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 situation of medical students' individual career management and its educational status.Methods Self-made questionnaire was used to investigate the present situation of individual career management and education of medical students in a medical college in November 2016.SPSS 20.0 was used for analyzing descriptive statistical analysis,t test and rank test in questionnaire data.From April to May 2017,30 students were randomly selected for interviews to explore the current situation of medical students' individual career management.Result 900 questionnaires were issued and 816 valid questionnaires were collected,and the recovery rate was 90.67％.Whether medical students accept the relevant education had significant difference in their career management ability (P＜ 0.05),30.15％ of the students who received the relevant education (246) had a higher total score of their own career management than those who had not received,which was reflected in social work environment cognition level,participation in extracurricular activities,consideration of graduation and stage goals setting.It is learned from the interview that most medical students lack clear self-awareness and professional goals are vague,and they fail to form a good personal career management atmosphere.Conclusion Individual career management education promotes the cognitive level of social work environment of medical students and then develops their self-awareness.At the same time,it urges medical students to participate in extracurricular activities,to consider the whereabouts after graduation,to set phased goals,and to carry out targeted self-improvement.The comprehensive development of self-cognition and self-improvement finally make the medical students' individual career management ability continuously improved.

Objective To construct a comprehensive evaluation model of long-term care for the elderly based on the situation of our country,which is suitable for the family,community and the pension service organization. Methods The model index item pool (7 one class indexes and 133 two class indexes) formed by literature research, theoretical extraction and qualitative interview were taken as the research object.To screen the model parameters by using the Delphi method,then formed a index system of hierarchical comprehensive evaluation model of long term care for the elderly. Results 25 experts were from 10 provinces of a total of 23 Medical Colleges and affiliated hospital,positive coefficients for the first round of 83.33% and the second round of 100.00%,the average value of the two authority coefficients were both >0.90, the coordination coefficient of the evaluation index for the first round of 0.221 and the second round of 0.266(both P<0.05).The primary model index system consists of 7 first level indicators,a total of 13 secondary indicators.Among them,the"daily life ability","cognitive ability","falling risk"and"pressure sore risk" evaluation were using very mature scales, the "medical care project", "abnormal performance/symptom" and "self care knowledge needs" evaluation were independently established in this study. Conclusions Preliminary construction process of the index system for the comprehensive evaluation model of long term care for the elderly was rigorous and had better theoretical support,and the Delphi method experts had higher degree of attention and participate in the research content, experts had good representativeness,can effectively guarantee the reliability of the selected items.

Objective To evaluate the role of talin in activation of astrocytes in the spinal cord of rats with diabetic neuropathic pain (DNP).Methods Twenty-four clean-grade healthy male SpragueDawley rats,aged 2-3 months,weighing 180-200 g,were assigned into 3 groups (n =8 each) using a random number table:control group (group C),group DNP and siRNA group (group siR).Rat DNP model was established by injecting streptozotocin (STZ).Group siR received intraspinal injection of siRNA silence stalin at 3 days before injecting STZ,and the equal volume of blank plasmid was given instead in C and DNP groups.The mechanical paw withdrawal threshold (MWT) was measured at 29-35 days after injection of STZ,the rats were then sacrificed and the lumbar spinal cords were removed for determination of the expression of integrin β1 (by Western blot),activation of astrocytes (by immunofluorescence) and contents of tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1) (using enzyme-linked immunosorbent assay).Results Compared with group C,the MWT was significantly decreased at each time point after surgery,the expression of integrin β1 was up-regulated,and the rate of activated astrocytes and contents of TNF-α and IL-1 were increased in group DNP (P＜0.05).Compared with group DNP,the MWT was significantly increased at each time point after surgery,the expression of integrin β1 was downregulated,and the rate of activated astrocytes and contents of TNF-α and IL-1 were decreased in group siR (P＜0.05).Conclusion Talin is involved in activation of astrocytes in the spinal cord of rats with DNP.

