Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

Theory and technology of Medical Immunology are widely used in scientific research.Our teaching and research group uses experimental teaching of Medical Immunology as a platform to carry out practice of scientific research project-based experi-mental system among"5+3"integration students.By completing a mini-project research including experimental design-experimental operation-research article writing,students cultivated scientific research thinking and exercised scientific research practice ability,and generally reported that the course is very difficult,but after completing it,it is very rewarding.

Objective:To observe the clinical efficacy and effects on emotional state, anorectal physiological function, serum inflammation factors and neurotransmitters of repetitive transcranial magnetic stimulation (rTMS) on functional anorectal pain (FAP) patients, and to explore the potential therapeutic mechanisms.Methods:From September 1, 2022 to December 31, 2023, a total of 50 FAP patients who were admitted to Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine were enrolled in this study. The patients were randomly divided into the treatment group (20 cases) and the control group (20 cases) according to a random number table and relevant exclusion criteria. The treatment group received rTMS treatment and the control group received sham rTMS treatment. The Hamilton anxiety scale (HAMA) score, Hamilton depression scale (HAMD) score, visual analogue scale (VAS) score, high-resolution anorectal manometry data (anal resting pressure, anal squeeze pressure, initial sensation shreshold, defecation shreshold, defecation urgency shreshold, and tolerance shreshold), and the levels of serum inflammatory factors (interleukin(IL)-4, IL-8, tumor necrosis factor-α) and 5-hydroxytryptamin(5-HT) were recorded before and after treatment. Independent sample t-test, paired t-test, Mann-Whitney U test and Wilcoxon signed-rank test were used for statistical analysis. Results:The VAS, HAMA, and HAMD scores of the treatment group after treatment were lower than those before treatment (3.85±2.23 vs. 6.85±1.98, 4.40±3.39 vs. 8.75±6.60, and 7.10±6.56 vs. 12.85±7.20), and were also lower than those of the control group after treatment(6.50±1.76, 8.20±6.65, 12.10±6.80), and the differences were statistically significant ( t=5.68, 4.72, 6.06; -4.17, -2.27, -2.37; P<0.001, <0.001, <0.001; <0.001, =0.028, and =0.023). The initial sensation shreshold, defecation shreshold, defecation urgency shreshold, and tolerance shreshold of the treatment group after treatment were higher than those before treatment(30.00(30.00, 46.00) mmHg (1 mmHg=0.133 kPa) vs. 23.00(18.50, 29.00) mmHg, 50.00(44.50, 60.00) mmHg vs. 37.00(30.75, 51.50) mmHg, (74.30±16.02) mmHg vs. (63.70±22.21) mmHg, 119.00(100.00, 148.00) mmHg vs. 98.00 (69.50, 153.00) mmHg), and the tolerance shreshold of the treatment group after treatment was higher than that of the control group after treatment(119.00 (100.00, 148.00) mmHg vs. 102.00(84.50, 111.50) mmHg), and the differences were statistically significant ( Z=–3.14 and –2.86, t=-4.02, Z=-2.84 and -2.11; P=0.002, 0.004, 0.001, 0.004, and 0.035). Additionally, the 5-HT level of the treatment group after treatment was higher than that before treatment (1 549.41 (1 320.21, 1 640.03) μg/L vs. 1 081.52(874.36, 1 626.79) μg/L), and the difference was statistically significant ( Z=-2.88, P=0.004). Conclusion:The rTMS treatment can effectively relieve the pain, anxiety and depression, improve visceral sensitivity, and influence the neurotransmitter level of brain-gut axis in FAP patients.

With the rapid development of artificial intelligence(AI),how to digitize the teaching of Medical Immunology is a new challenge posed by the times and education.This study is based on the advanced teaching model of Medical Immunology,which includes lectures-PAD class-flipped classrooms-expert lecture.By introducing knowledge mapping and AI teaching assistant into the entire learning process,the students not only deepen their understanding of the knowledge system of Medical Immunology,but also ex-ercise their ability to apply immunological knowledge to solve practical clinical problems,enhance their self-learning ability,expres-sion ability,communication ability,on-site performance ability,and cultivate a spirit of unity,cooperation,and exploration.The practice of empowering Medical Immunology teaching with digital intelligence achieves the integration of theory and application,the linkage between in class and out of class teaching,the connection between commonalities and individualities,and the union of abili-ties and qualities in Medical Immunology teaching.It also provides practical basis for exploring the implementation path of digital intel-ligence empowerment in Medical Immunology teaching.

