元界

入住儿科重症监护病房（PICU）最常见的原因是哮喘。高流量鼻导管（HFNC）和双水平气道正压通气（BiPAP）是治疗重症哮喘的辅助疗法。本系统评价的目的在于评估HFNC和BiPAP在治疗儿童重症哮喘中的临床有效性。遵循PRISMA 2020指南，在PubMed、Scopus、Google Scholar、Embase、Lilacs和ProQuest中进行了截至2025年9月的全面检索。采用JBI偏倚风险评估工具进行偏倚评估。…

The most common reason for admission to the pediatric intensive care unit (PICU) is asthma. The high-flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP) are adjunctive therapies in the treatment of critical asthma. The purpose of this systematic review is to evaluate the clinical effectiveness of HFNC and BiPAP in the treatment of Pediatric critical asthma. Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, Google Scholar, Embase, Lilacs, and ProQuest till September 2025. Bias assessment was done using the JBI risk of bias tool.…

目的：评估早期活动对急性呼吸窘迫综合征（ARDS）患者的疗效。方法：计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、万方数据、CBM和VIP数据库，收集关于ARDS患者早期活动的随机对照试验（RCT）。检索时限为各数据库建库至2025年9月30日。由两名研究者按照Cochrane系统评价方法独立评估纳入文献质量和提取数据。…

OBJECTIVE: To evaluate the effect of early mobilization in patients with acute respiratory distress syndrome (ARDS). METHODS: Computerized searches were conducted in PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, CBM, and VIP databases for randomized controlled trials (RCTs) on early mobilization in ARDS patients. The retrieval period was from the establishment of each database to September 30, 2025. Two reviewers independently assessed the quality of included literature and extracted data in accordance with Cochrane systematic review methodology.…

背景：氯吡格雷已成为经皮冠状动脉介入治疗（PCI）后维持治疗中阿司匹林单药治疗的有前景的替代方案；然而，按性别划分的最佳抗血小板策略仍存在争议。目的：我们旨在探讨抗血小板治疗的治疗效果是否因性别而异。方法：本研究是SMART-CHOICE 3试验的一项预先设定的亚研究。…

BACKGROUND: Clopidogrel has emerged as a promising alternative to aspirin monotherapy for maintenance therapy after percutaneous coronary intervention (PCI); however, the optimal antiplatelet strategy according to sex remains controversial. AIMS: We aimed to investigate whether the treatment effect of antiplatelet therapy differs according to sex. METHODS: This study was a prespecified substudy of the SMART-CHOICE 3 trial.…

背景与目的：运动越来越多地用于肺癌的支持性护理，但其对抑郁症状的影响仍不确定。本系统评价与荟萃分析综合了随机证据。材料与方法：检索了四个电子数据库，查找自2000年1月至2026年7月发表的报告。符合条件的研究纳入肺癌成人患者，并将结构化运动干预与常规护理或符合条件的积极康复对照进行比较。…

Background and Objectives: Exercise is increasingly used in supportive care for lung cancer, but its effects on depressive symptoms remain uncertain. This systematic review and meta-analysis synthesized randomized evidence. Materials and Methods: Four electronic databases were searched for reports published from January 2000 to July 2026. Eligible studies enrolled adults with lung cancer and compared a structured exercise-based intervention with usual care or an eligible active rehabilitation comparator.…

背景：目前的卒中指南认为，既往3个月内的急性缺血性卒中（AIS）是静脉溶栓（IVT）的相对禁忌证，因为存在症状性颅内出血（sICH）的风险。该推荐主要基于专家共识，而越来越多的证据表明，重复静脉溶栓（RIVT）在经选择的患者中可能是可行的。目的：系统评价既往接受过IVT治疗的卒中后90天内发生复发性AIS时行RIVT的有效性和安全性。……

BACKGROUND: Current stroke guidelines consider a previous acute ischemic stroke (AIS) within 3 months a relative contraindication to intravenous thrombolysis (IVT) because of the perceived risk of symptomatic intracranial haemorrhage (sICH). The recommendation is largely based on expert consensus, while growing evidence suggests repeated IVT (RIVT) may be feasible in selected patients. AIMS: To systematically review the efficacy and safety of RIVT for recurrent AIS within 90 days of a previous IVT-treated stroke.…

