元界

目的：评估组织病理学确诊的原发性眼眶黑色素瘤（POM）的临床特征、治疗及预后。方法：按照PRISMA指南进行系统评价，并在PROSPERO注册。纳入报告1例或以上组织病理学确诊POM且具有可提取数据的研究；排除继发性眼眶受累及非原创报告。提取的数据包括人口统计学、临床特征、治疗和结局。……

PURPOSE: To evaluate the clinical characteristics, management, and outcomes for histopathologically confirmed primary orbital melanoma (POM). METHODS: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO. Studies reporting 1 or more patients with histopathologically confirmed POM and extractable data were included; secondary orbital involvement and nonoriginal reports were excluded. Data were extracted for demographics, clinical features, treatment, and outcomes.…

背景：有必要评估多组分非药物干预在预防和管理重症监护病房（ICU）谵妄中的疗效，并确定最有效的干预组合。方法：系统检索了PubMed、EMBASE、CINAHL、Cochrane Library及ProQuest Dissertations and Theses A&I数据库，检索时间从建库至2026年7月3日，并辅以对既往荟萃分析的手工检索。仅纳入随机试验。……

BACKGROUND: It is necessary to evaluate the efficacy of multicomponent non-pharmacological interventions in preventing and managing intensive care unit (ICU) delirium and identify the most effective intervention combinations. METHODS: A systematic literature search was conducted in PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest Dissertations and Theses A&I databases from inception to July 3, 2026, supplemented by a hand search of prior meta-analyses. Only randomized trials were included.…

背景：非稳态负荷（AL）指长期应激暴露导致的累积性生理失调。本系统综述和荟萃分析旨在评估产前AL与不良妊娠结局（APOs）之间的关联，并综合现有证据，为产前保健策略提供信息，并可能降低APOs的发生率。…

BACKGROUND: Allostatic load (AL) denotes the cumulative physiological dysregulation resulting from chronic stress exposure. This systematic review and meta-analysis aimed to evaluate the association between prenatal AL and adverse pregnancy outcomes (APOs), and to synthesize current evidence to inform prenatal health strategies and potentially reduce the incidence of APOs.…

背景：对住院患者临床恶化的识别失败已促使基于规则的电子监测（RB-ES）、基于预测模型的电子监测（PM-ES）和连续生理监测（CPM）的发展。然而，它们对以患者为中心的结局的比较效应仍不确定。目的：本研究旨在比较非重症监护病房医院环境中紧急强化RB-ES、PM-ES、CPM与当地标准护理的临床效果。

BACKGROUND: Failure to recognize clinical deterioration in hospitalized patients has prompted the development of rule-based electronic surveillance (RB-ES), predictive model-based electronic surveillance (PM-ES), and continuous physiologic monitoring (CPM). However, their comparative effects on patient-centered outcomes remain uncertain. OBJECTIVE: The aim of this study is to compare the clinical effects of emergent intensive RB-ES, PM-ES, CPM, and local standard care in nonintensive care unit hospital settings.…

背景：左心耳是心脏血栓的主要来源，心脏手术中预防性封闭左心耳可能降低血栓栓塞风险。然而，其在术前无心房颤动（AF）患者中的获益仍不确定。方法：我们检索了PubMed、Web of Science、EMBASE和Cochrane Library，以查找比较在接受心脏手术的窦性心律患者中外科左心耳封堵（LAAO）与未行LAAO的随机对照试验和观察性研究。…

BACKGROUND: The left atrial appendage is the primary source of cardiac thrombi, and prophylactic exclusion during cardiac surgery may reduce thromboembolic risk. However, its benefit in patients without preoperative atrial fibrillation (AF) remains uncertain. METHODS: We searched PubMed, Web of Science, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies comparing surgical left atrial appendage occlusion (LAAO) versus no LAAO in patients with sinus rhythm undergoing cardiac surgery.…

