元界

背景：传统分诊依赖于临床医生的判断和首次接触时可获得的有限信息。人工智能和机器学习（ML）可能改善早期风险分层，而远程分诊和面向患者的工具主要支持远程评估、可及性和就医路径引导。目的：本研究旨在评估人工智能和机器学习辅助分诊系统的诊断和预后性能，并总结关于远程分诊、工作流程、实施、经济和公平性结局的证据。…

BACKGROUND: Conventional triage relies on clinician judgment and limited information available at first contact. AI and machine learning (ML) may improve early risk stratification, whereas tele-triage and patient-facing tools primarily support remote assessment, access, and care routing. OBJECTIVE: This study aimed to evaluate the diagnostic and prognostic performance of AI- and ML-assisted triage systems and summarize evidence on tele-triage, workflow, implementation, economic, and equity outcomes.…

背景：多囊肝病（PLD）以多发性肝囊肿为特征，有时会导致肝脏严重增大，并伴有相关的躯体及心理社会症状。治疗选择有限。女性性别是PLD的一个危险因素；在患有PLD的女性中，补充雌激素会使肝脏增大，而绝经后多囊肝则会缩小。因此，雌激素可能成为治疗的靶点。…

BACKGROUND: Polycystic liver disease (PLD) is characterized by multiple liver cysts, sometimes leading to severe liver enlargement, with associated physical and psychosocial complaints. Treatment options are limited. Female gender is a risk factor for PLD; estrogen supplementation increases liver size in women with PLD, whereas the polycystic liver decreases after menopause. Estrogens may therefore be a target for therapy.…

目的：这项前瞻性随机对照临床研究比较了口内（IO）与口外（EO）光生物调节（PBM）在儿童肿瘤患者中预防化疗所致口腔黏膜炎（OM）的效果。方法：共155例因白血病、淋巴瘤或骨肉瘤接受高剂量甲氨蝶呤（HDMTX）治疗的患者（1-18岁）被随机分配至PBM-IO组（n=73）或PBM-EO组（n=82）。预防性PBM自入院至出院每日实施。两种方案均使用红光，剂量参数相同（660 nm，100 mW，每点1 J）。…

PURPOSE: This prospective randomized controlled clinical study compared intraoral (IO) and extraoral (EO) photobiomodulation (PBM) for the prevention of chemotherapy-induced oral mucositis (OM) in pediatric oncology patients. METHODS: A total of 155 patients (1-18 years), receiving high-dose methotrexate (HDMTX) for leukemia, lymphoma, or osteosarcoma, were randomized to PBM-IO (n = 73) or PBM-EO (n = 82). Preventive PBM was administered daily from hospital admission through discharge. Both protocols used red light with equivalent dosimetry (660 nm, 100 mW, 1 J per point).…

目的：头、颈及面部（HNF）特应性皮炎（AD）显著损害生活质量，然而生物制剂在HNF区域的长期疗效数据仍然有限。方法：本项事后分析评估lebrikizumab在3期试验（ADvocate 1&2、ADjoin）及目标人群（ADmirable、ADapt）中，对≥12岁、体重≥40 kg的青少年及中重度AD成人患者的HNF疗效。结局指标包括HN EASI子评分和面部研究者整体评估（F-IGA）。结果：在第16周应答者中，lebrikizumab 250 mg Q4W提供持续至3年的持久疗效。…

OBJECTIVES: Head, neck, and face (HNF) atopic dermatitis (AD) substantially impairs quality of life, yet long-term biologic efficacy data in HNF areas remain limited. METHODS: This post hoc analysis evaluates HNF efficacy of lebrikizumab across phase 3 trials (ADvocate 1&2, ADjoin) and targeted populations (ADmirable, ADapt) in adolescents (≥12 years, ≥40 kg) and adults with moderate-to-severe AD. Outcomes included HN EASI sub-scores and Face Investigator's Global Assessment (F-IGA). RESULTS: Lebrikizumab 250 mg Q4W provided durable efficacy through 3 years among week 16 responders.…

