元界

背景：本系统综述和荟萃分析评估妊娠期或围孕期暴露于胰高血糖素样肽-1受体激动剂（GLP-1 RA）是否与不良母胎结局相关。方法：检索Medline、Embase和Cochrane图书馆，查找比较妊娠试验阳性前6个月内暴露与未暴露于GLP-1 RA的妊娠的观察性研究。…

BACKGROUND: This systematic review and meta-analysis assesses whether exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) during pregnancy or the periconceptional period is associated with adverse maternal and perinatal outcomes. METHODS: Medline, Embase, and the Cochrane Library were searched for observational studies comparing pregnancies exposed and unexposed to GLP-1 RAs within 6 months before a positive pregnancy test.…

背景：中血管闭塞（MeVO）占急性缺血性卒中的25-40%，是重要的治疗前沿。尽管血管内取栓术（EVT）的技术成功率很高，但近期随机试验结果较为复杂，形成了悖论，并凸显了精准化治疗方法的必要性。方法：我们按照PRISMA指南进行了系统综述。筛选后，共纳入42项原始研究（4项随机对照试验和38项队列研究）。采用三级层级结构对证据进行综合与评价。应用了GRADE框架。

BACKGROUND: Medium vessel occlusions (MeVOs) account for 25-40% of acute ischemic strokes and present a significant therapeutic frontier. Despite high technical success rates of endovascular thrombectomy (EVT), recent randomized trial results have been nuanced, creating a paradox and underscoring the need for a precision-based approach. METHODS: We conducted a systematic review following PRISMA guidelines. After screening, 42 original studies were included (4 RCTs and 38 cohort studies). Evidence was synthesized and appraised using a three-tiered hierarchy. The GRADE framework was applied.…

无标记：评估50%葡萄糖溶液（D50W）对高危晚期早产儿和足月儿持续性无症状产后低血糖的治疗效果及对静脉（IV）葡萄糖治疗的影响。在泰国曼谷的两所高危新生儿病房进行的一项多中心、随机、双盲、安慰剂对照试验。…

UNLABELLED: To evaluate the efficacy of 50% dextrose solution (D50W) for treating persistent asymptomatic postnatal hypoglycemia in at-risk late preterm and term neonates and the effect on intravenous (IV) dextrose therapy. A multicenter, randomized, double-blind, placebo-controlled trial conducted at two high-risk nurseries in Bangkok, Thailand.…

背景：复发/难治性多发性骨髓瘤（RRMM）患者在接受多线治疗后预后不佳。现有证据大多将不同的免疫治疗平台合并分析。本系统综述和荟萃分析旨在按靶点分别描述BCMA×CD3靶向、GPRC5D×CD3靶向及双靶向双特异性抗体治疗在RRMM中的疗效和毒性谱，以指导毒性监测和支持性护理规划。……

BACKGROUND: Patients with relapsed/refractory multiple myeloma (RRMM) experience poor outcomes following multiple lines of therapy. Available evidence has largely pooled disparate immunotherapy platforms. The present systematic review and meta-analysis was performed to describe, separately by target, the efficacy and toxicity spectra of BCMA×CD3-directed, GPRC5D×CD3-directed, and dual-target bispecific antibody therapy in RRMM, in order to inform toxicity monitoring and supportive-care planning.…

背景：尽管器械和技术不断进步，经导管主动脉瓣植入术仍伴有影响结局的并发症。2021年，瓣膜学术研究联盟（VARC）推出了VARC-3标准，以更好地对手术并发症进行分类。方法：我们对2021年至2025年间使用VARC-3定义报告经导管主动脉瓣植入术相关并发症的研究进行了系统评价和Meta分析。主要终点为最近一次随访时的全因死亡率。…

BACKGROUND: Despite continuous advancements in devices and techniques, transcatheter aortic valve implantation remains associated with complications impacting outcomes. In 2021, the Valve Academic Research Consortium (VARC) introduced the VARC-3 criteria to better classify procedural complications. METHODS: We conducted a systematic review and meta-analysis of studies reporting transcatheter aortic valve implantation-related complications using VARC-3 definitions between 2021 and 2025. The primary end point was all-cause mortality at latest follow-up.…

目的：评估药物干预对慢性肾脏病患者血管钙化及相关结局的疗效。方法：检索PubMed、Embase、Web of Science和Cochrane Library，检索时间从建库至2026年5月1日。纳入比较药物干预与安慰剂、标准治疗或其他对照在慢性肾脏病患者中的随机对照试验。……

ObjectiveTo evaluate the efficacy of pharmacological interventions for vascular calcification and related outcomes in patients with chronic kidney disease.MethodsPubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to 1 May 2026. Randomized controlled trials comparing pharmacological interventions with placebo, standard care, or other controls in patients with chronic kidney disease were included.…