With the rapid development of artificial intelligence(AI),how to digitize the teaching of Medical Immunology is a new challenge posed by the times and education.This study is based on the advanced teaching model of Medical Immunology,which includes lectures-PAD class-flipped classrooms-expert lecture.By introducing knowledge mapping and AI teaching assistant into the entire learning process,the students not only deepen their understanding of the knowledge system of Medical Immunology,but also ex-ercise their ability to apply immunological knowledge to solve practical clinical problems,enhance their self-learning ability,expres-sion ability,communication ability,on-site performance ability,and cultivate a spirit of unity,cooperation,and exploration.The practice of empowering Medical Immunology teaching with digital intelligence achieves the integration of theory and application,the linkage between in class and out of class teaching,the connection between commonalities and individualities,and the union of abili-ties and qualities in Medical Immunology teaching.It also provides practical basis for exploring the implementation path of digital intel-ligence empowerment in Medical Immunology teaching.

Theory and technology of Medical Immunology are widely used in scientific research.Our teaching and research group uses experimental teaching of Medical Immunology as a platform to carry out practice of scientific research project-based experi-mental system among"5+3"integration students.By completing a mini-project research including experimental design-experimental operation-research article writing,students cultivated scientific research thinking and exercised scientific research practice ability,and generally reported that the course is very difficult,but after completing it,it is very rewarding.

Objective:To observe the clinical efficacy and effects on emotional state, anorectal physiological function, serum inflammation factors and neurotransmitters of repetitive transcranial magnetic stimulation (rTMS) on functional anorectal pain (FAP) patients, and to explore the potential therapeutic mechanisms.Methods:From September 1, 2022 to December 31, 2023, a total of 50 FAP patients who were admitted to Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine were enrolled in this study. The patients were randomly divided into the treatment group (20 cases) and the control group (20 cases) according to a random number table and relevant exclusion criteria. The treatment group received rTMS treatment and the control group received sham rTMS treatment. The Hamilton anxiety scale (HAMA) score, Hamilton depression scale (HAMD) score, visual analogue scale (VAS) score, high-resolution anorectal manometry data (anal resting pressure, anal squeeze pressure, initial sensation shreshold, defecation shreshold, defecation urgency shreshold, and tolerance shreshold), and the levels of serum inflammatory factors (interleukin(IL)-4, IL-8, tumor necrosis factor-α) and 5-hydroxytryptamin(5-HT) were recorded before and after treatment. Independent sample t-test, paired t-test, Mann-Whitney U test and Wilcoxon signed-rank test were used for statistical analysis. Results:The VAS, HAMA, and HAMD scores of the treatment group after treatment were lower than those before treatment (3.85±2.23 vs. 6.85±1.98, 4.40±3.39 vs. 8.75±6.60, and 7.10±6.56 vs. 12.85±7.20), and were also lower than those of the control group after treatment(6.50±1.76, 8.20±6.65, 12.10±6.80), and the differences were statistically significant ( t=5.68, 4.72, 6.06; -4.17, -2.27, -2.37; P<0.001, <0.001, <0.001; <0.001, =0.028, and =0.023). The initial sensation shreshold, defecation shreshold, defecation urgency shreshold, and tolerance shreshold of the treatment group after treatment were higher than those before treatment(30.00(30.00, 46.00) mmHg (1 mmHg=0.133 kPa) vs. 23.00(18.50, 29.00) mmHg, 50.00(44.50, 60.00) mmHg vs. 37.00(30.75, 51.50) mmHg, (74.30±16.02) mmHg vs. (63.70±22.21) mmHg, 119.00(100.00, 148.00) mmHg vs. 98.00 (69.50, 153.00) mmHg), and the tolerance shreshold of the treatment group after treatment was higher than that of the control group after treatment(119.00 (100.00, 148.00) mmHg vs. 102.00(84.50, 111.50) mmHg), and the differences were statistically significant ( Z=–3.14 and –2.86, t=-4.02, Z=-2.84 and -2.11; P=0.002, 0.004, 0.001, 0.004, and 0.035). Additionally, the 5-HT level of the treatment group after treatment was higher than that before treatment (1 549.41 (1 320.21, 1 640.03) μg/L vs. 1 081.52(874.36, 1 626.79) μg/L), and the difference was statistically significant ( Z=-2.88, P=0.004). Conclusion:The rTMS treatment can effectively relieve the pain, anxiety and depression, improve visceral sensitivity, and influence the neurotransmitter level of brain-gut axis in FAP patients.