颅外-颅内（EC-IC）搭桥是一种成熟的技术，用于增加烟雾病（MMD）及其他狭窄闭塞性疾病患者的颅内血流。直接EC-IC搭桥治疗MMD与非烟雾病（N-MMD）病理的结局尚未在荟萃分析中加以系统综述或比较。我们对报告成人接受EC-IC搭桥并按适应证分层结局的研究进行了系统综述和荟萃分析。…

Extracranial-intracranial (EC-IC) bypass is an established technique to augment intracranial flow in patients with moyamoya disease (MMD) and other steno-occlusive diseases. The outcomes after direct EC-IC bypass for MMD compared to non-MMD pathologies (N-MMD) have not been systematically reviewed or compared in a meta-analysis. We performed a systematic review and meta‑analysis of studies reporting on outcomes in adults undergoing EC-IC bypass stratified by indication.…

引言：CDK4/6抑制后的疾病进展仍是激素受体阳性、HER2阴性晚期乳腺癌的治疗难题。吉达替西（Gedatolisib），一种经FDA批准的泛I类PI3K/mTORC1/2抑制剂，为未检测出PIK3CA突变的疾病引入了一种治疗策略。涵盖领域：本综述对吉达替西的药理学、临床证据、安全性、生物标志物及治疗定位进行了批判性评估。

INTRODUCTION: Progression following CDK4/6 inhibition remains a therapeutic challenge in hormone receptor-positive, HER2-negative advanced breast cancer. Gedatolisib, an FDA-approved pan-class I PI3K/mTORC1/2 inhibitor, introduces a treatment strategy for disease without a detected PIK3CA mutation. AREAS COVERED: This review critically evaluates gedatolisib pharmacology, clinical evidence, safety, biomarkers, and therapeutic positioning.…

比较基于风险比（HR）和基于限制性平均生存时间差（dRMST）的网络荟萃分析，评估一线免疫检查点抑制剂方案治疗转移性透明细胞肾细胞癌的效果。我们还引入一个基于RMST的框架，将生存获益与毒性、皮质类固醇负担和药品采购成本结合起来进行背景分析。共纳入五项比较ICI联合方案与舒尼替尼治疗mccRCC的III期试验。……

To compare hazard ratio (HR)- and difference in restricted mean survival time (dRMST)-based network meta-analyses of first-line immune checkpoint inhibitor-based regimens for metastatic clear-cell renal cell carcinoma. We also introduce a RMST-based framework contextualizing survival benefit alongside toxicity, corticosteroid burden, and drug-acquisition cost. Five phase III trials comparing ICI-based combinations with sunitinib in mccRCC were included.…

比较显微外科夹闭术与Woven EndoBridge（WEB）栓塞术治疗颅内动脉瘤（包括破裂和未破裂病例）在血管造影闭塞率、致残率、死亡率及不良事件（AEs）方面的差异。本系统评价和荟萃分析遵循PRISMA指南和Cochrane手册。检索PubMed、Scopus和Web of Science中自建库至2026年1月29日比较显微外科夹闭术与WEB栓塞术的研究。……

To compare microsurgical clipping and Woven EndoBridge (WEB) embolization for the treatment of intracranial aneurysms, including ruptured and unruptured cases, with respect to angiographic occlusion, morbidity, mortality, and adverse events (AEs). This systematic review and meta-analysis followed PRISMA guidelines and the Cochrane Handbook. PubMed, Scopus, and Web of Science were searched from inception to January 29, 2026, for comparative studies evaluating microsurgical clipping versus WEB embolization.…

