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.

OBJECTIVE To investigate the effect of obstructive sleep apnea hypopnea syndrome(OSAHS) on the quality of voice. METHODS Electroglottography (EGG) method was used for detecting the vocal cords vibration, waveforms of electroglottography and voice parameters such as Jitter, Shimmer, normalized noise energy (NNE), contact quotient(CQ), contact index (CI), contact quotient perturbation(CQP), contact index perturbation(CIP), and the in 82 OSAHS patients and 53 healthy subjects. The voice parameters were analyzed with Dr.Speech software, RESULTS While in normal pronunciation, the Jitter, Shimmer, NNE, CQP and CIP were (1.037±1.493)%, (5.627±1.872)%, (-16.109±1.719)dB, (2.638±0.633)% and (166.789±30.492)% in 22 mild OSAHS patients, (1.578±0.362)%, (8.478±1.635)%, (-11.517±1.614)dB, (6.043±0.936)% and (255.210±91.224)% in 24 moderate OSAHS patients, and (2.138±1.384)%, (14.888±4.089)%, (-7.677±2.151)dB, (11.749±7.164)% and (431.233±259.266)%in 36 severe OSAHS patients respectively. They were all higher than those in 53 normal subjects as (0.517±0.303)%, (3.299±2.196)%, (-21.933±5.477)dB, (1.322±0.942)% and (58.834±131.849)%. The regularity of vocal fold vibration in all patients with OSAHS was seriously out of whack. EGG waveform was irregular. CONCLUSION The OSAHS patients have structural changes in their upper airway, it will cause non-physiological breathing and lead dry of the vocal cord mucosa and weak elasticity. Their EGG parameters will get higher and vibration will be irregular seriously. We should pay attention to the voice qualities of the OSAHS patients and let them receive treatment as early as possible.

BACKGROUNDMisdiagnosis and missed diagnosis of septic pulmonary embolism (SPE), a rare disease, occurs among the patients with right heart infective endocarditis. The purpose of this study was to analyze the characteristics of SPE and improve the early diagnosis and treatment.

METHODSWe retrospectively studied 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis who were seen from June 1, 2002 to June 1, 2013. We reviewed the medical records and radiological images of these cases and extracted the following information: age, gender, and symptoms, physical examination, laboratory findings, transthoracic echocardiography (TTE) results, treatment information, comorbid medical conditions, and outcomes. Microbiological samples were collected and processed according to well-established and published guidelines.

RESULTSWe identified basic heart disease in 97.1% of the patients. A high proportion of the right-sided infective endocarditis patients had congenital heart defects (82.4%); predominantly, ventricular septal defects. Clinical symptoms were fever (97.1%), cardiac murmurs (94.1%) and fatigue (88.2%). Respiratory symptoms included cough (58.8%), pleuritic chest pain (47.1%) and hyoxemia (52.9%). Positive blood cultures were grown from 35.2% of patients and 50.0% were caused by staphylococcal species. Chest X-rays or CT examinations detected patchy infiltrates and/or nodules in all cases. Transthoracic echocardiography demonstrated infectious foci of the right-side heart in all cases. Parenteral antibiotics were administered for all, and cardiac surgery was carried out for 76.5% of patients with an effective rate of 82.3%.

CONCLUSIONSSPE lacks characteristic clinical manifestation. Congenital heart disease is a common risk of SPE. Most patients with SPE have a good prognosis as long as early diagnosis and proper treatment can be provided.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Endocarditis ; diagnosis ; therapy ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; Pulmonary Embolism ; Retrospective Studies ; Sepsis ; diagnosis ; therapy ; Young Adult

Objective:To explore the effect of folic acid on helicobacter pylori (HP)-negative patients with chronic atrophic gastritis (CAG).Methods:Eighty HP-negative CAG patients were randomly divided into folic acid treatment group (folic acid group)and placebo treatment group (control group),according to different therapy methods,with 40 cases in each group.The course of treatment was 12 weeks.The clinical symptom scores,gastroscopic scores and histopathological scores were com-pared between the two groups.Results:The clinical symptom scores,gastroscopic scores and histopathological scores in folic acid group were significantly decreased after treatment (P <0.05).No statistical significant differences were found in those scores before and after treatment in the control group (P >0.05).After treatment,the scores in folic acid group were signifi-cantly lower than those in the control group (P <0.05).Conclusions:Folic acid can effectively improve the clinical symptoms and pathological changes of HP-negative patients with CAG.

