元界

背景与目的：目前，对于用于管理2型糖尿病的胰高血糖素样肽1受体激动剂，仍存在对有效且耐受性良好的口服制剂未满足的临床需求。奥福格利普隆和口服司美格鲁肽是ACHIEVE-3临床试验（NCT06045221）中评估的两种口服胰高血糖素样肽1受体激动剂。这些新型治疗手段能够实现具有临床意义的血糖控制和体重减轻，可能对患者的日常生活产生显著的积极改变。…

BACKGROUND AND OBJECTIVE: There is an unmet need for effective and well-tolerated oral formulations of glucagon-like peptide 1 receptor agonists for the management of type 2 diabetes. Orforglipron and oral semaglutide are two oral glucagon-like peptide 1 receptor agonists evaluated in the ACHIEVE-3 clinical trial (NCT06045221). These novel treatments have the means to achieve clinically meaningful glycemic control and weight reduction, which may result in substantial positive changes in patients' daily lives.…

这是一份Cochrane系统评价（干预性）的方案。目标如下：评估他汀类药物在首次发生深静脉血栓患者中，用于二级预防复发性静脉血栓栓塞性疾病（RVTE）：深静脉血栓（DVT）、肺血栓栓塞（PTE）和血栓后综合征（PTS）的获益与危害。次要目标：评估他汀类药物在伴有或不伴有癌症的患者、不同性别以及年龄超过70岁的普通人群中，用于二级预防RVTE、DVT、PTE和PTS的获益与危害。

This is a protocol for a Cochrane review (intervention). The objectives are as follows: To evaluate the benefits and harms of statins in the secondary prevention of Recurrent Venous ThromboEmbolic disease (RVTE): Deep Vein Thrombosis (DVT), Pulmonary ThromboEmbolism (PTE) and Post-Thrombotic Syndrome (PTS) in patients with a first episode of deep vein thrombosis Secondary objective To evaluate the benefits and harms of statins in the secondary prevention of RVTE, DVT, PTE and PTS in patients with or without cancer, in different sexes and in the general population aged over 70 years.

目的：免疫治疗联合化疗可显著改善晚期子宫内膜癌（EC）的无进展生存期，尤其是在微卫星高度不稳定（MSI-H）病例中。尽管如此，对于免疫治疗后的复发性EC，迫切需要新的治疗选择。PI3K通路在包括EC在内的妇科癌症中频繁发生改变，代表了一个潜在的治疗靶点。……

PURPOSE: Immunotherapy with chemotherapy significantly improves progression-free survival in advanced endometrial cancer (EC), especially in microsatellite instability-high (MSI-H) cases. Despite this, for recurrent EC in the postimmunotherapy setting, new treatment options are urgently needed. The PI3K pathway is frequently altered in gynecologic cancers, including EC, representing a potential treatment target.…

针对14 000名囚犯的药物目录变更被批评为不符合最佳实践。保罗·韦伯斯特报道。

Changes to the formulary for 14 000 prisoners have been criticised as inconsistent with best practice. Paul Webster reports.

托马斯·霍布斯（1588–1679）最著名的是他在《利维坦》（1651）中的那句话：“人的一生孤独、贫困、卑污、残忍而短促。”这一论断在17世纪的英格兰或许属实，但得益于卫生体系的演进与扩展，如今对许多人而言已非如此，尽管显然并非对所有人。然而，仅抽出这句话会错失霍布斯关于人性本质的更广阔观点。他认为，如果没有一个统治社会的“共同权力”，我们的自然倾向便是“那种被称为战争的状态……每个人反对每个人的战争”。

Thomas Hobbes (1588–1679) is most famous for his line in Leviathan (1651) that, “the life of man, solitary, poor, nasty, brutish, and short”. That proposition may have been true in 17th-century England, but, thanks to the evolution and expansion of health systems, it is not so today for many, although obviously not all. But abstracting that line alone is to miss Hobbes’ wider views about the nature of human being. He believed that without a “common power” ruling over society, our natural tendency is “that condition which is called war…of every man against every man”.

