元界

背景：当前的ST段抬高型心肌梗死（STEMI）/NSTEMI框架可能无法完全识别无诊断性STE表现的ACO患者。尽管推荐对具有极高危NSTEMI特征的患者进行立即有创管理，但这些标准在临床实践中的应用并不一致。OMI/NOMI框架已被提出作为一种替代策略。…

BACKGROUND: The current ST-segment elevation myocardial infarction (STEMI)/NSTEMI framework may not fully identify patients with ACO who present without diagnostic STE. Although immediate invasive management is recommended for patients with very-high-risk NSTEMI features, these criteria are inconsistently applied in clinical practice. The OMI/NOMI framework has been proposed as an alternative strategy.…

在血压控制充分的高血压患者中，残余心血管风险仍然存在，其部分由炎症、氧化应激和内皮功能障碍驱动。希俄斯乳香（Pistacia lentiscus var. Chia）在实验和临床环境中已显示出降压、抗氧化和血管作用。本试验评估了补充希俄斯乳香是否在血压控制良好的高血压个体中带来额外的心血管获益。…

Residual cardiovascular risk persists in patients with adequately controlled hypertension, driven partly by inflammation, oxidative stress and endothelial dysfunction. Chios mastic (Pistacia lentiscus var. Chia) has shown antihypertensive, antioxidant and vascular effects in experimental and clinical settings. This trial evaluated whether Chios mastic supplementation confers additional cardiovascular benefits in well-controlled hypertensive individuals.…

引言：妊娠期高血压疾病（HDP）不仅是全球孕产妇死亡的主要原因，还会使母亲终身心血管疾病（CVD）风险增加。尽管生活方式干预可能减轻这些风险，但有力证据仍然缺乏。…

INTRODUCTION: Hypertensive disorders of pregnancy (HDP), as well as being a leading global cause of maternal mortality, confer lifelong increased maternal cardiovascular disease (CVD) risk. Although lifestyle interventions may mitigate these risks, robust evidence remains scarce.…

目的：肌少症和肌少性肥胖（SO）是以骨骼肌质量减少和肌力受损为特征的老年综合征，其特定生物标志物及潜在机制尚不明确。本研究旨在通过收集过去15年的相关文献，对生物标志物与肌少症/肌少性肥胖之间的关联进行荟萃分析和文献综述。……

OBJECTIVE: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes characterized by reduced skeletal muscle mass and impaired muscle strength, whose specific biomarkers and underlying mechanisms remain unclear. This study aimed to conduct a meta-analysis and literature review on the associations between biomarkers and sarcopenia/SO by collecting relevant publications over the past 15 years.…

背景：采用贝叶斯网状荟萃分析，评估3种中成药（复方斑蝥胶囊、槐耳颗粒、金龙胶囊）联合经动脉化疗栓塞术（TACE）治疗原发性肝癌的客观缓解率（ORR）和疾病控制率。方法：系统检索了Cochrane图书馆、Embase、PubMed、Web of Science、维普中文科技期刊数据库、中国知网及万方数据库，检索时间从建库至2025年1月10日，纳入随机对照试验（RCTs）。……

BACKGROUND: To evaluate the objective response rate (ORR) and disease control rate of 3 Chinese herbal medicines (Compound Banmao Capsule, Huaier Granule, and Jinlong Capsule) combined with transarterial chemoembolization (TACE) for primary liver cancer using Bayesian network meta-analysis. METHODS: We systematically searched randomized controlled trials (RCTs) across the Cochrane Library, Embase, PubMed, Web of Science, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang databases from their inception to January 10, 2025.…

准确的无创评估左心室舒张功能障碍及充盈压，对于心力衰竭的诊断和管理至关重要，尤其是射血分数保留的心力衰竭（HFpEF）。尽管经胸超声心动图广泛应用，但基于指南的算法常常结果不确定、可重复性不一，且难以在常规实践中一致应用。人工智能（AI）已成为一种潜在策略，用于标准化测量、整合多参数超声心动图数据，并减少诊断不确定性。…

