Shared Decision Making (SDM), as a "patient-centered" medical decision-making model, has gradually demonstrated its application value in the diagnosis and treatment of esophageal diseases. This study is a structured narrative review (without quantitative synthesis or heterogeneity assessment). This structured narrative review systematically searched databases including PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) from 1990 to 2026 for clinical studies, meta-analyses, and guideline documents related to SDM in the field of esophageal diseases.It clarified the application scenarios and implementation pathways of SDM in major esophageal diseases such as esophageal cancer and gastroesophageal reflux disease. especially focusing on surgical decision-making in esophageal cancer.Meanwhile, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, this study critically analyzed the advantages of SDM in enhancing patient decision-making satisfaction, optimizing the doctor-patient relationship, and formulating individualized treatment plans. It also objectively expounded on real-world challenges, including the lag in physicians' conceptual transformation, variations in patients' ability to participate, and limitations in medical resources. This study innovatively constructed a three-dimensional SDM implementation framework of "disease classification - evidence hierarchy - patient preference" and proposed differentiated application strategies tailored to the clinical characteristics of different esophageal diseases. The research findings provide evidence-based support for the standardized application of SDM in clinical practice for esophageal diseases and lay a foundation for clarifying future research directions in this field.

INTRODUCTION: Patients undergoing primary restrictive bariatric metabolic surgery procedures (BMS) are at risk of having suboptimal initial response (SIR) and late postoperative clinical deterioration (LPCD), which can be an indication for conversion. Roux-en-Y gastric bypass (RYGB) is currently the most common conversion procedure. Still, one anastomosis gastric bypass (OAGB) has emerged as a viable alternative conversion procedure to RYGB, due to its relative technical simplicity and easy reversibility. We aim to assess the safety and effectiveness of laparoscopic OAGB as a conversion procedure for managing SIR or LPCD after primary restrictive BMS procedures. METHODS: A retrospective observational study was conducted at our university hospital between July 2017 and December 2024. It included patients with failed primary restrictive bariatric procedures. All patients underwent conversion to OAGB and were followed for a minimum of 5 years. RESULTS: 115 patients completed the 5-year follow-up. The early postoperative complication rate was 7.6%, and the reoperation rate was 1.6%. After 5 years, late postoperative complications occurred in 11.3% of patients. The mean body mass index loss (BMIL%) was 28.59% and 17.4% of patients had SIR during the study period. Significant improvement in obesity-associated medical problems was observed after 5 years, with remission rates of 70.8% for type 2 diabetes mellitus, 82.4% for dyslipidemia, 64.1% for sleep apnea, and 61.3% for hypertension. CONCLUSION: OAGB is a safe and effective conversion procedure for the management of SIR and LPCD after restrictive procedures, achieving favorable mid-term outcomes.

Objective:To evaluate the real-world efficacy and safety of stapokibart in the treatment of moderate-to-severe chronic rhinosinusitis with nasal polyps（CRSwNP） and to explore baseline predictors for quality-of-life improvement. Methods:This prospective study included 36 patients with moderate-to-severe CRSwNP who received stapokibart treatment（300 mg every 2 weeks for 16 weeks）. Observational indicators included SNOT-22 scores, total nasal Visual Analog Scale（VAS） scores, olfactory function scores, nasal polyp scores（NPS）, sinus CT Lund-Mackay scores, and peripheral blood eosinophil counts. The primary endpoints were the mean changes from baseline in the SNOT-22 score and nasal endoscopy-assessed nasal polyp score（NPS） at Week 16. Univariate random intercept mixed linear models were employed to evaluate factors influencing therapeutic response. Results:After 16 weeks of treatment, both subjective and objective indicators showed significant improvement: the mean SNOT-22 score decreased from（45.90±15.60） at baseline to（18.20±13.60）, the NPS improved by an average of（2.72±1.93） points, and the Sniffin'Sticks olfactory identification score increased by（5.36±3.84） points（all P<0.001）. Olfactory symptoms exhibited early improvement by week 2 of treatment. The univariate random intercept mixed linear model revealed that baseline variables-including age, BMI, history of surgery, allergic rhinitis, history of asthma, and peripheral blood counts-did not significantly predict the longitudinal improvement trend of the SNOT-22 score（P>0.05）. Regarding safety, injection site reactions involving swelling and pain were the most frequently reported adverse events, and no serious adverse events occurred. Conclusion:Stapokibart demonstrated significant and rapid efficacy with a favorable safety profile in real-world clinical practice for moderate-to-severe CRSwNP, showing strong applicability across different baseline patient characteristics.

