或代谢应激状态下的能量生成。临床表现从新生儿低酮性低血糖和心肌病，到肝病、复发性横纹肌溶解症和慢性肌病不等。尽管新生儿筛查（NBS）可实现早期检测，但由于证据有限、表型谱不断扩大以及地区实践差异，管理策略仍不一致。…

Long-chain fatty acid oxidation disorders (LC-FAOD) are rare inherited defects of mitochondrial β-oxidation that impair energy generation during fasting or metabolic stress. Clinical manifestations range from neonatal hypoketotic hypoglycemia and cardiomyopathy to hepatopathy, recurrent rhabdomyolysis, and chronic myopathy. Although newborn screening (NBS) enables early detection, management remains inconsistent due to limited evidence, broadening phenotypic spectrum, and regional practice variation.…

卡贝缩宫素是一种催产素受体激动剂，用于预防产后出血。虽然催产素已知会短暂延长QT/QTc间期，但关于卡贝缩宫素的可靠QTc数据有限。卡贝缩宫素已知会升高心率（HR），这可能影响QTc分析；因此，选择一种不会过度升高HR的剂量非常重要。这项随机、安慰剂和阳性对照试验评估了在45分钟内单次静脉输注超治疗剂量（650 μg）卡贝缩宫素对健康成人心脏复极的影响（N = 42）。……

Carbetocin is an oxytocin receptor agonist used for postpartum hemorrhage prevention. While oxytocin is known to transiently prolong the QT/QTc interval, robust QTc data for carbetocin are limited. Carbetocin is known to elevate HR, which can impact QTc analyses; thus, a dose that did not overly elevate HR was important to select. This randomized, placebo- and positive-controlled trial evaluated the effect of a single intravenous infusion of a supratherapeutic dose (650 μg) of carbetocin over 45 min on cardiac repolarization in healthy adults (N = 42).…

背景：法洛四联症（ToF）是最常见的发绀型先天性心脏病，发病率约为每3,500例活产中1例，占所有先天性心脏缺陷的7-10%。心脏外科和重症监护的进步使成年期生存率提高到超过85%，导致越来越多的接受修复手术的成人先天性心脏病患者，以及在资源有限环境中未接受治疗或既往未确诊的成人患者。在此背景下，专科护理在整个连续护理过程中发挥着关键作用。…

BACKGROUND: Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, with an incidence of approximately 1 in 3,500 live births, accounting for 7-10% of all congenital heart defects. Advances in cardiac surgery and intensive care have increased survival into adulthood to over 85%, resulting in a growing population of adults with repaired congenital heart disease and, in resource-limited settings, adults with untreated or previously undiagnosed disease. In this context, specialist nursing care plays a pivotal role throughout the continuum of care.…

背景：认知行为疗法（CBT）在解决癌症照护者的痛苦方面显示出前景，尽管结果不一。传统CBT可能无法完全解决照护者痛苦背后的跨诊断过程，如注意僵化和持续性思维。情绪调节疗法（ERT）是一种针对这些机制的当代CBT，对癌症照护者（ERT-C）具有前景。我们比较了ERT-C与照护者适应性CBT（CBT-C）在照护者和患者报告结局方面的效果。方法：我们进行了一项多中心随机对照试验（ERT-C vs.…）

BACKGROUND: Cognitive Behavioral Therapy (CBT) shows promise for addressing distress in cancer caregivers, though results are mixed. Traditional CBT may not fully address transdiagnostic processes underlying caregiver distress, such as attentional rigidity and perseverative thinking. Emotion Regulation Therapy (ERT), a contemporary CBT targeting these mechanisms, has promise for cancer caregivers (ERT-C). We compared ERT-C to caregiver-adapted CBT (CBT-C) on caregiver- and patient-reported outcomes. METHODS: We conducted a multisite RCT (ERT-C vs.…

背景：重症监护病房（ICU）中谵妄的患病率很高。为减少ICU患者的谵妄，已实施强化护理干预。目前有多种多样的强化护理干预可用于治疗谵妄。然而，最佳干预措施仍未知。本系统评价和网状Meta分析（NMA）旨在比较强化护理干预在谵妄患者中的疗效。方法：我们纳入了在ICU中对谵妄采用不同强化护理干预的随机对照试验。…

BACKGROUND: Delirium prevalence in the intensive care unit (ICU) is high. Intensive nursing interventions have been performed to reduce delirium in ICU patients. There is now a wide variety of intensive nursing interventions available for treating delirium. However, the optimal intervention remains unknown. This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of intensive nursing interventions in patients with delirium. METHODS: We included randomized controlled trials of different intensive nursing interventions for delirium in the ICU.…

背景：在急性冠脉综合征（ACS）患者中，超短程（≤1个月）双联抗血小板治疗（DAPT）后接续抗血小板单药治疗的疗效和安全性仍不明确。目的：本研究旨在比较接受经皮冠状动脉介入治疗（PCI）的ACS患者中，超短程与标准疗程DAPT的差异。方法：我们对截至2026年2月15日的随机对照试验进行了系统评价和荟萃分析。主要终点为主要不良心脑血管事件（MACCE）、大出血和净不良临床事件（NACE）。…