Accurate non-invasive assessment of left ventricular diastolic dysfunction and filling pressures is central to the diagnosis and management of heart failure, particularly heart failure with preserved ejection fraction (HFpEF). Despite widespread use of transthoracic echocardiography, guideline-based algorithms are frequently indeterminate, variably reproducible, and difficult to apply consistently in routine practice. Artificial intelligence (AI) has emerged as a potential strategy to standardize measurement, integrate multiparametric echocardiographic data, and reduce diagnostic uncertainty.…

目的：对乙酰氨基酚作为解热镇痛药被广泛使用，但其易获得性也使其成为药物过量中的常见药物。故意对乙酰氨基酚中毒的发生率不断上升，尤其是在青少年中，引发了公共卫生方面的关注。本研究旨在探讨对乙酰氨基酚过量的近期模式，并识别故意自我中毒的风险人群。方法：使用PubMed、Scopus、Web of Science和Cochrane图书馆，对2018—2023年间已发表的描述对乙酰氨基酚过量的病例报告进行系统综述。……

OBJECTIVES: Paracetamol is widely used as an analgesic and antipyretic, but its accessibility also makes it a frequent drug in overdose cases. Increasing rates of intentional paracetamol poisoning, particularly among adolescents, raise public health concerns. This study aimed to examine recent patterns of paracetamol overdose and identify risk groups for intentional self-poisoning. METHODS: A systematic review of published case reports (2018-2023) describing paracetamol overdose was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library.…

背景：疼痛是儿科急诊科就诊的最常见原因之一，但及时有效的镇痛仍未能持续落实。鼻内（IN）镇痛药为注射途径提供了一种无创替代方案，但其在不同药物和不同给药途径之间的相对有效性、安全性和可接受性仍未得到充分界定。方法：我们对评估鼻内镇痛药用于急诊或院前环境中0—18岁儿童急性疼痛管理的随机对照试验进行了系统综述和网络荟萃分析。…

BACKGROUND: Pain is one of the most common reasons for presentation to pediatric emergency departments, yet timely and effective analgesia remains inconsistently delivered. Intranasal (IN) analgesics offer a noninvasive alternative to injectable routes, but their comparative effectiveness, safety, and acceptability across agents and routes remain incompletely defined. METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating IN analgesics for acute pain management in children aged 0-18 years presenting to emergency or prehospital settings.…

背景：比伐卢定和肝素是急性冠脉综合征（ACS）患者接受经皮冠状动脉介入治疗（PCI）时常用的抗凝药物。本荟萃分析旨在比较比伐卢定与肝素在接受PCI的ACS患者中的安全性和有效性。方法：我们系统检索了PubMed、Embase、Web of Science和Cochrane图书馆，纳入比较比伐卢定与肝素在接受PCI的ACS患者中应用的随机对照试验（RCT）和队列研究。…

BACKGROUND: Bivalirudin and heparin are commonly employed anticoagulants in percutaneous coronary intervention (PCI) for patients diagnosed with acute coronary syndrome (ACS). This meta-analysis aimed to compare the safety and efficacy of bivalirudin and heparin in patients with ACS undergoing PCI. METHODS: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and cohort studies comparing bivalirudin with heparin in patients with ACS undergoing PCI.…

背景：肥胖与心力衰竭（HF）密切相关，但在初级保健中识别仍具挑战性，因为症状、体征和利钠肽浓度可能难以解读。目的：描述一项评估肥胖成人主动性多模式HF筛查的试验的设计、招募、基线特征和可接受性。方法：45岁及以上、患有肥胖且无已知心脏病的成人按1：1随机分配至主动性多模式HF筛查组或常规护理组。…

BACKGROUND: Obesity is strongly associated with heart failure (HF), but recognition remains challenging in primary care because symptoms, physical findings, and natriuretic peptide concentrations may be difficult to interpret. OBJECTIVES: To describe the design, recruitment, baseline characteristics, and acceptability of a trial evaluating proactive multimodal HF screening in adults with obesity. METHODS: Adults aged 45 years or older with obesity and no known cardiac disease were randomized 1:1 to proactive multimodal HF screening or usual care.…