Objective To investigate the diagnosis and surgical treatment for the intracardiac leiomyomatosis (ICL).Methods Retrospectively reviews the data of 18 cases of ICL from February 1995 to June 2011 in Anzhen Hospital.Preoperative diagnosis of right atrial myxoma in 2 cases,right atrium/ventricular thrombus in 2 cases,pulmonary embolism in 2 cases,the inferior vena cava and right atrial tumor in 3 cases,the inferior vena cava lesions in 9 cases.18 cases of ICL were diagnosed by echocardiography,magnetic resonance imaging ( MRI ),computer tomography (CT) and angiography.ICL were recected under anesthesia,cardiopulmonaray bypass surgery,he incisions were respectively through the chest,thoraco-abdominal or abdominal incision,cardiopulmonary bypass method were respectively at room temperature,mid-low temperature with cardiac arrest,lowflow,deep hypothermic circulatory arrest.Results There was no operative death.Right atrium,inferior vena cava,bilateral renal vein,bilater alIliac vein vascular were not found leiomyoma by vascular ultrasound.Follow-up time was 5 ～ 106 (49 ± 42 )months,1 patient died of the leiomyoma recurrence after 5 months after the primary operation,the remaining 17 patients were followed up asymptomatically.10 were in NYHA functional class Ⅰ,and 7 in class Ⅱ.The 5yrs survival rate calculated by the Kaplan-Meier survival curve was (93 ±5 )％.Conclusion The ICL preoperative diagnosis is difficult,surgical treatment of ICL can get a good mid-long term survival rate and living quality.

OBJECTIVETo study the effects and mechanisms of sinensetin on proliferation and apoptosis of human AGS gastric cancer cells.

METHODMTT assay was used to detect the growth inhibition rates of human AGS gastric cancer cells treated with sinsesectin in different concentrations and times. The cell cycle distribution was measured by flow cytometry. The apoptosis was examined by Annexin-FITC/PI staining and DNA fragment analysis. The apoptosis morphology was observed by inverted fluorescence microscope after Hoechst 33342 staining. The protein expressions of p21 and p53 were detected by western blot.

RESULTMTT assay showed that sinensetin inhibited the growth of AGS gastric cancer cells in a dose- and time-dependent manner. Sinensetin blocked AGS cells in G2/ M and increased the apoptosis rates of AGS cells in a dose-dependent manner. DNA ladder was observed in cells treated with 60 micromol x L(-1) sinensetin for 48 h. The typical apoptotic morphological changes including cell nucleus shrinkage, chromatin condensation and apoptotic bodies were observed when treated with different dose of sinensetin. Western blot showed that sinensetin increased expressions of p53 and p21 in a dose-dependent manner.

CONCLUSIONSinensetin could inhibit human AGS gastric cancer cells proliferation and induce cell cycle block in G2/M phase and apoptosis. The up regulation of p53 and p21 protein might be one of the mechanisms.

Apoptosis ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cyclin-Dependent Kinase Inhibitor p21 ; analysis ; Dose-Response Relationship, Drug ; Flavonoids ; pharmacology ; Humans ; Stomach Neoplasms ; drug therapy ; pathology ; Tumor Suppressor Protein p53 ; analysis

Objective: The main ingredients and the inhibitory effects of essential oil of a compound Chinese herbal medicine Weiqi Decoction (WQD) on AGS cell proliferation were to be investigated. Methods: Chemical compounds of WQD essential oil were detected by gas chromatography and mass spectrometry analysis. Cell viability was measured by methyl thiazolyl tetrazolium method. Cell cycle distribution was detected by flow cytometry. Apoptosis and necrosis of AGS cells were determined by Hoechst 33342/propidium iodine staining. Results: Chemical analysis showed that the main ingredients of WQD essential oil were bornylene and 3-n-butylphthalide. Ligustilide, which is the effective compound of Danggui (Radix Angelicae Sinensis), was not detected in WQD essential oil. The essential oil inhibited cell proliferation in a dose- and time-dependent manner, and blocked cell cycle progression at G(2)/M stage. At the concentrations that resulted in significant inhibition of cell proliferation and cell cycle arrest, essential oil induced both apoptosis and necrosis. Conclusion: The results suggest that WQD essential oil contains some effective ingredients for treating chronic atrophic gastritis and functional dyspepsia, and also has an antiproliferative effect on AGS cells through cell cycle arrest and apoptosis promotion in vitro. Therefore, essential oil should be retained as much as possible during stewing this decoction.