肺移植传统上通过蚌壳式胸骨胸廓切开术或胸骨切开术进行，这些入路与疼痛、伤口愈合受损和慢性神经痛相关。机器人辅助技术直到最近才进入移植领域。我们系统评价了机器人辅助肺移植的临床经验。按照PRISMA 2020和PRISMA-S指南，我们检索了MEDLINE、Embase、Scopus、Web of Science和Cochrane CENTRAL，时间从建库至2026年8月15日，同时检索试验注册平台、会议摘要和中文文献来源，不设语言限制。……

Lung transplantation is conventionally performed through clamshell thoracosternotomy or sternotomy, approaches associated with pain, impaired wound healing, and chronic neuralgia. Robotic assistance has reached transplantation only recently. We systematically reviewed the clinical experience with robotic-assisted lung transplantation. Following PRISMA 2020 and PRISMA-S, we searched MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL from inception to 15 August 2026, with trial registries, conference abstracts, and Chinese-language sources, without language restriction.…

引言：来自非头颈部原发肿瘤的喉部转移性受累极为罕见，常被误诊为原发性喉部病变，并存在接受不恰当侵袭性外科治疗的风险。本系统综述旨在明确来自远处部位的喉部转移性肿瘤最常见的原发灶来源、临床特征、诊断评估、治疗及生存结局。…

INTRODUCTION: Metastatic involvement of the larynx from nonhead and neck primary tumors is an exceptionally rare event, frequently misdiagnosed as a primary laryngeal lesion and at risk of inappropriately aggressive surgical management. This systematic review aimed to define the most common primary sources, clinical features, diagnostic workup, treatment, and survival outcomes of tumors metastatic to the larynx from distant sites.…

理由：冠心病（CHD）是全球死亡的主要原因。冠心病死亡率在中低收入国家保持稳定，但在高收入国家正在下降，这意味着更多冠心病患者带病生存，需要支持以管理其症状和预后。基于运动的心脏康复（CR）旨在改善冠心病患者的健康结局。…

RATIONALE: Coronary heart disease (CHD) is the leading cause of death globally. CHD mortality rates remain steady in low- and middle-income countries but are declining in high-income countries, meaning more people are living with CHD and need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health outcomes of people with CHD.…

目的：尽管接受了指南指导的治疗，慢性心力衰竭（CHF）仍与症状负担、反复住院和生活质量降低相关。真武汤（ZWD）是一种经典中药方剂，用作阳虚水泛证的辅助治疗。本证据图谱旨在描述真武汤治疗慢性心力衰竭的临床研究的数量、分布、方法学质量和证据缺口。……

OBJECTIVE: Chronic heart failure (CHF) remains associated with symptom burden, recurrent hospitalization, and reduced quality of life despite guideline-directed therapy. Zhenwu Decoction (ZWD), a classical traditional Chinese medicine formula, is used as adjunctive therapy for yang-deficiency and fluid-retention patterns. This evidence map aimed to characterize the volume, distribution, methodological quality, and evidence gaps in clinical research on ZWD for CHF.…

背景：使用Sapien（Edwards Lifesciences，Irvine，CA）经导管心脏瓣膜进行的经导管二尖瓣置换术（TMVR）已成为高风险患者发生二尖瓣生物瓣衰败或既往外科二尖瓣修复术后的首选治疗方式。瓣中瓣TMVR（ViV-TMVR）与环中瓣TMVR（ViR-TMVR）在解剖学和手术复杂性上的差异可能影响临床结局。……

BACKGROUND: Transcatheter mitral valve replacement (TMVR) using the Sapien (Edwards Lifesciences, Irvine, CA) transcatheter heart valve has become the preferred treatment for high-risk patients with failed mitral bioprosthetic valves or prior surgical mitral valve repairs. Differences in anatomy and procedural complexity between valve-in-valve TMVR (ViV-TMVR) and valve-in-ring TMVR (ViR-TMVR) may influence clinical outcomes.…

目的：对心电图碎裂QRS（fQRS）与肺栓塞（PE）患者死亡率及其他临床结局的相关性，提供一项更新且方法学上更严谨的评估。设计：采用DerSimonian-Laird随机效应模型对观察性研究进行系统评价和荟萃分析，用于所有合并分析。异质性采用I²统计量评估，I²>50%表示存在显著异质性。研究质量采用纽卡斯尔-渥太华量表（NOS）评估，发表偏倚通过漏斗图目视检查评估。…