MK-1942是代谢型谷氨酸受体2的负变构调节剂，曾被研究用于治疗阿尔茨海默病和抑郁症。使用重组人CYP和基因分型人肝细胞进行的非临床研究提示，CYP2C19参与MK-1942的代谢。鉴于日本人群中不同CYP2C19多态性的高发生率，在健康日本参与者中开展的一项1期单次和多次给药研究为确定CYP2C19表型对MK-1942临床PK的影响提供了机会。…

MK-1942 is a negative allosteric modulator of the metabotropic glutamate receptor 2 that was investigated for the treatment of Alzheimer's disease and depression. Nonclinical studies with recombinant human CYPs and genotyped human hepatocytes suggested that CYP2C19 is involved in the metabolism of MK-1942. Given the high incidence of different CYP2C19 polymorphisms in the Japanese population, a Phase 1 single and multiple dose study in healthy Japanese participants provided an opportunity to determine the involvement of CYP2C19 phenotype on the clinical PK of MK-1942.…

肝细胞癌（HCC）是最常见的肝脏原发性恶性肿瘤。NCCN肝细胞癌指南为HCC患者的全面管理提供建议，包括筛查、评估、治疗和监测。多学科专家小组至少每年召开一次会议，根据新的和不断涌现的数据讨论NCCN指南的更新。本指南见解聚焦于近期的一些更新内容。

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. The NCCN Guidelines for HCC provide recommendations for the comprehensive care of patients with HCC, including screening, evaluation, treatment, and surveillance. The multidisciplinary panel of experts meets at least once a year to discuss updates to the NCCN Guidelines based on new and emerging data. These Guidelines Insights focus on some of the recent updates.

NCCN肿瘤学临床实践指南（NCCN指南）针对胰腺腺癌提供多学科诊断检查、分期以及可切除、临界可切除、不可切除、局部晚期和转移性疾病的治疗建议。本文总结了作为NCCN胰腺腺癌指南中所包含综合治疗建议依据的研究和专家组讨论。

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pancreatic Adenocarcinoma provide multidisciplinary diagnostic workup, staging, and treatment recommendations for resectable, borderline resectable, unresectable, locally advanced, and metastatic disease. This article summarizes the studies and Panel discussion that serve as the rationale for comprehensive care recommendations included in the NCCN Guidelines for Pancreatic Adenocarcinoma.

目的：本系统评价旨在分析在膝骨关节炎（KOA）患者中，手法治疗（MT）联合运动（EX）相较于单纯运动对疼痛、功能及压力痛阈（PPT）的附加效应。方法：检索6个数据库（MEDLINE、PEDro、EMBASE、CENTRAL、CINAHL和Web of Science），检索时间从建库至2026年5月。由两名独立评价者筛选随机临床试验。采用随机效应模型计算标准化均数差（SMD）和95%置信区间（CI）进行荟萃分析。…

OBJECTIVE: This systematic review aimed to analyse the additional effects of manual therapy (MT) to exercise (EX) compared to EX alone on pain, function, and PPT in individuals with knee osteoarthritis (KOA). METHODS: Six databases (MEDLINE, PEDro, EMBASE, CENTRAL, CINAHL, and Web of Science) were searched from inception up to May 2026. Two independent reviewers selected randomized clinical trials. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated by random-effects for meta-analyses.…

背景：对于ST段抬高型心肌梗死（STEMI）合并多支血管病变的患者，推荐进行完全血运重建。非罪犯病变干预的时机——是在首次手术中即刻进行，还是稍后分期进行——已在随机对照试验（RCT）中得到了研究。目的：本研究旨在对比较STEMI合并多支血管病变患者即刻与分期完全血运重建的RCT进行荟萃分析。方法：我们进行了一项频率学派配对荟萃分析。……

BACKGROUND: For patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization is recommended. The timing of nonculprit lesion intervention, either immediately during the index procedure or staged at a later time, has been investigated in randomized controlled trials (RCTs). OBJECTIVES: This study sought to perform a meta-analysis of RCTs comparing immediate vs staged complete revascularization in patients with multivessel disease presenting with STEMI. METHODS: We conducted a frequentist, pairwise meta-analysis.…