BACKGROUND: Anxiety is one of the most prevalent mental health problems in adolescence, and its onset often coincides with the secondary school years. Mindfulness-based interventions (MBIs) have shown short-term benefits for reducing anxiety in young people, but the durability of these benefits after treatment remains uncertain. To inform clinical and school-based practice, a quantitative synthesis focused specifically on follow-up effects is needed. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating MBIs in adolescents aged 10-19 years and reporting anxiety outcomes at follow-up assessments conducted at least 3 months after the intervention. The review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251234254). Major databases (PubMed, Embase, Web of Science, Cochrane Library, Scopus and CNKI) were searched from inception to November 2025. Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane RoB 2 tool. Standardized mean differences (SMDs; Hedges' g) with 95% confidence intervals (CIs) were calculated under a random-effects model. Pre-specified subgroup analyses were conducted by age group (10-14 vs. 15-19 years), intervention type (MBSR/MBCT vs. mindfulness-based stress prevention, MBSP), and follow-up interval (3-6 vs. ≥6 months). Univariable meta-regression explored the impact of mean age and total intervention duration on effect sizes. Certainty of evidence for key outcomes was rated using GRADE. RESULTS: Eleven randomized controlled trials (n = 9,856 adolescents) were included. Overall, MBIs were associated with a modest reduction in anxiety symptoms at follow-up assessments ≥ 3 months after treatment (SMD = - 0.30, 95% CI - 0.44 to - 0.16; I² = 79%). Subgroup analyses indicated a moderate effect at 3-6 months (SMD = - 0.40, 95% CI - 0.56 to - 0.25; I² = 52%) but a very small effect at ≥ 6 months (SMD = - 0.09, 95% CI - 0.14 to - 0.05; I² = 0%), with a significant difference between subgroups (p < 0.001). CONCLUSIONS: MBIs may confer a modest follow-up benefit on adolescent anxiety, driven mainly by outcomes measured at 3-6 months. Evidence at ≥ 6 months is limited and of low certainty, and does not support a firm conclusion regarding maintenance of effects. Future trials should test whether maintenance-focused components, such as booster sessions or ongoing practice support, improve durability.

BACKGROUND: Ovarian vein thrombophlebitis (OVT) is a rare but serious postpartum complication. This report presents a case of OVT with acute pyelonephritis successfully managed at our hospital. By summarizing the clinical course, diagnostic process, and treatment-alongside a literature review-it aims to improve clinical recognition and management of this uncommon condition. CASE PRESENTATION: A 28-year-old woman in the early postpartum period was admitted to the Department of Obstetrics and Gynecology with persistent high fever and flank pain. Diagnostic evaluations included contrast-enhanced abdominal computed tomography (CT), urinary tract ultrasonography, and routine blood and urine tests. A multidisciplinary team formulated an individualized treatment plan consisting of right-sided ureteral double-J stent placement, antimicrobial therapy with meropenem, anticoagulation with low-molecular-weight heparin, and supportive care including fluid resuscitation. Based on clinical symptoms, physical examination, and imaging findings, a diagnosis of ovarian vein thrombophlebitis (OVT) complicated by acute pyelonephritis was established. The patient responded well to the comprehensive treatment regimen, with significant reductions in inflammatory markers-white blood cell count (WBC), neutrophil percentage (NEUT), C-reactive protein (CRP), and procalcitonin (PCT). Coagulation function normalized, and both fever and flank pain were notably alleviated. She achieved full recovery after 15 days of hospitalization and showed no abnormalities at the 42-day postpartum follow-up. CONCLUSIONS: OVT complicated with acute pyelonephritis often manifests as persistent postpartum fever and flank pain, with poor response to first- and second-line antibiotics. Diagnosis relies on contrast-enhanced abdominal CT and urinary tract ultrasound, supplemented by coagulation studies. Early ureteral double-J stent placement, combined with third-line antibiotic therapy and anticoagulation, is essential for effective infection control and prevention of thrombus progression. In postpartum patients with unexplained fever and flank pain, clinicians should maintain a high index of suspicion for OVT and complicated urinary tract infections.

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BACKGROUND: Post-cardiac arrest syndrome (PCAS) is a critical condition arising from systemic inflammation and ischemia-reperfusion injury, often leading to poor outcomes despite advanced supportive therapies. Cytokine adsorption has been proposed as a therapeutic approach to mitigate the inflammatory response and improve survival and recovery in PCAS patients. MATERIALS AND METHODS: This narrative review aims to synthesize and critically evaluate recent literature (2013-2024) on the role of cytokine adsorption in PCAS management, focusing on inflammatory modulation, clinical outcomes, and safety. A comprehensive search of PubMed, Cochrane Library, Embase, Medline Complete, Scopus and Web of Science identified 17 studies investigating cytokine adsorption in PCAS. Inclusion criteria encompassed clinical trials, observational studies, and preclinical investigations. RESULTS: Cytokine adsorption reduces inflammatory markers, particularly interleukin-6 (IL-6), in patients with PCAS. While some studies report modest improvements in hemodynamic stability and reduced vasopressor requirements, survival benefits remain inconsistent across the literature. CONCLUSIONS: Cytokine adsorption appears to be a safe and feasible intervention in PCAS, with potential benefits in inflammatory modulation and hemodynamic support. However, its impact on long-term survival and neurological recovery remains unclear. Future large-scale randomized controlled trials are needed to establish definitive clinical guidelines for its use in PCAS management.