OBJECTIVES: To provide an updated and methodologically rigorous assessment of the association of fragmented QRS (fQRS) on ECG with mortality and other clinical outcomes in patients with pulmonary embolism (PE). DESIGN: Systematic review and meta-analysis of observational studies using a DerSimonian-Laird random-effects model for all pooled analyses. Heterogeneity was assessed using the I² statistic, with I²>50% indicating substantial heterogeneity. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS), and publication bias was assessed by funnel plot inspection.…

目的：系统评价2型（T2）炎症相关生物标志物如何被纳入预测成人哮喘未来急性发作的多变量模型，并评估模型性能、验证、校准、偏倚风险和临床适用性。方法：检索PubMed、Embase、Web of Science、Cochrane Library和Scopus，检索时间从建库至2026年5月，随后为截止至2026年7月31日的PubMed补充更新。……

OBJECTIVE: To systematically evaluate how type 2 (T2) inflammation-related biomarkers are incorporated into multivariable models that predict future acute exacerbations in adults with asthma, and to appraise model performance, validation, calibration, risk of bias, and clinical applicability. METHODS: PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were searched from inception to May 2026, followed by a supplementary PubMed update through 31 July 2026.…

背景：基于PARP抑制剂的维持治疗已成为新诊断晚期卵巢癌一线治疗的核心。随着治疗选择的不断扩展，治疗决策越来越依赖于BRCA突变和同源重组缺陷（HRD）状态。2026年NCCN指南强调以生物标志物为导向的维持治疗；然而，不同分子亚组间的比较性证据仍然有限。我们开展了一项更新的网络荟萃分析，以比较基于PARP抑制剂的一线维持策略的疗效和安全性。

BACKGROUND: PARP inhibitor-based maintenance has become central to first-line treatment of newly diagnosed advanced ovarian cancer. With expanding therapeutic options, treatment selection increasingly relies on BRCA mutation and homologous recombination deficiency (HRD) status. The 2026 NCCN Guidelines emphasize biomarker-directed maintenance; however, comparative evidence across molecular subgroups remains limited. We conducted an updated network meta-analysis to compare efficacy and safety of PARP inhibitor-based first-line maintenance strategies.…

目的：为筛查和咨询孕妇及育龄个体关于酒精摄入和酒精使用障碍的问题，制定国家护理标准。预期使用者：护理孕妇和育龄女性的医疗保健提供者。目标人群：孕妇和育龄女性及其家庭。证据：检索了Medline、EMBASE和CENTRAL数据库中关于“酒精使用与妊娠”的文献。检索结果按发表日期在2018年10月至2026年2月之间进行了筛选。…

OBJECTIVE: To establish national standards of care for screening and counselling pregnant women and individuals of reproductive age regarding alcohol consumption and alcohol use disorder. INTENDED USERS: Health care providers who care for pregnant women and women of childbearing age. TARGET POPULATION: Pregnant women and women of childbearing age and their families. EVIDENCE: Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy". The results were filtered for a publication date between October 2018 and February 2026.…

背景：将他莫昔芬与高甘油三酯血症（HTG）相关联的证据主要来自病例报告。本研究旨在评估临床特征，并为改善识别与管理提供证据。方法：检索至2026年2月25日，数据库包括中国知网（CNKI）、万方、维普、Web of Science、PubMed、Embase和Elsevier。收集关于他莫昔芬诱发高甘油三酯血症（HTG）的病例报告和病例系列并进行描述性分析。…

BACKGROUND: Evidence linking tamoxifen to hypertriglyceridemia (HTG) is mainly derived from case reports. This study aimed to evaluate clinical characteristics and provide evidence to improve identification and management. METHODS: Databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Web of Science, PubMed, Embase, and Elsevier were searched up to 25 February 2026. Case reports and case series on tamoxifen-induced hypertriglyceridemia (HTG) were collected and descriptively analyzed.…

理由：子宫内膜异位症被定义为子宫内膜样组织出现在子宫腔外。该疾病依赖雌激素，因此主要见于育龄期。由于孕激素受体调节剂（PRM）对子宫内膜具有抗增殖作用，已被提倡用于治疗子宫内膜异位症。这是对先前发表于2017年的Cochrane系统评价的更新。目的：评估孕激素受体调节剂（PRM）在治疗子宫内膜异位症中的有效性和安全性。…