背景：本研究总结并分析了中性粒细胞与淋巴细胞比值（NLR）对一氧化碳（CO）中毒所致迟发性神经后遗症（DNS）的预后价值。方法：检索PubMed、Embase、Cochrane Library、Web of Science、ScienceDirect和中国知网数据库，查找从建库至2026年2月的相关文献。估算NLR预测DNS的比值比及其95%置信区间（CI）、曲线下面积、荟萃回归分析、敏感性分析和发表偏倚。…

BACKGROUND: This study summarized and analyzed the prognostic value of the neutrophil to lymphocyte ratio (NLR) for delayed neurologic sequelae (DNS) caused by carbon monoxide (CO) poisoning. METHODS: PubMed, Embase, Cochrane Library, Web of Science, ScienceDirect, and China National Knowledge Infrastructure Database were searched to identify relevant articles from their inception to February 2026. The odds ratio and its 95% confidence interval (CI), area under the curve, meta-regression analysis, sensitivity analysis, and publication bias for NLR were estimated to predict DNS.…

随着症状前筛查项目和疾病修饰疗法的不断扩展，1型糖尿病（T1D）的早期筛查正受到越来越多的关注。然而，专业利益相关方在实施、患者参与和卫生系统准备方面发挥着关键作用，其观点尚未得到系统整合。我们开展了一项系统综述，以考察专业人士对儿童T1D早期筛查的看法。…

Early screening for type 1 diabetes (T1D) is receiving increasing attention as presymptomatic screening initiatives and disease-modifying therapies continue to expand. However, the perspectives of professional stakeholders, who play a pivotal role in implementation, patient engagement, and health system preparedness, have not been systematically synthesised. We conducted a systematic review to examine professional views on paediatric early T1D screening.…

背景：因心力衰竭住院的患者通常需要长时间静脉利尿剂治疗，这增加了住院相关成本和风险。目的：我们评估了采用通过可穿戴微型泵皮下注射呋塞米的早期出院策略是否可增加存活且出院天数（DAOH）。

BACKGROUND: Patients hospitalized for heart failure often require prolonged intravenous diuretic therapy, contributing to costs and risks associated with inpatient care. OBJECTIVES: We evaluated whether an early discharge strategy using subcutaneous furosemide delivered via a wearable minipump could increase days alive and out of hospital (DAOH).…

背景：HIV/AIDS 治疗的进步已将该病转变为一种可管理的慢性疾病，预期寿命得以延长。然而，生存期的延长并不总能保证更好的生活质量（QoL）。诸如 BATHE 技术等社会心理干预，为在常规诊疗中处理情感和社会挑战提供了一种结构化方法。本研究旨在评估 BATHE 技术对 HIV/AIDS 感染者（PLWH）生活质量的影响，该领域实证证据有限，尤其是在撒哈拉以南非洲地区。…

BACKGROUND: Advancements in HIV/AIDS treatment have transformed the condition into a manageable chronic disease with improved life expectancy. However, increased survival does not always guarantee better quality of life (QoL). Psychosocial interventions, such as the BATHE technique, offer a structured approach to addressing emotional and social challenges in routine care. This study aims to evaluate the impact of the BATHE technique on the QoL of people living with HIV/AIDS (PLWH), an area with limited empirical evidence, particularly in sub-Saharan Africa.…

重要性：子痫前期是全球孕产妇发病和死亡的主要原因。随着真实世界数据源越来越多地用于孕产妇健康监测和药物流行病学研究，有效的算法对于在常规收集的医疗保健数据中准确识别子痫前期至关重要。目的：识别和描述在基于人群的医疗保健数据库中用于确认子痫前期的算法，总结验证指标，并描述所报告患病率估计值的范围。…

IMPORTANCE: Preeclampsia is a leading cause of maternal morbidity and mortality globally. As real-world data sources are increasingly used for maternal health surveillance and pharmacoepidemiologic studies, valid algorithms are essential for accurately identifying preeclampsia in routinely collected healthcare data. OBJECTIVE: To identify and characterize algorithms used to ascertain preeclampsia in population-based healthcare databases, summarize validation metrics, and describe the range of reported prevalence estimates.…