Objective To explore the application of polysomnography combined with arterial spin labeling(ASL)perfusion magnetic resonance imaging in the diagnosis of insomnia.Methods Forty-two insomnia patients admitted to Department of Neurology were included as insomnia group,while 41 healthy subjects during the same period were included as control group.The two groups were assessed using sleep habits questionnaire,hospital anxiety and depression scale,polysomnography,and ASL perfusion magnetic resonance imaging.Results Compared with control group,insomnia group took significantly more time to fall asleep(P<0.05),and has shorter sleep duration(P<0.05).The differences in the levels of anxiety and depression between two groups were trivial.The total sleep time,rapid eye movement sleep duration,and non-rapid eye movement sleep stage S2-S4were shorter,while the sleep latency and non-rapid eye movement sleep stage S1were longer in insomnia group as compared with control group(all P<0.05).In insomnia group,perfusion was increased in bilateral prefrontal lobes,right temporal lobe,left parietal lobe,right thalamus,and pons(P<0.05),but decreased in bilateral insula and bilateral basal ganglia(P<0.05).Conclusion The combination of polysomnography and ASL perfusion magnetic resonance imaging enables precise quantification of sleep condition.

Objective To understand the changing distribution and antimicrobial resistance profiles of Proteus,Morganella and Providencia in hospitals across China from January 1,2015 to December 31,2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods Antimicrobial susceptibility testing was carried out following the unified CHINET protocol.The results were interpreted in accordance with the breakpoints in the 2021 Clinical & Laboratory Standards Institute(CLSI)M100(31 st Edition).Results A total of 32 433 Enterobacterales strains were isolated during the 7-year period,including 24 160 strains of Proteus,6 704 strains of Morganella,and 1 569 strains of Providencia.The overall number of these Enterobacterales isolates increased significantly over the 7-year period.The top 3 specimen source of these strains were urine,lower respiratory tract specimens,and wound secretions.Proteus,Morganella,and Providencia isolates showed lower resistance rates to amikacin,meropenem,cefoxitin,cefepime,cefoperazone-sulbactam,and piperacillin-tazobactam.For most of the antibiotics tested,less than 10％of the Proteus and Morganella strains were resistant,while less than 20％of the Providencia strains were resistant.The prevalence of carbapenem-resistant Enterobacterales(CRE)was 1.4％in Proteus isolates,1.9％in Morganella isolates,and 15.6％in Providencia isolates.Conclusions The overall number of clinical isolates of Proteus,Morganella and Providencia increased significantly in the 7-year period from 2015 to 2021.The prevalence of CRE strains also increased.More attention should be paid to antimicrobial resistance surveillance and rational antibiotic use so as to prevent the emergence and increase of antimicrobial resistance.

To implement the strategy of healthy China and promote the construction of "new medicine science", it is urgent to focus on new needs and challenges to advance the reform of medical education curricula in China. Using literature research methods, we summarize the process of modern medical education curriculum reforms in the United States, and discuss the main features of the third-round reforms—introducing the concept of value-based medicine, offering health systems science courses, and promoting the curriculum system reform from the perspectives of learning time, curriculum integration, and learning methods. Based on these features, we put forward the enlightenment for the reform of medical education curricula in China.