RATIONALE: Endometriosis is defined as the presence of endometrium-like tissue developing outside the uterine cavity. This condition is oestrogen-dependent and thus is seen primarily during the reproductive years. Owing to their antiproliferative effects on the endometrium, progesterone receptor modulators (PRMs) have been advocated for the treatment of endometriosis. This is an update of a Cochrane review previously published in 2017. OBJECTIVES: To assess the effectiveness and safety of progesterone receptor modulators (PRMs) in the management of endometriosis.…

引言：N-乙酰半胱氨酸（NAC）在小动物医学中用作解毒剂、黏液溶解剂、硫醇供体和细胞保护辅助药物，但其证据基础在不同适应症之间以及犬与猫之间存在显著差异。我们系统评估了物种特异性药代动力学、临床、实验和体外证据，以区分已确立的用途与基于外推的实践。

INTRODUCTION: N-acetylcysteine (NAC) is used in small-animal medicine as an antidote, mucolytic, thiol donor, and cytoprotective adjunct, yet its evidentiary basis varies markedly among indications and between dogs and cats. We systematically evaluated species-specific pharmacokinetic, clinical, experimental, and in vitro evidence to distinguish established uses from extrapolated practice.…

背景：谵妄是一种常见且临床上重要的急性院内精神状态恶化形式。基于电子健康记录（EHR）的预测模型可能有助于早期识别和针对性预防，但其方法学质量、验证严谨性和临床就绪程度仍不确定。目的：本系统综述旨在综合并批判性评估使用常规收集的EHR数据开发的院内谵妄预测模型，重点关注模型特征、验证策略、性能、偏倚风险和临床适用性。…

BACKGROUND: Delirium is a common and clinically important form of acute in-hospital mental status deterioration. Electronic health record (EHR)-based prediction models may support early identification and targeted prevention, but their methodological quality, validation rigor, and clinical readiness remain uncertain. OBJECTIVE: This systematic review aimed to synthesize and critically evaluate prediction models for in-hospital delirium developed using routinely collected EHR data, focusing on model characteristics, validation strategies, performance, risk of bias, and clinical applicability.…

理由：预防骨折的药物疗法通常针对骨质疏松症，这是一种以骨量或骨质量（或两者）受损为特征的骨骼疾病。由于骨质疏松症试验中的大多数参与者为女性，因此有必要对男性骨折预防的药物疗法进行综述。目的：确定双膦酸盐、甲状旁腺激素（PTH）或甲状旁腺激素相关蛋白（PTHrP）类似物、地舒单抗和罗莫佐单抗治疗用于预防男性骨折的获益和危害。……

RATIONALE: Pharmacological therapies for fracture prevention usually target osteoporosis, a skeletal disorder characterised by compromised bone mass or quality (or both). As most participants in osteoporosis trials are women, a review of pharmacological therapies for fracture prevention in men was warranted. OBJECTIVES: To determine the benefits and harms of bisphosphonates, parathyroid (PTH) or parathyroid-related protein (PTHrP) analogues, denosumab, and romosozumab therapy for the prevention of fractures in men.…

引言：替奈普酶（TNK）已成为急性缺血性卒中（AIS）静脉溶栓中阿替普酶（tPA）的有前景的替代药物。本研究旨在评价TNK与tPA相比的有效性和安全性。方法：遵循PRISMA 2020指南，系统检索了PubMed、Web of Science、Cochrane Central、EBSCO和Scopus从建库至2026年1月的文献，以纳入比较TNK与tPA在成人AIS患者中应用的随机对照试验（RCTs）和观察性研究。…

INTRODUCTION: Tenecteplase (TNK) has emerged as a promising alternative to alteplase (tPA) for intravenous thrombolysis in acute ischemic stroke (AIS). This study aimed to evaluate the efficacy and safety of TNK compared with tPA. METHODS: Following the PRISMA 2020 guidelines, PubMed, Web of Science, Cochrane Central, EBSCO, and Scopus were systematically searched from inception through January 2026 to identify randomized controlled trials (RCTs) and observational studies comparing TNK with tPA in adults with AIS.…