目的：“2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM 非心脏手术围手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手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：心力衰竭是导致发病、住院、残疾和死亡的重要原因，但来自索马里的证据仍然零散，且主要局限于单个医院的研究。本范围综述梳理了与索马里心力衰竭相关的流行病学、病因、临床和诊断特征、管理、结局及研究缺口方面的现有证据。方法：检索PubMed/MEDLINE、Scopus和Embase数据库，时间范围从建库至2026年7月27日。于2026年8月3日进行了回溯引文检索。……

BACKGROUND: Heart failure is an important cause of morbidity, hospitalisation, disability, and mortality, but evidence from Somalia remains fragmented and largely confined to individual hospital-based studies. This scoping review mapped the available evidence on the epidemiology, aetiologies, clinical and diagnostic characteristics, management, outcomes, and research gaps relating to heart failure in Somalia. METHODS: PubMed/MEDLINE, Scopus, and Embase were searched from inception to 27 July 2026. Backward citation searching was conducted on 3 August 2026.…

在ADRIATIC研究中，度伐利尤单抗单药作为局限期小细胞肺癌（LS-SCLC）的巩固治疗显示出良好的获益-风险特征。我们评估了度伐利尤单抗在LS-SCLC患者中的群体药代动力学（PopPK）和暴露-反应（E-R）关系。通过整合ADRIATIC研究的PK数据，对度伐利尤单抗的PopPK模型进行了更新。个体暴露指标由经验贝叶斯估计得出，用于与安全性（不良事件[AE]）和疗效（无进展生存期[PFS]和总生存期[OS]）相关的E-R分析。…

Durvalumab monotherapy as a consolidation treatment for limited-stage small-cell lung cancer (LS-SCLC) demonstrated a favourable benefit-risk profile in the ADRIATIC study. We evaluated population pharmacokinetics (PopPK) and exposure-response (E-R) relationships of durvalumab in patients with LS-SCLC. The durvalumab PopPK model was updated by integrating PK data from the ADRIATIC study. Individual exposure metrics were derived from empirical Bayes estimates for E-R analyses relating to safety (adverse events [AEs]) and efficacy (progression-free survival [PFS] and overall survival [OS]).…

目的：评估低强度脉冲超声（LIPUS）在促进产后子宫复旧和减轻产后并发症方面的临床疗效和安全性，并通过体外和体内实验动物模型探讨其作用的分子机制。方法：这项多中心、随机、双盲、对照试验于2023年1月至2024年12月在中国三个中心进行。参与者被随机分为LIPUS组或对照组。…

OBJECTIVE: To assess the clinical efficacy and safety of low-intensity pulsed ultrasound (LIPUS) in facilitating uterine involution after delivery and mitigating postpartum complications, and to explore its molecular mechanisms of action through both in-vitro and in-vivo experimental animal models. METHODS: This multicenter, randomized, double-blind, controlled trial was conducted across three centers in China from January 2023 to December 2024. Participants were randomized to a LIPUS group or a control group.…

目的：在接受低剂量阿司匹林预防的高危女性中，识别与后续发生早产型子痫前期（PE）相关的潜在危险因素——包括母体因素、PE特异性生物标志物以及基于孕早期胎儿医学基金会（FMF）三联检测得出的估计风险——并使用时间-事件分析评估任何起病类型子痫前期的预测因素。

OBJECTIVES: To identify potential risk factors - among maternal factors, pre-eclampsia (PE)-specific biomarkers and estimated risks derived from the first-trimester Fetal Medicine Foundation (FMF) triple test - that are associated with the subsequent development of preterm PE, and to evaluate predictors of any-onset PE using time-to-event analysis, in high-risk women receiving low-dose aspirin prophylaxis.…

基因编辑技术的突破已将猪-人异种移植推至临床前沿。然而，受者体内复杂的病理生理环境对移植物在微观尺度上的影响长期以来一直被学术界忽视。……

Breakthroughs in gene-editing technologies have brought pig-to-human xenotransplantation to the clinical forefront. Nevertheless, the micro-scale impacts of the complex pathophysiological milieu within recipients on grafts have long been overlooked by the academic community.…

糖尿病足溃疡与坏疽诊断和治疗指南第三版是由日本皮肤科学会伤口/压疮/烧伤指南起草委员会全面修订的指南。该指南采用推荐分级的评估、制定与评价（GRADE）方法，以系统、透明的方式制定。…

Guidelines for the diagnosis and treatment of diabetic foot ulcers and gangrenes, third edition, are fully revised guidelines drafted by the Japanese Dermatological Association Wound/Pressure Ulcer/Burn Guidelines Drafting Committee. They were developed in a systematic and transparent manner with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.…

背景：戒烟是改变慢性阻塞性肺疾病（COPD）临床病程最有效的干预措施，但许多患者在确诊后仍继续吸烟。我们在一项多中心随机戒烟试验中评估了伴有COPD的吸烟者在一年时与戒烟相关的特征。方法：这项预先指定的亚组分析纳入了被随机分配至立即转诊至戒烟门诊或常规护理的COPD患者。……