Objective: To investigate the effects of taraxerol and taraxeryl acetate on cell cycle and apoptosis of human gastric epithelial cell line AGS cells. Methods: The inhibitory effects of taraxerol and taraxeryl acetate at different concentrations on AGS cell growth were measured by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) method and the concentrations of taraxerol and taraxeryl acetate to be used in following experiments were decided. Then, cell cycle analysis was performed by FACScan flow cytometry after culture with taraxerol or taraxeryl acetate. Annexin V-fluorescein isothiocyanate/propidium iodide staining was used to measure cell apoptosis. Results: Taraxerol significantly inhibited AGS cell proliferation in a dose- and time-dependent manner. Taraxerol arrested the AGS cells at G(2)/M stage. 110 μmol/L taraxerol elevated the population of AGS cells arrested in G(2)/M phase compared with solvent (P<0.05). Taraxerol also promoted early cell apoptosis in AGS cells. 110 μmol/L taraxerol increased the early cell apoptosis rate from 4.45% to 10.29%, which was 1.31 times higher than that of the untreated cells. However, taraxeryl acetate had a lower inhibitory effect than taraxerol, and it showed a tendency of G(2)/M arrest and apoptosis promotion but with no statistical significance (P>0.05). Conclusion: Taraxerol has inhibitory effects on AGS cell growth through inducing G(2)/M arrest and promotion of cell apoptosis. Taraxeryl acetate has less effect on cell cycle arrest and apoptosis of AGS cells than taraxerol.

Objective To investigate the curriculum construction and evaluation of teaching effectiveness of simulation and comprehensive experiment for clinical nursing. Methods Based on the investigation of hospital, taking working progress and working task of nurses as orientation, we constructed the curriculum of simulation and comprehensive experiment for clinical nursing, and unfold in junior class (before clinical practice) for student nurses. The teaching effect was evaluated. Results Unfolding simulation and comprehensive experiment could effectively enhance the nursing students' ability to transform theoretical knowledge into clinical nursing practice, and was favorable to change the role of nurses and improve the satisfaction degree of clinical practice.Conclusions Unfolding simulation and comprehensive experiment for clinical nursing for student nurses before clinical practice is practicable and essential.

Objective:To explore the prevalence of irritable bowel syndrome (IBS) based on a community population of Shanghai and the treatment of IBS by acupuncture therapy.Methods:A population of 1 685 subjects aged between 18-80 years were randomly selected by clustered sampling from the inhabitants in Changqiao Community of Shanghai to receive a questionnaire,for understanding the symptomatology and prevalence of IBS according to modified Manning and Rome II criteria,and the voluntary IBS patients were treated by acupuncture therapy.Results:The community- based prevalence of IBS was 11.45 % and 5.04% respectively according to modified Manning criteria and Rome II criteria.The ratio of male and female was 0.77:1 in IBS patients and the proportion was 10.62% and 12.19% respectively.But there were no significant difference in prevalence between different age groups (P＞0.05) .IBS is more common in subjects aged between 45-65 years (38.86%).Regarding the 62 IBS patients treated by electroacupuncture (EA),the total effective rate in Tianshu (ST 25) group (n=32) was 84.38%,and it was 56.67% in Daheng (SP 15) group (n=30),which showed a significant difference.(P＜0.05).Conclusion:IBS is a commonly encountered disorder in Changqiao Community of Shanghai and should be taken into consideration for human welfare,disease prevention and further epidemical investigation.Acupuncture treatment is recommended for treating IBS due to its satisfactory therapeutic effect.