背景：妄想构成精神分裂症谱系障碍的一种跨诊断核心症状，并与不良功能结局相关。尽管近期大量努力成功地将神经精神症状映射到特定脑网络，但聚焦于妄想的网络定位的研究仍然很少。方法：我们最初对44项已发表的神经影像学研究进行了系统综述，以识别表现出与妄想相关的结构和功能改变的脑区。…

BACKGROUND: Delusions constitute a cross-diagnostic core symptom of schizophrenia spectrum disorders and correlate with poor functional outcomes. Despite much recent effort successfully mapping neuropsychiatric symptoms to specific brain networks, investigations focusing on network localization of delusions are still scarce. METHODS: We initially conducted a systematic review of 44 published neuroimaging studies to identify brain regions exhibiting structural and functional alterations associated with delusions.…

目的：本荟萃分析旨在综合英文随机对照试验（RCTs）的数据，以评估奥马珠单抗在6～20岁过敏性哮喘患者中的有效性和安全性，并在可行的情况下特别关注按年龄分层的结果。方法：本综述按照PRISMA 2020指南进行，并遵循预先注册的研究方案（PROSPERO：CRD420251132811）。…

OBJECTIVES: This meta-analysis aimed to synthesize data from English-language randomized controlled trials (RCTs) to evaluate the efficacy and safety of omalizumab in patients aged 6-20 years with allergic asthma, with specific attention to age-stratified outcomes where feasible. METHODS: Conducted in accordance with the PRISMA 2020 guidelines, this review followed a pre-registered protocol (PROSPERO: CRD420251132811).…

目的：本系统评价评估了在45-75岁成年人中使用粪便隐血试验（gFOBT或FIT）进行人群结直肠癌（CRC）筛查项目的有效性。方法：我们纳入了将人群结直肠癌筛查项目参与者与未筛查个体进行比较的研究。结局为全因死亡率、结直肠癌特异性死亡率、结直肠癌发病率和IV期结直肠癌发病率。两名审稿人独立完成研究筛选、数据提取和偏倚风险评估。…

PURPOSE: This systematic review evaluated the effectiveness of population-based colorectal cancer (CRC) screening programs using fecal occult blood tests (gFOBT or FIT) among adults aged 45-75 years. METHODS: We included studies comparing participants in population-based CRC screening programs with unscreened individuals. Outcomes were all-cause mortality, CRC-specific mortality, CRC incidence, and stage IV CRC incidence. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment.…

这项初步试验评估了帕金森病（PD）患者口服N-乙酰半胱氨酸（NAC）1200 mg/天一年的耐受性，并探讨了其与临床进展、左旋多巴剂量及纹状体多巴胺转运体显像的相关性。42例患者在常规治疗基础上，被随机分配至NAC组或匹配的安慰剂组，每日两次，持续12个月。完成者（n = 32）在基线和12个月时接受原始统一帕金森病评定量表（UPDRS）I-IV部分、99mTc-TRODAT-1单光子发射计算机断层扫描（SPECT）、处方左旋多巴剂量以及肝/肾功能检查评估。…

This pilot trial evaluated the one-year tolerability of oral N-acetylcysteine (NAC) 1200 mg/day in Parkinson's disease (PD) and explored associations with clinical progression, levodopa dose, and striatal dopamine-transporter imaging. Forty-two patients were randomized to NAC or matching placebo twice daily for 12 months in addition to usual care. Completers (n = 32) were assessed at baseline and 12 months with the original UPDRS parts I-IV, 99mTc-TRODAT-1 SPECT, prescribed levodopa dose, and liver/kidney tests.…

背景：非静脉曲张性上消化道出血（NVUGIB）是一种常见的急症，具有显著的发病率和死亡率。指南建议在24小时内进行内镜检查，但超早期内镜检查（≤6小时）的获益仍不明确，尤其是在高危患者中。本研究旨在系统评价与早期内镜检查（>6小时）相比，超早期内镜检查（≤6小时）是否能改善非静脉曲张性上消化道出血成年患者的临床结局，包括病死率、再出血、医疗资源利用以及高危亚组的结局。…