BACKGROUND: Smoking cessation is the most effective intervention for modifying the clinical course of chronic obstructive pulmonary disease (COPD), yet many patients continue to smoke after diagnosis. We evaluated the characteristics associated with cessation at one year among smokers with COPD in a multicentre randomised cessation trial. METHODS: This prespecified subgroup analysis included patients with COPD randomised to immediate referral to a smoking cessation clinic or to usual care.…

背景：头孢氨苄越来越多地用作重症感染的初始治疗和口服转换治疗，但在该情况下最佳剂量仍不确定。方法：将涵盖早产新生儿至年轻成人的四个头孢氨苄药代动力学（PK）数据集进行汇总，以建立统一的群体药代动力学模型。……

BACKGROUND: Cephalexin is increasingly used as initial and oral transition therapy for severe infections, but optimal dosing in this setting remains uncertain. METHODS: Four cephalexin pharmacokinetic (PK) datasets spanning preterm neonates through young adults were pooled to develop a unified population PK model.…

尽管机器人辅助全膝关节置换术（RA-TKA）因其提高手术精度的潜力而被越来越多地采用，但与传统全膝关节置换术（C-TKA）相比，其对功能结局的影响仍不明确。现有综合研究存在局限性，因为其合并了观察性与随机化数据，关注术后绝对评分而未评估恢复轨迹，并且缺乏对异质性的严格探索。…

Although robotic-assisted total knee arthroplasty (RA-TKA) is increasingly adopted for its potential to improve surgical precision, its impact on functional outcomes compared with conventional TKA (C-TKA) remains unclear. Existing syntheses are limited by pooling observational and randomized data, focusing on absolute postoperative scores without evaluating recovery trajectories, and lacking rigorous exploration of heterogeneity.…

背景：生境成像（HI）能够识别肿瘤异质性并表征肿瘤微环境。尽管基于MRI的HI已经成熟，但其基于CT或PET/CT的实施仍处于起步阶段且未被充分探索。目的：本系统综述分析了基于CT或PET/CT的HI在肿瘤诊断和治疗中的最新进展，评估其临床实用性和局限性。方法：在PubMed、Embase、Web of Science和Cochrane Library中系统检索了文献。采用影像组学质量评分（RQS）评估研究质量。…

BACKGROUND: Habitat imaging (HI) enables the identification of tumor heterogeneity and characterization of the tumor microenvironment. Although HI based on MRI is well-established, its implementation using CT or PET/CT remains nascent and underexplored. OBJECTIVE: This systematic review analyzes recent advances in HI based on CT or PET/CT for tumor diagnosis and treatment, evaluating its clinical utility and limitations. METHODS: Literatures were systematically searched in PubMed, Embase, Web of Science, and Cochrane Library. Study quality was assessed using the radiomics quality score (RQS).…

引言：胰腺导管腺癌（PDAC）预后较差，且超过90%的病例存在RAS基因突变。因此，直接抑制RAS是一种有前景但迄今难以实现的治疗策略。达拉索拉西（RMC-6236）是一种首创的口服、非共价、多选择性RAS活性形式抑制剂。它与亲环蛋白A形成细胞内三聚体复合物，从而阻断KRAS、NRAS和HRAS基因的突变型及野生型变体。…

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is associated with a poor prognosis, and RAS gene mutations are present in more than 90% of cases. For this reason, direct RAS inhibition is a promising, but thus far difficult to achieve, therapeutic strategy. Daraxonrasib (RMC-6236) is a first-in-class, oral, non-covalent, multiselective inhibitor of the active form of RAS. It forms an intracellular trimeric complex with cyclophilin A, blocking both mutant and wild-type variants of the KRAS, NRAS, and HRAS genes.…

目的：关于遗传性出血性毛细血管扩张症（HHT），亦称 Rendu-Osler-Weber 病患者中胰腺动静脉畸形（AVMs）的可用数据有限。本系统综述旨在识别所有已报道的 HHT 患者胰腺 AVM 病例，并总结患者人口学特征、临床表现、诊断方式、治疗策略及随访情况。设计：遵循系统综述和荟萃分析优先报告条目（PRISMA）指南进行系统综述。…

OBJECTIVES: Limited data are available on pancreatic arteriovenous malformations (AVMs) in patients with hereditary haemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber disease. This systematic review aimed to identify all reported cases of pancreatic AVMs in patients with HHT and summarise patient demographics, clinical presentation, diagnostic modalities, treatment strategies and follow-up. DESIGN: Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.…

引言：放射肿瘤学-AI MITO小组开展了一项系统综述，旨在梳理当前在接受放疗（RT）的妇科恶性肿瘤患者中基于AI的预测建模现状。目的是评估现有证据、方法学质量以及已有模型的临床适用性。方法：按照PRISMA指南，从PubMed、EMBASE和Scopus中检索相关研究。…

INTRODUCTION: The Radiation Oncology-AI MITO group conducted a systematic review to map the current landscape of AI-based predictive modelling in patients with gynaecological malignancies treated with radiotherapy (RT). The aim was to evaluate available evidence, methodological quality, and the clinical applicability of existing models. METHODS: Relevant studies were retrieved from PubMed, EMBASE, and Scopus following PRISMA guidelines.…