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 current status of clinical nurses' knowledge, attitudes, and practices (KAP) regarding geriatric frailty syndrome in a general hospital and to analyze the influencing factors.Methods:Using convenience sampling, 319 clinical nurses from the First Affiliated Hospital of Wenzhou Medical University, were recruited between May and September 2024. A KAP questionnaire on geriatric frailty syndrome was developed through literature review and the Delphi method. Data were collected with a demographic questionnaire and the KAP questionnaire. Multiple linear regression was performed to identify factors influencing KAP levels.Results:The finalized KAP questionnaire consisted of three dimensions and 27 items. Cronbach's α coefficients for the total scale and the knowledge, attitudes, and practices subscales were 0.974, 0.981, 0.974, and 0.967, respectively. The overall KAP score among 319 nurses was (96.65±20.83). The average scores for each dimension were (4.08±0.82) for attitudes, (3.84±0.84) for practices, and (3.12±1.00) for knowledge. Multiple linear regression indicated that age and positions were respective significantly influenced the total KAP score and attitudes score ( P<0.05) ; frailty-related training was also a significant factor for KAP score and dimension scores ( P<0.05) . Conclusions:Clinical nurses demonstrated a moderate overall KAP level regarding geriatric frailty syndrome, with relatively high attitudes but insufficient professional knowledge. Hospital managers should provide effective education and training for frontline nurses to improve KAP levels and to promote early identification, assessment, and intervention of geriatric frailty.

Objective To investigate the application of the"integration of four dimensions(mainline teaching-on-line course-medical case-mind map)"teaching mode in the undergraduate compulsory teaching course"Health-care-associated Infection Control",and provide reference for further improving the design of undergraduate compul-sory course on infection control.Methods A questionnaire survey on undergraduate students' satisfaction for com-pulsory course"Healthcare-associated Infection Control"was conducted using KANO model.A total of 4 dimen-sions and 21 quality indicators were set up.KANO attribute classification,satisfaction degree,and importance coef-ficients etc.were analyzed,and curriculum design was optimized.Results The overall questionnaire reliability Cronbach's a coefficient was 0.915,and the validity analysis Kaiser-Meyer-Olkin(KMO)measure of sampling adequacy value was 0.867.Among the 21 quality indicators,12 were charismatic attributes,which accounted for the largest proportion(57.14％)of the total indicators.Most quality indicators received high student satisfaction ratings.The indicators with the highest satisfaction coefficients were"playing teaching videos in class"(4.73),along with"in-tegrating typical healthcare-associated infection cases into the curriculum for relevant teaching""maintaining a relax-ed and pleasant teaching atmosphere",and"humorous and witty teaching style of the teacher"(all scoring 4.71).Four important but currently with low satisfaction indicators were"combining course content with utilitarian exam preparation""adopting a completely offline teaching format""adopting relatively strict assessment methods",and"reflecting differentiation based on difficulty coefficient in final assessment".Conclusion This course has achieved certain efficacy in undergraduate compulsory education,but there is still room for improvement in the setting of cur-riculum assessment methods.In the future,the course system should be integrated,the assessment mode of combi-ning theory and practice should be optimized,and course improvement and innovation should be promoted.

Objective:To investigate the current status of clinical nurses' knowledge, attitudes, and practices (KAP) regarding geriatric frailty syndrome in a general hospital and to analyze the influencing factors.Methods:Using convenience sampling, 319 clinical nurses from the First Affiliated Hospital of Wenzhou Medical University, were recruited between May and September 2024. A KAP questionnaire on geriatric frailty syndrome was developed through literature review and the Delphi method. Data were collected with a demographic questionnaire and the KAP questionnaire. Multiple linear regression was performed to identify factors influencing KAP levels.Results:The finalized KAP questionnaire consisted of three dimensions and 27 items. Cronbach's α coefficients for the total scale and the knowledge, attitudes, and practices subscales were 0.974, 0.981, 0.974, and 0.967, respectively. The overall KAP score among 319 nurses was (96.65±20.83). The average scores for each dimension were (4.08±0.82) for attitudes, (3.84±0.84) for practices, and (3.12±1.00) for knowledge. Multiple linear regression indicated that age and positions were respective significantly influenced the total KAP score and attitudes score ( P<0.05) ; frailty-related training was also a significant factor for KAP score and dimension scores ( P<0.05) . Conclusions:Clinical nurses demonstrated a moderate overall KAP level regarding geriatric frailty syndrome, with relatively high attitudes but insufficient professional knowledge. Hospital managers should provide effective education and training for frontline nurses to improve KAP levels and to promote early identification, assessment, and intervention of geriatric frailty.