脓毒症是一种危及生命的器官功能障碍，由宿主对感染的反应失调引起1，常见且常常致命。2,3 目前对急性不适的脓毒症患者的诊疗标准依赖于临床医生的早期怀疑、感染源控制（如脓肿引流和清创）、给予经验性广谱抗菌药物，以及对衰竭的重要器官提供生命支持。4 尽管此类维持生命的治疗通常在重症监护病房中实施，但全球大多数脓毒症患者是在重症监护病房之外或无此类设施的病房中接受治疗的。

Sepsis, a life-threatening organ dysfunction, is caused by dysregulated host responses to infection1 and is common, and often deadly.2,3 The current standard of care for the acutely unwell patient with sepsis relies on early suspicion by the clinician, infection source control (eg, abscess drainage and debridement), administering empirical broad spectrum antimicrobials, and life support for failing vital organs.4 Although such life-sustaining therapies are commonly delivered in intensive care units, globally most patients with sepsis are managed outside intensive care units or in wards without such facilities.

在2000年至2002年担任智利卫生部长期间，我管理着一个公共网络，它缩短了候诊名单并扩大了初级保健，尽管它无法修复恐惧、隔离和信任破裂对民众造成的伤害。作为我国第一位女性总统（2006–10年和2014–18年），我签署法律设立了文化、艺术与遗产部，使智利的文化生活第一次在内阁层面有了归属。这些经历让我认识到，一个国家的文化生活和健康是同一项事业，只是从两个角度来看的。

As Chile's Minister of Health from 2000 to 2002, I ran a public network that shortened waiting lists and expanded primary care, although it could not repair what fear, isolation, and broken trust do to a population. As the first female President in my country (2006–10 and 2014–18), I signed into law the Ministry of Cultures, the Arts, and Heritage, giving Chile's cultural life its first cabinet-level home. These experiences taught me that a country's cultural life and its health are the same project, seen from two angles.

尽管抗逆转录病毒治疗（ART）取得了重大进展，但与一般人群相比，感染HIV的青少年仍然存在巨大的死亡率差距。1 青少年获得ART的机会落后于成人——青少年约为60%，而总体为78%。2 对于确实接受了救命治疗的青少年，许多感染HIV的青少年对每日ART的依从性不稳定，导致病毒未抑制，增加临床失败和死亡的风险。3 由M

Despite major advancements in antiretroviral therapy (ART), a substantial mortality gap remains for adolescents living with HIV compared with the general population.1 Adolescents’ access to ART lags behind that of adults—approximately 60% for adolescents compared with 78% overall.2 For those who do receive life-saving therapy, inconsistent adherence to daily ART among many adolescents with HIV leads to viral non-suppression, increasing risks of clinical failure and death.3 The LATA trial, reported in The Lancet by Mutsa Bwakura-Dangarembizi and colleagues, was conducted in the four African countries in which most of the world's 1·57 million adolescents living with HIV reside; it offers hope that the challenges of adhering to daily oral ART for adolescents can be mitigated with longer actin

手术切除仍是非典型脑膜瘤（对应WHO 2级肿瘤）的主要治疗手段，尤其是在次全切除后复发风险显著的情况下。因此，辅助放疗已被提议作为降低复发风险的一种手段，且其在存在残留肿瘤的患者中的作用相对已被广泛接受。然而，在大体全切除（定义为Simpson分级I–III级）后，其合理性尚不明确：仅行大体全切除的5年无进展生存率为67%–86%，辅助放疗的作用仍存在争议，其疾病控制获益需与潜在毒性相权衡。

Surgical resection remains the mainstay of treatment for atypical meningiomas, corresponding to WHO grade 2 tumours, particularly given the substantial risk of recurrence after subtotal resection. Accordingly, adjuvant radiotherapy has been proposed as a means of reducing the risk of recurrence, and its role is relatively well accepted in patients with residual tumour. After gross total resection (defined as Simpson grade I–III), however, the rationale is less clear: 5-year progression-free survival with gross total resection alone is 67–86%, and the role of adjuvant radiotherapy remains controversial, with its benefit in disease control weighed against potential toxicities.