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common emergency with substantial morbidity and mortality. Guidelines recommend endoscopy within 24 hours, but the benefit of ultra-early endoscopy (≤6 hours) remains unclear, particularly in high-risk patients. This study aimed to systematically evaluate whether ultra-early endoscopy (≤6 hours) improves clinical outcomes compared with early endoscopy (>6 hours) in adult patients with nonvariceal upper gastrointestinal bleeding, including mortality, rebleeding, healthcare utilization, and outcomes in high-risk subgroups.…

目的：化疗所致恶心呕吐（CINV）在儿童肿瘤学中仍是一项重大挑战，指导最佳止吐方案的数据有限。本2期研究评估了口服奈妥匹坦联合口服帕洛诺司琼（NEPA）在接受高度或中度致吐化疗的儿童患者中的药代动力学（PK）、药效学、疗效和安全性。方法：在这项多中心、随机、双盲、剂量探索研究中，儿童患者（<18岁）按年龄、化疗致吐性和治疗方案进行分层。…

PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) remains a significant challenge in pediatric oncology, with limited data guiding optimal antiemetic regimens. This phase 2 study evaluated pharmacokinetics (PK), pharmacodynamics, efficacy, and safety of oral netupitant combined with oral palonosetron (NEPA) in pediatric patients receiving highly or moderately emetogenic chemotherapy. METHODS: In this multicenter, randomized, double-blind, dose-finding study, pediatric patients (< 18 years) were stratified by age, chemotherapy emetogenicity, and schedule.…

背景：运用网状Meta分析，比较非侵入性干预对I期脑卒中后肩手综合征（SHS）患者疼痛、上肢运动功能及日常生活活动能力的疗效。方法：系统检索评价非侵入性干预治疗I期SHS的随机对照试验。结局指标包括视觉模拟评分（VAS）、Fugl-Meyer上肢运动功能评定量表（FMA-UE）和Barthel指数（BI）。……

BACKGROUND: To compare the effectiveness of non-invasive interventions for pain, upper-limb motor function, and activities of daily living in patients with stage I post-stroke shoulder-hand syndrome (SHS) using network meta-analysis. METHODS: Randomized controlled trials evaluating non-invasive interventions for stage I SHS were systematically retrieved. Outcomes included visual analogue scale (VAS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), and Barthel Index (BI).…

《新英格兰医学杂志》，第395卷，第14期，第1374-1386页，2026年10月8日。

New England Journal of Medicine, Volume 395, Issue 14, Page 1374-1386, October 8, 2026.

职业倦怠包含高情感耗竭（EE）、高去人格化（DP）和低个人成就感（PA），由马斯勒职业倦怠量表（MBI）测量，在儿科牙医中仍缺乏充分的特征描述。本系统综述与荟萃分析旨在估计基于MBI的职业倦怠维度的患病率及相关因素，遵循在PROSPERO前瞻性注册的方案（CRD420251238894），并根据PRISMA 2020和MOOSE指南报告。……

Burnout, encompassing high emotional exhaustion (EE), high depersonalisation (DP), and low personal accomplishment (PA) as measured by the Maslach Burnout Inventory (MBI), remains poorly characterised among paediatric dentists. This systematic review and meta-analysis aimed to estimate prevalence of MBI-based burnout dimensions and associated factors, following a protocol prospectively registered with PROSPERO (CRD420251238894) and reported per PRISMA 2020 and MOOSE guidelines.…

目的：本研究旨在系统评价基于机器学习（ML）模型对中国糖尿病患者低血糖进行预测的预测性能。方法：我们系统检索了PubMed、Embase、Web of Science、Cochrane Library、CINAHL、CNKI和万方数据库，检索时间从建库至2026年2月。符合条件的研究聚焦于开发或验证用于预测中国糖尿病患者低血糖的机器学习模型。研究筛选和数据提取由两名评审员独立进行。…