Objective To investigate the application of the"integration of four dimensions(mainline teaching-on-line course-medical case-mind map)"teaching mode in the undergraduate compulsory teaching course"Health-care-associated Infection Control",and provide reference for further improving the design of undergraduate compul-sory course on infection control.Methods A questionnaire survey on undergraduate students' satisfaction for com-pulsory course"Healthcare-associated Infection Control"was conducted using KANO model.A total of 4 dimen-sions and 21 quality indicators were set up.KANO attribute classification,satisfaction degree,and importance coef-ficients etc.were analyzed,and curriculum design was optimized.Results The overall questionnaire reliability Cronbach's a coefficient was 0.915,and the validity analysis Kaiser-Meyer-Olkin(KMO)measure of sampling adequacy value was 0.867.Among the 21 quality indicators,12 were charismatic attributes,which accounted for the largest proportion(57.14％)of the total indicators.Most quality indicators received high student satisfaction ratings.The indicators with the highest satisfaction coefficients were"playing teaching videos in class"(4.73),along with"in-tegrating typical healthcare-associated infection cases into the curriculum for relevant teaching""maintaining a relax-ed and pleasant teaching atmosphere",and"humorous and witty teaching style of the teacher"(all scoring 4.71).Four important but currently with low satisfaction indicators were"combining course content with utilitarian exam preparation""adopting a completely offline teaching format""adopting relatively strict assessment methods",and"reflecting differentiation based on difficulty coefficient in final assessment".Conclusion This course has achieved certain efficacy in undergraduate compulsory education,but there is still room for improvement in the setting of cur-riculum assessment methods.In the future,the course system should be integrated,the assessment mode of combi-ning theory and practice should be optimized,and course improvement and innovation should be promoted.

Objective To conduct an epidemiological survey of common congenital heart disease(CHD)among children in ethnic minority areas in southeastern Guizhou and to explore the influencing factors of delayed medical treatment.Methods From January 2019 to July 2022,18 850 children aged 3 months to 14 years in Qiandongnan Miao and Dong Autonomous Prefecture were selected;105 children with CHD were included in the training set,and they were divided into delayed group(80 cases)and non-delayed group(25 cases)according to whether or not to delay medical treatment.In addition,children with CHD(35 cases)from July 2022 to December 2022 were included in the validation set.The general data of the subjects in the two groups were compared and ana-lyzed.Multivariate logistic regression was performed and risk scoring model was constructed.Results The preva-lence of CHD in 18 850 children was 5.57‰(105/18 850),with the highest prevalence in Liping County,and the lowest in Huangping County.The proportion of children with secondary atrial septal defect was the highest,and that of the aortic valve malformation was the lowest.Among the complex cases of CHD,the proportion of children with single type was the highest,and that of children with three or more types were the lowest.Among children with CHD,the rate of delayed medical treatment was 76.19% (80/105).The median delay in medical treatment was 12 months,with an average of(18.78±4.77)months.Multifactor logistic regression analysis showed that heart murmur(level 2～3),less-educated(primary and secondary school)guardian,family per capita income<2 000 yuan,and frequent drinking of the guardian were independent risk factors for delayed medical treatment(P<0.05),and commercial settlement of medical expenses was independent protective factor(P<0.05).Risk scoring model divided the children into three groups:low risk(≤80 points),medium risk(>80 points and≤134 points)and high(>134 points)risk group.The evaluation of the model show that it was accurate,effective,safe,and reliable.Conclusion The highest prevalence is observed in Liping County.The proportion of children with secondary atrial septal defect and the proportion of children with single type are the highest.Delayed medical treat-ment is found in most of the children with CHD.Cardiac murmur,education background of the guardian,per capita family income,guardian alcohol consumption,and medical expense settlement method are all independent influencing factors for delayed medical treatment.