BACKGROUND: The efficacy and safety of ultrashort (≤1-month) dual antiplatelet therapy (DAPT) followed by antiplatelet monotherapy remain uncertain in acute coronary syndrome (ACS) patients. OBJECTIVES: This study sought to compare ultrashort vs standard-duration DAPT in patients with ACS undergoing percutaneous coronary intervention (PCI). METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials until February 15, 2026. Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), major bleeding, and net adverse clinical event (NACE).…

目的：本研究旨在评估短波透热疗法（SWD）联合高频胸壁振荡（HFCWO）与单独HFCWO及常规治疗相比，在因慢性阻塞性肺疾病急性加重（AECOPD）住院患者中的疗效和安全性。方法：这项单中心、平行组随机对照试验纳入了2024年3月至2025年3月期间收治于永康市第一人民医院的89例AECOPD患者。……

OBJECTIVE: This study aimed to evaluate the efficacy and safety of combining short-wave diathermy (SWD) with high-frequency chest wall oscillation (HFCWO) compared with HFCWO alone and routine treatment in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: This single-center, parallel-group randomized controlled trial enrolled 89 patients with AECOPD admitted to Yongkang First People's Hospital between March 2024 and March 2025.…

背景：血肿周围水肿（PHE）是脑出血（ICH）继发性脑损伤的影像学标志物。强化降压是否能减轻血肿周围水肿的扩大仍不确定。我们开展了一项系统评价和荟萃分析，以评估强化降压对自发性脑出血患者约24小时血肿周围水肿扩大的影响。方法：检索了MEDLINE、Embase和Cochrane图书馆，检索时间从建库至2026年1月。…

BACKGROUND: Perihematomal edema (PHE) is a radiological marker of intracerebral hemorrhage (ICH)-induced secondary brain injury. Whether intensive blood pressure (BP) reduction attenuates PHE expansion remains uncertain. We conducted a systematic review and meta-analysis to assess the effect of intensive BP reduction on approximately 24-h PHE expansion in patients with spontaneous ICH. METHODS: MEDLINE, Embase, and the Cochrane Library were searched from database inception to January 2026.…

背景：据我们所知，既往尚无系统评价对当前研究所纳入的广泛心血管和心脏代谢疾病中的癌症患病率进行全面量化。我们旨在估算冠状动脉疾病（CAD）、心力衰竭（HF）、心房颤动（AF）、高血压、2型糖尿病（DM）、卒中、外周动脉疾病（PAD）和心脏瓣膜病（VHD）患者中活动性癌症（主要结局）和其他癌症类别的合并患病率。……

BACKGROUND: To the best of our knowledge, no previous systematic review has comprehensively quantified cancer prevalence across the broad spectrum of cardiovascular and cardiometabolic conditions included in the present study. We aimed to estimate pooled prevalence of active cancer (primary outcome) and other cancer categories among patients with coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), hypertension, Type 2 diabetes mellitus (DM), stroke, peripheral artery disease (PAD), and valvular heart disease (VHD).…

BACKGROUND: Blinatumomab, a bispecific T-cell engager targeting the CD19 antigen on B cells, may offer an option to safely replace cycles of traditional chemotherapy in pediatric patients with newly diagnosed high-risk B-cell acute lymphoblastic leukemia (ALL). METHODS: We randomly assigned, in a 1:1 ratio, children with high-risk B-cell ALL to receive two cycles of blinatumomab (blinatumomab group) or two cycles of chemotherapy (control group) after consolidation.…

背景：CD38单克隆抗体的补体依赖性细胞毒性（CDC）与输注相关反应有关，并可能降低依赖CDC的CD38抗体的临床疗效，尤其是在伴有1q21+的复发或难治性多发性骨髓瘤患者中。我们旨在评估felzartamab——一种新型抗CD38单克隆抗体，其保留强效的抗体依赖性细胞介导的细胞毒性（ADCC）和抗体依赖性细胞吞噬作用（ADCP），同时在复发或难治性多发性骨髓瘤的中国患者中表现出显著减弱的CDC活性。……

BACKGROUND: Complement-dependent cytotoxicity (CDC) of CD38 monoclonal antibodies has been associated with infusion-related reactions and might contribute to reduced clinical efficacy of CDC-reliant CD38 antibodies, particularly in patients with relapsed or refractory multiple myeloma with 1q21+. We aimed to evaluate felzartamab, a novel anti-CD38 monoclonal antibody that retains potent antibody-dependent cellular cytotoxicity and antibody-dependent cellular phagocytosis while exhibiting markedly attenuated CDC activity in Chinese patients with relapsed or refractory multiple myeloma.…

背景：脑出血（ICH）是一种严重的卒中类型，与高发病率和高死亡率相关。虽然手术清除旨在减轻血肿负荷并改善预后，但其相对于药物治疗的临床获益仍不确切。既往系统评价已评估了多种手术治疗脑出血的干预措施；然而，针对微创手术（MIS）的特异性证据仍不够明确。……