目的：立体定向放射外科（SRS）是局限性脑转移瘤（BM）的首选治疗方法，其与PD-1/PD-L1抑制剂联合应用被认为可提供协同治疗获益。然而，人们对其可能增加放射性脑坏死（RIBN）风险存在担忧。本系统评价和荟萃分析评估PD-1/PD-L1抑制剂联合SRS或分次立体定向放疗（FSRT）的疗效和毒性特征。方法：检索四个数据库，即Embase、Web of Science、PubMed和Scopus，检索时间从建库至2025年11月。…

PURPOSE: Stereotactic radiosurgery (SRS) is the treatment of choice for limited brain metastases (BM), and its combination with PD-1/PD-L1 inhibitors is hypothesized to offer synergistic therapeutic benefits. However, there are concerns regarding augmented risk of radiation-induced brain necrosis (RIBN). This systematic review and meta-analysis evaluate the efficacy and toxicity profile of PD-1/PD-L1 inhibitors combined with SRS or fractionated stereotactic radiotherapy (FSRT). METHODS: Four databases were screened, Embase, Web of Science, PubMed and Scopus from inception to November 2025.…

大学和学术机构是现代世界不可或缺的支柱，几个世纪以来一直是社会不可分割的组成部分。然而，学术界与社会的关系以及大学的核心责任是不断被协商的。理想情况下，学术界提供可靠的科学见解，推动在可持续星球上实现所有人更好的健康和福祉的进步。在这一过程中，值得信任的科学旨在增加知识，这些知识不受开展研究时特定背景的约束，也不受政治或意识形态力量的影响。

Universities and academic institutions are indispensable pillars of the modern world, and have been an integral part of societies over centuries. However, academia's relation to society and the core responsibilities of universities are continuously negotiated. Ideally, academia provides reliable scientific insights that drive progress towards better health and wellbeing for all on a sustainable planet. In this process, trustworthy science aims to increase knowledge that is unconstrained by the specific backgrounds under which research is performed and not influenced by political or ideological forces.

由 Christopher J L Murray 及其同事撰写的《柳叶刀》21世纪全球健康威胁委员会报告，使用基于预期累积可干预伤残调整生命年（DALYs）的预测，来量化和比较 2025 年至 2100 年的威胁。1 该委员会的意图是使政府具备工具，以作出基于“系统、可重复的风险评估和应急准备规划”而非“短期主义和地方主义”的降低风险的明智长期决策。

The Lancet Commission on 21st century global threats to health's report by Christopher J L Murray and colleagues uses forecasts based on expected cumulative amenable disability-adjusted life-years (DALYs) to quantify and compare threats from 2025 to 2100.1 The Commission's intent is to equip governments with the tools to make smart long-term decisions that reduce risk based on “systematic, repeatable risk assessment and preparedness planning” as opposed to “short-termism and localism”.

针对丙型肝炎病毒（HCV）感染的简单口服直接抗病毒治疗已改变了临床管理方式，并为消除丙型肝炎铺平了道路。1 第一种泛基因型固定剂量联合方案——索磷布韦–维帕他韦——于2016年获批使用，第二种——格卡瑞韦–哌仑他韦——于2017年紧随其后获批。两种被推荐为一线HCV治疗方案，适用于伴或不伴代偿性肝硬化的患者，两者共享几个重要特征——高效、耐受性良好、口服给药、每日一次——但在药片负担、治疗持续时间和可获得性方面有所不同，其中索磷布韦–维帕他韦疗程为12周（每日一片；有仿制药可用），而格卡瑞韦–哌仑他韦疗程为8周（每日三片；受专利保护）。

Simple oral direct-acting antiviral treatment for hepatitis C virus (HCV) infection has transformed clinical management and paved the way for elimination.1 The first pan-genotypic fixed-dose combination regimen, sofosbuvir–velpatasvir, was approved for use in 2016, with the second, glecaprevir–pibrentasvir, following in 2017. Both recommended first-line HCV treatments for people with or without compensated cirrhosis share several important features—high efficacy, excellent tolerability, oral administration, once daily dosing—but differ by pill burden, treatment duration, and availability, with sofosbuvir–velpatasvir prescribed for 12 weeks (one tablet daily; available as a generic formulation) and glecaprevir–pibrentasvir for 8 weeks (three tablets daily; under patent protection).