OBJECTIVES: This study aimed to systematically evaluate the predictive performance of machine learning (ML)-based models for predicting hypoglycemia in Chinese patients with diabetes. METHODS: We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, CNKI, and Wanfang databases from inception to February 2026. Eligible studies focused on the development or validation of ML-based models for predicting hypoglycemia in Chinese patients with diabetes. Study selection and data extraction were performed independently by two reviewers.…

目的：评估当前比较高频（HF）（> 20 Hz）与低频（LF）（≤ 20 Hz）激光碎石术在行软性及/或硬性输尿管镜治疗肾和输尿管结石患者中的证据，重点关注无石率（SFR）、手术结局和安全性。方法：按照系统综述和荟萃分析优先报告的条目（PRISMA）指南进行了一项系统综述。…

PURPOSE: To evaluate the current evidence comparing high-frequency (HF) (> 20 Hz) versus low-frequency (LF) (≤ 20 Hz) laser lithotripsy in patients undergoing flexible and/or rigid ureteroscopy for renal and ureteral stones, with focus on stone-free rate (SFR), operative outcomes, and safety profiles. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.…

背景：预防性机械循环支持（MCS）在室性心动过速（VT）消融中的获益仍不明确。本荟萃分析比较了预防性MCS与标准治疗在VT消融中的有效性和安全性。方法：对PubMed、Embase和Web of Science进行无限制文献检索，以确定关于预防性MCS用于VT消融的研究。MCS包括经皮左心室辅助装置或体外膜肺氧合。……

BACKGROUND: The benefit of preemptive mechanical circulatory support (MCS) for ventricular tachycardia (VT) ablation remains unclear. This meta-analysis compared the efficacy and safety of preemptive MCS to standard care for VT ablation. METHODS: An unrestricted literature search of PubMed, Embase, and Web of Science identified studies on preemptive MCS for VT ablation. MCS included percutaneous left ventricular assist devices or extracorporeal membrane oxygenation.…

为比较三种用于适合顺铂的肌层浸润性膀胱癌（MIBC）的围手术期方案的疗效和安全性：恩诺单抗维多汀联合帕博利珠单抗（EV + P）、吉西他滨-顺铂联合度伐利尤单抗（GC + Durva）和剂量密集型MVAC（dd-MVAC），在缺乏头对头试验的情况下，采用贝叶斯网络荟萃分析（NMA）。一项截至2026年3月的系统检索确定了比较围手术期方案与GC用于适合顺铂的MIBC的III期试验。…

To compare the efficacy and safety of three perioperative regimens for cisplatin-eligible muscle-invasive bladder cancer (MIBC); enfortumab vedotin plus pembrolizumab (EV + P), gemcitabine-cisplatin plus durvalumab (GC + Durva), and dose-dense MVAC (dd-MVAC), in the absence of head-to-head trials, using a Bayesian network meta-analysis (NMA). A systematic search through March 2026 identified phase III trials comparing perioperative regimens against GC in cisplatin-eligible MIBC.…

背景：减轻膈肌功能障碍对于长期机械通气（PMV）患者十分重要。蛋白质补充、核心肌群康复和神经肌肉电刺激（NMES）在PMV患者中的临床影响尚不清楚。研究设计与方法：我们针对PMV危重症患者开展了一项单中心、前瞻性、随机对照预试验研究。…

BACKGROUND: Attenuating diaphragmatic dysfunction is important in patients with prolonged mechanical ventilation (PMV). The clinical impact of protein supplementation, core muscle rehabilitation and neuromuscular electrostimulation (NMES) in patients with PMV remains unknown. STUDY DESIGN AND METHODS: We conducted a single center, prospective, randomized controlled pilot study for critically ill patients with PMV .…

背景：心肌梗死（MI）患者的用药不依从性是心血管疾病管理的主要障碍。然而，缺乏以用药依从性行为的客观测量为重点的研究，尤其是随机对照试验（RCT）。……

BACKGROUND: Medication nonadherence in patients with myocardial infarction (MI) is a key obstacle to managing cardiovascular disease. However, there is a lack of studies, particularly randomized controlled trials (RCTs), focusing on objective measures of medication adherence behavior.…