Objective:To investigate the clinical characteristics of pemphigoid caused by immune checkpoint inhibitors (ICIs).Methods:The relevant databases at home and abroad (up to October 15, 2021) were searched and the case reports on pemphigoid caused by ICIs were collected. The relevant information of patients (gender, age, tumor type, drug varieties of ICIs, incubation period of pemphigoid, main symptoms, distribution site of lesions, biopsy and immunological examination, treatment and outcome, etc.) were collected and analyzed descriptively.Results:A total of 82 relevant literature were included, involving 103 patients, 72 males and 31 females, aged 30-90 years, of which 82 (79.6%) were ≥60 years old. The primary diseases were melanoma in 45 cases (43.7%) and lung cancer in 29 cases (28.2%). The 103 patients involved 6 varieties of ICI, including programmed cell death 1 receptors [pablizumab (47 cases, 45.6%), navulizumab (44 cases, 42.7%), and terepril (4 cases, 3.9%)], and programmed cell death ligand 1 inhibitors [atezumab (3 cases, 2.9%), duvalizumab (2 cases, 1.9%)], and CTLA-4 inhibitor ipimamab (3 cases, 2.9%). Eighty-four patients had a record of the time from the beginning of ICI to the occurrence (incubation period) of pemphigoid. The incubation period of pabolizumab was 3-850 days, of navulizumab was 21-790 days, and of terepril was 70-728 days. Among 103 patients, 88 (85.4%) were bullous pemphigoid, 8 (7.8%) were mucous pemphigoid, 4 (3.9%) were non bullous pemphigoid, and 1 (1.0%) was dyshidrosiform pemphigoid; the clinical manifestations were bullous and vesicular lesions in 98 cases (95.1%), rash in 51 cases (49.5%), and pruritus in 48 cases (45.6%). Nine four patients had skin biopsy results, 78 patients (83.0%) had eosinophil infiltration in the lesion site; immunological examination was performed in 92 cases (97.8%), of which 63 cases (68.5%) were IgG and C3 deposits. Thirty-five patients had pemphigoid associated antigen test records, BP180 was detected in 25 patients, and 24 patients (96%) were positive; BP180 and BP 230 were detected simultaneously in 8 cases, both were positive in 6 cases, and BP180 was positive and BP 230 was negative in the other 2 cases; BP-Ag2 was detected in 2 cases, all of them were positive. After treatment with glucocorticoid or immunosuppressant and/or withdrawal of ICIs, 86 (83.5%) of 103 patients were improved, and 6 were not; 8 cases died, of which 7 cases of pemphigoid were improved but died of other causes, and 1 case died of unreported causes; 9 cases did not report the outcome.Conclusions:ICIs can cause pemphigoid, and the incidence in the elderly is higher. The incubation period of pemphigoid varies from 3 days to more than 2 years. After glucocorticoid or immunosuppressant treatment and/or withdrawal of ICIs, most patients had good prognosis.