Non-invasive brain stimulation techniques, such as transcranial electric stimulation (tES), are increasingly promoted as methods to enhance attention. However, their efficacy and optimal stimulation targets remain uncertain. We conducted a preregistered meta-analysis of randomized controlled trials in healthy adults (58 trials, 295 outcomes) examining the effects of tES on attentional functions (PROSPERO: CRD42023487035), complemented by a performance-electric field correlation (PEC) analysis to identify brain regions most strongly linked to tES-induced behavioral improvements. In general, tES produced a small but significant improvement in attentional functions compared to control conditions (standardized mean difference [SMD] = 0.24, 95% confidence interval [CI] = 0.12-0.36, I2 = 61%). Small but consistent benefits were observed in trials assessing attentional functions after stimulation (40 trials, SMD = 0.23, 95% CI = 0.12-0.33, I2 = 39%) and in trials applying anodal transcranial direct current stimulation (tDCS) targeting prefrontal regions (vs sham; 31 trials, SMD = 0.26, 95% CI = 0.12-0.39, I2 = 46%) with no evidence of publication bias or serious imprecision. The PEC analysis further revealed that tDCS-induced electric fields in the ventral subregion of the left dorsolateral prefrontal cortex (left vDLPFC) were most strongly associated with improvements in attentional functions following tDCS. Taken together, these findings suggest that tES may enhance attentional functions and the left vDLPFC may be a potential target for future tES studies aiming to improve attention.

BACKGROUND: Adjunctive corticosteroids improve outcomes in hospitalized patients with community-acquired pneumonia (CAP), but whether higher-dose regimens provide additional benefit over lower-dose regimens remains uncertain. METHODS: We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) up to January 25, 2026. Interventions were standardized to protocol-assigned dexamethasone-equivalent doses: high (≥ 7.5 mg/d) and low (< 7.5 mg/d). A frequentist network meta-analysis was performed. The primary outcome was short-term all-cause mortality. Confidence in network meta-analysis estimates was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. RESULTS: 32 RCTs involving 9,746 participants were included. Compared with placebo or usual care, higher-dose corticosteroids were associated with lower short-term mortality (Risk Ratio [RR], 0.83; 95% Confidence Interval [CI], 0.74-0.92), as were lower-dose corticosteroids (RR, 0.84; 95% CI, 0.75-0.95). The indirect comparison showed no clear difference between higher- and lower-dose regimens (RR, 0.98; 95% CI, 0.83-1.16). In severe patients with CAP, the corresponding indirect estimate was RR 1.01 (95% CI, 0.77-1.33). Most secondary active-dose comparisons were imprecise and showed no consistent advantage of either strategy. CONCLUSION: Compared with placebo or usual care, lower-dose corticosteroids (moderate confidence) and higher-dose corticosteroids (low confidence) were both associated with lower short-term mortality. The indirect higher-versus-lower dose comparison showed no clear mortality difference between dose categories; confidence in this comparison was low. Future research should prioritize large, head-to-head RCTs designed to evaluate whether selected inflammatory phenotypes benefit from higher-dose corticosteroids.

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease caused by JC polyomavirus (JCV) that affects immunosuppressed individuals and has no approved therapy. Here we evaluate the safety and efficacy of third-party, off-the-shelf, partially HLA-matched BK virus-specific T cells (BK-VST) in patients with PML. METHODS: We conducted a single-center phase 2 study where 37 patients received most closely HLA-matched BK-VST at 2.0 x 105 T cells/kg, with additional infusions permitted for subjects who did not achieve a complete response. Twenty-three patients had an underlying diagnosis of hematologic malignancy. Each patient received a median of 2 doses (range, 1-12; IQR 2). Overall response (OR) was defined as virologic clearance with neurologic stabilization or improvement. RESULTS: During 12 months of follow-up, 21 patients (56.8%) achieved an OR, including 16 (43.2%) with a complete response. Responses were rapid (median 23 days) and durable, with no loss of response observed despite limited HLA matching. The 1-year overall survival was 61.1% (95% CI, 41.9-77.4). Patients achieving an OR after the first infusion had markedly improved 1-year survival compared with non-responders (93.3% vs 0%; p<0.001). Higher donor IL-2 and IFN-γ-producing T-cell frequencies and greater HLA matching correlated with clinical benefit. CONCLUSIONS: These data demonstrate that third-party BK-VST infusions are safe and potentially effective, supporting a scalable immunotherapeutic approach for this otherwise fatal disease. (ClinicalTrials.gov NCT02479698).