普遍观察到，使用GLP-1受体激动剂所获得的体重减轻程度，在2型糖尿病患者中低于无糖尿病且BMI相似的人群。这种差异能否被具有更强减重效果的新型三重激动剂所克服？Virginia Bellido及其同事1在《柳叶刀》上发表的TRIUMPH-2研究，是一项双盲、平行分组、随机、安慰剂对照的3期试验，评估了瑞他鲁肽（一种三重激动剂，作用于GLP-1、GIP和胰高血糖素）在肥胖合并2型糖尿病患者中的效果。

It is a general observation that the degree of weight loss obtained with GLP-1 receptor agonists is less in individuals with type 2 diabetes than in people without diabetes and similar BMI. Could this difference be overcome with the new triple agonists with superior weight-lowering effects? The TRIUMPH-2 study by Virginia Bellido and colleagues1 in The Lancet is a double-blind, parallel-group, randomised, placebo-controlled, phase 3 trial of the effects of retatrutide, a triple agonist (GLP-1, GIP, and glucagon), in people with obesity and type 2 diabetes.

今年10月10日举行的世界精神卫生日的主题是“倾听亲历经验：真实的声音，真正的改变”。WHO在其网站上表示，有亲历经验的人的声音应该“影响那些关乎他们生活的政策、服务和决策”。虽然这些是值得称赞的目标，但它们也凸显了在精神卫生领域内外，亲历经验参与和共同生产所涉及的复杂挑战。

The theme of this year's World Mental Health Day, held on Oct 10, is Lived experiences heard: real voices, real change. On its website, WHO states that the voices of people with lived experience should “shape the policies, services and decisions that affect their lives”. While these are laudable aims, they also serve to highlight the complex challenges involved in lived experience engagement and co-production, both within the field of mental health and beyond.

新英格兰医学杂志，第395卷，第15期，第1553-1555页，2026年10月15日

New England Journal of Medicine, Volume 395, Issue 15, Page 1553-1555, October 15, 2026.

《新英格兰医学杂志》第395卷第15期，第1562-1564页，2026年10月15日。

New England Journal of Medicine, Volume 395, Issue 15, Page 1562-1564, October 15, 2026.

《新英格兰医学杂志》，第395卷，第15期，第1558-1561页，2026年10月15日。

New England Journal of Medicine, Volume 395, Issue 15, Page 1558-1561, October 15, 2026.

《新英格兰医学杂志》，第395卷第15期，第1562-1562页，2026年10月15日。

New England Journal of Medicine, Volume 395, Issue 15, Page 1562-1562, October 15, 2026.

New England Journal of Medicine, Volume 395, Issue 15, Page 1495-1504, October 15, 2026.

新英格兰医学杂志，第395卷第15期，第1483-1494页，2026年10月15日。

New England Journal of Medicine, Volume 395, Issue 15, Page 1483-1494, October 15, 2026.

《新英格兰医学杂志》，第395卷，第15期，第1505-1518页，2026年10月15日

New England Journal of Medicine, Volume 395, Issue 15, Page 1505-1518, October 15, 2026.

新英格兰医学杂志，第395卷，第14期，第1455-1457页，2026年10月8日。

New England Journal of Medicine, Volume 395, Issue 14, Page 1455-1457, October 8, 2026.

《新英格兰医学杂志》，第395卷第14期，第1457-1459页，2026年10月8日。

New England Journal of Medicine, Volume 395, Issue 14, Page 1457-1459, October 8, 2026.