进行性骨化性纤维发育不良（FOP）是最具破坏性的肌肉骨骼疾病之一。FOP由ACVR1的激活变异引起，最常见的是新生突变，其特征为大脚趾先天性畸形，随后出现间歇性发作和软组织进行性异位骨化。1,2 病变可由轻微创伤、肌内注射或手术触发，但也可在没有明确诱因的情况下出现。随着时间推移，异位骨形成第二副骨骼，逐渐限制下颌、脊柱、髋部、肩部和胸部的活动。

Fibrodysplasia ossificans progressiva (FOP) is among the most devastating musculoskeletal disorders. FOP is caused by activating variants in ACVR1, most often arising de novo, and is characterised by congenital malformations of the great toes, followed by episodic flare-ups and progressive heterotopic ossification in soft tissues.1,2 Lesions can be triggered by minor trauma, intramuscular injections, or surgery, but can also arise without an identifiable trigger. Over time, heterotopic bone forms a second skeleton, progressively restricting movement of the jaw, spine, hips, shoulders, and thorax.

黄热病是一个重要的公共卫生问题，但疫苗生产难以轻易扩大规模，因此有必要利用现有疫苗库存来保护尽可能多的人。分剂量（通常为每瓶的五分之一）已在疫情期间使用。分剂量的使用得到了成人中显示免疫原性1,2的证据支持，并得到世界卫生组织（WHO）的认可。3黄热病疫苗在流行地区常规接种给婴幼儿，但分剂量在儿童中是否有效一直不清楚，直到2023年和2026年的近期试验回答了这个问题。

Yellow fever is an important public health problem, but vaccine manufacturing cannot be scaled up easily, making it necessary to use existing vaccine stocks to protect as many people as possible. Fractional doses, usually one-fifth of a vial, have been used during outbreaks. The use of fractional doses is supported by evidence in adults showing immunogenicity1,2 and is endorsed by WHO.3 Yellow fever vaccine is routinely given to infants and young children in endemic areas, but whether fractional dosing is effective in children was unclear until recent trials from 2023 and 2026 addressed this question.

GLP-1受体激动剂的心血管结局试验，迄今为止主要包含肠促胰岛素激素GLP-1的肽类似物，已从最初主要设计用于确立心血管安全性的研究，发展为证明心血管获益的试验。1–3 多种皮下给药的GLP-1受体激动剂已显示可显著降低主要不良心血管事件（MACE）并提供肾脏保护，1–3 最近口服司美格鲁肽也显示出类似获益。

Cardiovascular outcomes trials with GLP-1 receptor agonists, which to date have largely comprised peptide analogues of the incretin hormone GLP-1, have evolved from studies primarily designed to establish cardiovascular safety to trials demonstrating cardiovascular benefit.1–3 Substantial reductions in major adverse cardiovascular events (MACE) and kidney protection have been demonstrated with multiple GLP-1 receptor agonists for subcutaneous administration,1–3 and, more recently, with oral semaglutide.

许多健康倡导活动是由单一议题行动主义驱动的。拥有共同利益的社群——从艾滋病到儿童健康，从气候到烟草控制——都密切关注自身领域。这可以理解。通过往往是大胆的直接行动，已经取得了重要进展。但根据一个新的“柳叶刀21世纪全球健康威胁委员会”的说法，这种激烈竞争的做法存在危险的缺陷。事实上，该委员会最重要的贡献或许在于将全球健康议题推进到超越对单一危害的考量。

Much health advocacy is driven by single-issue activism. Communities with a common interest—from AIDS to child health, climate to tobacco control—focus intensely on their own domain. And understandably so. Important progress has been made through often courageous direct action. But this sharply competitive approach is, according to a new Lancet Commission on 21st Century Global Threats to Health, dangerously flawed. Indeed, perhaps the most important contribution of this Commission is to move global health beyond the consideration of individual harms.