Objective:To investigate the clinical characteristics of pemphigoid caused by immune checkpoint inhibitors (ICIs).Methods:The relevant databases at home and abroad (up to October 15, 2021) were searched and the case reports on pemphigoid caused by ICIs were collected. The relevant information of patients (gender, age, tumor type, drug varieties of ICIs, incubation period of pemphigoid, main symptoms, distribution site of lesions, biopsy and immunological examination, treatment and outcome, etc.) were collected and analyzed descriptively.Results:A total of 82 relevant literature were included, involving 103 patients, 72 males and 31 females, aged 30-90 years, of which 82 (79.6%) were ≥60 years old. The primary diseases were melanoma in 45 cases (43.7%) and lung cancer in 29 cases (28.2%). The 103 patients involved 6 varieties of ICI, including programmed cell death 1 receptors [pablizumab (47 cases, 45.6%), navulizumab (44 cases, 42.7%), and terepril (4 cases, 3.9%)], and programmed cell death ligand 1 inhibitors [atezumab (3 cases, 2.9%), duvalizumab (2 cases, 1.9%)], and CTLA-4 inhibitor ipimamab (3 cases, 2.9%). Eighty-four patients had a record of the time from the beginning of ICI to the occurrence (incubation period) of pemphigoid. The incubation period of pabolizumab was 3-850 days, of navulizumab was 21-790 days, and of terepril was 70-728 days. Among 103 patients, 88 (85.4%) were bullous pemphigoid, 8 (7.8%) were mucous pemphigoid, 4 (3.9%) were non bullous pemphigoid, and 1 (1.0%) was dyshidrosiform pemphigoid; the clinical manifestations were bullous and vesicular lesions in 98 cases (95.1%), rash in 51 cases (49.5%), and pruritus in 48 cases (45.6%). Nine four patients had skin biopsy results, 78 patients (83.0%) had eosinophil infiltration in the lesion site; immunological examination was performed in 92 cases (97.8%), of which 63 cases (68.5%) were IgG and C3 deposits. Thirty-five patients had pemphigoid associated antigen test records, BP180 was detected in 25 patients, and 24 patients (96%) were positive; BP180 and BP 230 were detected simultaneously in 8 cases, both were positive in 6 cases, and BP180 was positive and BP 230 was negative in the other 2 cases; BP-Ag2 was detected in 2 cases, all of them were positive. After treatment with glucocorticoid or immunosuppressant and/or withdrawal of ICIs, 86 (83.5%) of 103 patients were improved, and 6 were not; 8 cases died, of which 7 cases of pemphigoid were improved but died of other causes, and 1 case died of unreported causes; 9 cases did not report the outcome.Conclusions:ICIs can cause pemphigoid, and the incidence in the elderly is higher. The incubation period of pemphigoid varies from 3 days to more than 2 years. After glucocorticoid or immunosuppressant treatment and/or withdrawal of ICIs, most patients had good prognosis.

Objective:To investigate health status and home care service demands of elderly people in urban-rural joint areas in Beijing.Methods:From December 2018 to September 2019, a stratified random sampling method was adopted to select permanent elderly residents from 2 sub-districts in Liangxiang area in Beijing as research subjects. The survey was conducted using general information questionnaires, Barthel Index Rating Scale and self-made Home Care Service Demand Questionnaire for Elderly People. A total of 1 410 questionnaires were distributed, all of which were effectively recovered.Results:Among 1 410 elderly persons, 1 173 suffer from chronic diseases, with a prevalence rate of 83.2%. The top 3 diseases in terms of prevalence were hypertension (55.3%, 780/1 410) , diabetes (22.7%, 320/1 410) and coronary heart disease (22.3%, 314/1 410) . The top 3 home care service demands were psychological comfort and companionship (92.3%, 1 301/1 410) , daily care (82.0%, 1 156/1 410) and medication guidance (43.1%, 608/1 410) . There were significant differences in the nursing needs of the elderly with different ages, family monthly average income and reimbursement methods of medical expenses ( P<0.05) . Conclusions:The prevalence of chronic diseases among the elderly in the urban-rural areas of Beijing is high and the demand for home care is urgent. Nursing staff should provide more accurate nursing services and implement comprehensive management based on illness and demands for home care service of the elderly.

Background: In suckling piglets, transmissible gastroenteritis virus (TGEV) causes lethal diarrhea accompanied by high infection and mortality rates, leading to considerable economic losses. This study explored methods of preventing or inhibiting their production.Bovine antimicrobial peptide-13 (APB-13) has antibacterial, antiviral, and immune functions. Objectives: This study analyzed the efficacy of APB-13 against TGEV through in vivo and in vitro experiments. Methods: The effects of APB-13 toxicity and virus inhibition rate on swine testicular (ST) cells were detected using 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT). The impact of APB-13 on virus replication was examined through the 50% tissue culture infective dose (TCID50 ). The mRNA and protein levels were investigated by real-time quantitative polymerase chain reaction and western blot (WB). Tissue sections were used to detect intestinal morphological development. Results: The safe and effective concentration range of APB-13 on ST cells ranged from 0 to 62.5 µg/mL, and the highest viral inhibitory rate of APB-13 was 74.1%. The log10 TCID50 of 62.5 µg/mL APB-13 was 3.63 lower than that of the virus control. The mRNA and protein expression at 62.5 µg/mL APB-13 was significantly lower than that of the virus control at 24 hpi. Piglets in the APB-13 group showed significantly lower viral shedding than that in the virus control group, and the pathological tissue sections of the jejunum morphology revealed significant differences between the groups. Conclusions APB-13 exhibited good antiviral effects on TGEV invivo and in vitro.