BACKGROUND: Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high morbidity and mortality. While surgical evacuation aims to reduce hematoma burden and improve outcomes, its clinical benefit over medical management remains uncertain. Previous systematic reviews have evaluated a broad range of surgical interventions for ICH; however, evidence specific to MIS remains less clearly defined.…

背景：急诊科（ED）日益服务于语言多样化的患者群体。专业口译服务可改善医疗质量，但其使用情况仍存在差异。量化使用率并了解差异可为政策制定和干预措施提供依据。我们进行了一项系统综述与荟萃分析，以估算英语国家急诊科中专业口译员的使用率，并比较不同患者群体和国家之间的使用情况。方法：检索了从建库至2025年5月15日的八个数据库。…

BACKGROUND: Emergency departments (EDs) increasingly serve linguistically diverse populations. Professional interpretation improves care, yet its use remains variable. Quantifying the prevalence of use and understanding disparities can inform policies and interventions. We conducted a systematic review and meta-analysis to estimate the prevalence of professional interpreter use in English-speaking EDs and compare use across patient populations and countries. METHODS: Eight databases were searched from inception to May 15, 2025.…

目的：为自发性绝经和诱发性绝经（40岁及以上）相关的血管运动、睡眠和情绪症状的管理提供循证建议。目标人群：出生时被指定为女性性别的围绝经期和绝经后期个体（即女性、跨性别男性和性别多样化个体），其血管运动、睡眠和情绪症状与自发性或诱发性绝经相关。……

PURPOSE: To provide evidence-based recommendations for the management of vasomotor, sleep, and mood symptoms related to spontaneous menopause and induced menopause (at or beyond age 40 years). TARGET POPULATION: Perimenopausal and postmenopausal individuals assigned female sex at birth (ie, women, transgender men, and gender-diverse individuals) with vasomotor, sleep, and mood symptoms related to spontaneous or induced menopause.…

背景：靶向白细胞介素-23通路的单克隆抗体可有效治疗炎症性肠病。然而，这些疗法必须通过静脉注射或皮下注射给药。方法：我们开展了一项2b期、双盲、随机试验，评估口服Icotrokinra（一种阻断白细胞介素-23受体的肽）用于中度至重度活动性溃疡性结肠炎成人的疗效。受试者被分配接受Icotrokinra每日一次400 mg、200 mg或100 mg口服或安慰剂治疗。主要终点是第12周的临床应答。…

BACKGROUND: Monoclonal antibodies targeting the interleukin-23 pathway are effective in treating inflammatory bowel disease. However, these therapies must be administered intravenously or by subcutaneous injection. METHODS: We conducted a phase 2b, double-blind, randomized trial of oral icotrokinra, a peptide that blocks the interleukin-23 receptor, in adults with moderately to severely active ulcerative colitis. Participants were assigned to receive icotrokinra at a once-daily dose of 400 mg, 200 mg, or 100 mg or placebo. The primary end point was clinical response at week 12.…

背景：出血仍然是良性前列腺增生（BPH）内镜手术中的一个重要问题。氨甲环酸（TXA）因其在经尿道前列腺手术中减轻出血相关问题的作用而受到越来越多的关注。我们进行了一项全面的荟萃分析，以评估TXA在接受良性前列腺增生内镜手术患者中的有效性和安全性，并承认现有数据主要来自经尿道前列腺电切术（TURP）。…

BACKGROUND: Hemorrhaging continues to be a significant issue in endoscopic procedures for benign prostatic hyperplasia (BPH). Tranexamic acid (TXA) has garnered heightened scrutiny for its ability to mitigate bleeding-associated problems during transurethral prostate procedures. We performed a comprehensive meta-analysis to assess the effectiveness and safety of TXA in individuals having endoscopic procedures for BPH, acknowledging that the existing data primarily originated from transurethral resection of the prostate (TURP).…

患有复发性流产（RPL）的女性表现出高水平的抑郁、焦虑和压力，这会对其生活质量产生负面影响。这项随机临床试验评估了一项为期八周的在线正念干预（MBI）（每周一次，每次一小时）对35名患有RPL的女性心理和生物学压力指标的影响。…

Women with recurrent pregnancy loss (RPL) exhibit high levels of depression, anxiety, and stress, which negatively impact their quality of life. This randomized clinical trial evaluated the effects of an eight-week online Mindfulness-Based Intervention (MBI), with weekly one-hour sessions, on psychological and biological markers of stress in 35 women with RPL.…

This randomized controlled trial examined the effects of prenatal haptonomy on pregnancy-related anxiety, distress, and psychological well-being. A total of 102 pregnant women were randomly assigned to a three-session haptonomy group, a six-session haptonomy group, or a control group receiving routine antenatal care. Data were collected using the Pregnancy-Related Anxiety Questionnaire-Revised 2, Tilburg Pregnancy Distress Scale, and Psychological Well-Being Scale at baseline, post-intervention, and follow-up.…