背景：Simedeutirom是一种选择性甲状腺激素受体β激动剂，先前已被证明可降低代谢功能障碍相关脂肪性肝病患者的肝脏脂肪含量。我们评估了simedeutirom在经活检证实的代谢功能障碍相关脂肪性肝炎（MASH）且伴有F2或F3纤维化的亚洲后裔患者中的疗效和安全性。方法：这项多中心、随机、双盲、安慰剂对照、2b期试验在中国42个临床中心开展。…

BACKGROUND: Simedeutirom is a selective thyroid hormone receptor-β agonist that has previously been shown to reduce hepatic fat content in metabolic dysfunction-associated steatotic liver disease. We assessed the efficacy and safety of simedeutirom in patients of Asian descent with biopsy-confirmed metabolic dysfunction-associated steatohepatitis (MASH) and F2 or F3 fibrosis. METHODS: This multicentre, randomised, double-blind, placebo-controlled, phase 2b trial was conducted at 42 clinical sites in China.…

被动抗β-淀粉样蛋白免疫治疗已从反复的3期失败转变为在生物标志物定义的早期阿尔茨海默病中可重复的、尽管适度的临床减缓。我们回顾了第一代抗体的经验教训，包括靶点结合不足、入组阶段过晚以及结局敏感性有限。然后我们比较了第二代药物（即阿杜卡努单抗、仑卡奈单抗和多奈单抗），重点介绍了β-淀粉样蛋白亚型选择性、斑块清除动力学和持久性，并讨论了新兴的递送创新。…

Passive anti-amyloid-β immunotherapy has shifted from repeated phase 3 failure to reproducible, although modest, clinical slowing in biomarker-defined early Alzheimer's disease. We review lessons from first-generation antibodies, including inadequate target engagement, late-stage enrollment, and limited outcome sensitivity. We then compare second-generation agents (i.e., aducanumab, lecanemab, and donanemab) highlighting amyloid-β species selectivity, plaque clearance kinetics, and durability, and we discuss emerging delivery innovations.…

目的：腱鞘巨细胞瘤（TGCT）是一种罕见的、局部侵袭性肿瘤，由集落刺激因子1（CSF1）过表达驱动。我们对CSF1受体抑制剂（CSF1Ri）与安慰剂治疗复发或不可切除TGCT（定义为手术将导致功能限制加重或严重并发症的症状性疾病）的疗效和安全性进行了Meta分析。…

AIM: Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm driven by overexpression of colony-stimulating factor 1 (CSF1). We performed a meta-analysis of the efficacy and safety of CSF1 receptor inhibitors (CSF1Ri) versus placebo in recurrent or unresectable TGCT, defined as symptomatic disease for which surgery would cause worsening functional limitation or severe morbidity.…

背景和目的：在经影像选择、发病超过4.5小时接受治疗的急性缺血性卒中患者中，静脉溶栓药物、血管内血栓切除术（EVT）和桥接治疗的相对效果仍不确定。我们在区分经证实的大血管闭塞（LVO）证据与更广泛的混合人群的同时比较了这些策略。方法：我们检索了PubMed、Embase、Web of Science和Cochrane图书馆，查找评估卒中发病后4.5至24小时或最后已知正常后接受再灌注治疗的随机试验。…

BACKGROUND AND PURPOSE: The comparative effects of intravenous thrombolytic agents, endovascular thrombectomy (EVT), and bridging therapy in imaging-selected patients with acute ischemic stroke treated beyond 4.5 hours remain uncertain. We compared these strategies while distinguishing confirmed large-vessel occlusion (LVO) evidence from broader mixed populations. METHODS: We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized trials evaluating reperfusion treatments administered 4.5 to 24 hours after stroke onset or last known well.…