Objective To investigate the mutations of epigenetic regulation factor ASXL1 gene in myelodysplastic syndrome(MDS).Methods Mutation analysis of ASXL1 gene in 53 de novo MDS patients and 20 healthy persons was performed by using polymerase chain reaction(PCR)followed by sequence analysis at DNA level.The clinical and laboratory characteristics were compared in MDS patients with ASXL1 gene mutation and ASXL1 wild type.ASXL1 mutation in mRNA level was detected by using reverse transcription PCR(RT-PCR)followed by sequence analysis.Results ASXL1 gene mutations were observed in 9 cases(16.9%)of 53 MDS patients.6 mutation types were detected,including 4 frameshift mutations types(2 cases with p.Glu635ArgfsX15,3 cases with p.Gly646TrpfsX12,1 case with p.Ala640GlyfsX14 and 1 case with p.Gly790TrpfsX10)and 2 nonsense mutation types(1 case with p.Gln1063X and 1 case with p.Gln695X).All the mutations were heterozygous,and p.Gly790TrpfsX10 and p.Gln695X were new mutation types.In addition,a single nucletide polymorphism(SNP)p.Gly652Ser was also detected in 4 cases with MDS.5 cases of p.G652S SNP and 1 case of p.Leu1173Leu SNP were detected in 20 healthy people.Frameshift mutation(p.Gly646TrpfsX12)could be detected at mRNA level by using RT-PCR.Differences were not observed in red blood cell counts,white blood cell counts,platelet counts,hemoglobin levels,reticulocyte,neutrophil granulocyte,the peripheral blood lymphocytes percentage,T-cell subsets in the peripheral blood,the proportion of primitive cell in the marrow and MDS types between the patients with ASXL1 gene mutation and ASXL1 wild type patients(P >0.05).Conclusion There is a high frequency of ASXL1 gene mutation in MDS patients,which can be detected at mRNA level.

Objective To investigate the effects of different depths of anesthesia on incidence of postopera-tive cognitive dysfunction (POCD). Methods We systematically retrievedPubmed,OVID,CNKI,CBM and Wanfang database and VIP database for randomized controlled trials(RCTs)from inceptionto December 312016, comparing different depths of anesthesia for their impacts on incidence of early POCD. After data extraction and quality evaluation,Revman 5.3 software was used for statistical data analysis. Results A total of 714 patients in 8 eligible RCTs were identified. Results of meta-analysis were as follows.(1)Incidence of POCD of depth anesthesia (NTS=E0-E1)was lower than general anesthesia(NTS=D0-D1)1 d after surgery(OR=0.21,95%CI 0.13~0.35,P < 0.00001).(2)Incidence of POCD of depth anesthesia(NTS = E1)was lower than general anesthesia (NTS=D0)7 d after surgery(OR=0.45,95%CI 0.23~0.91,P=0.03).(3)Incidence of POCD of NTS=E1 was lower than NTS=D07d after surgery(OR=0.42,95%CI 0.24~0.71,P=0.001). Conclusion Comparedwith general anesthesia,depth anesthesia is associated with a lower incidence of early POCD.

Objective: To investigate the effect of biology and mTOR pathway activity of down-regulated TSC2 gene expression on U937 leukemia cells. Methods: Gene expression was down-regulated by lentivirus induced RNA interference on TSC2 high expressed U937 cell line; the proliferation, apoptosis and differentiation were detected by CCK-8 assay, colony formation assay and flow cytometry; the gene expression level and protein kinase activity were detected by qRT-PCR and Western blot. Results: Down-regulated expression of TSC2 gene promoted U937 cell proliferation and colony formation ability (P<0.05) . The proportion in G₀/G₁ phase of TSC2 down-regulated U937 cell was much lower than that of the control cells [ (52.53±3.75) % vs (75.10±4.33) %, t=6.829, P=0.002], the S phase [ (22.43±1.00) % vs (15.47±1.20) %, t=-5.581, P=0.019] and G₂/M phase [ (25.03±4.34) % vs (14.33±0.91) %, t=-5.413, P=0.013] was remarkably higher than that of the control cells (P<0.05) . There were no statistically significant differences in cell apoptosis and differentiation (P>0.05) . Down-regulation of TSC2 led to the increased activity of mTOR, 4EBP1 and S6K1, but did not influence the activity of AKT. The expressions of proliferation related cyclinD1, c-myc and PTEN were also up-regulated after TSC2 silenced, but the expressions of P27KIP and BCL-XL were not changed. Conclusion Downregulation of TSC2 could promote the proliferation of U937 cells through up-regulation of mTOR activity.

Objective To evaluate the effect of dexmedetomidine on the expression of antisense hypoxia-inducible factor-1α (aHIF-1α) during brain injury after asphyxial cardiac arrest and resuscitation in rats.Methods Twenty-four pathogen-free healthy male Sprague-Dawley rats,weighing 250-280 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (group S),cardiac arrest and resuscitation group (group R) and dexmedetomidine group (group D).Asphyxial cardiac arrest and resuscitation were performed in R and D groups.The rats were tracheally intubated without clipping the trachea in group S.Dexmedetomidine 4 μg/kg was injected via the tail vein at 5 min before clipping the trachea in group D,while the equal volume of normal saline was given instead in S and R groups.Neurological deficit was assessed and scored (NDS) at 12,24,48 and 72 h after recovery of spontaneous circulation (T1 4).The rats were sacrificed after assessing neurological deficit at T4,brains were removed and hippocampi were isolated for determination of cell apoptosis (by TUNEL),HIF-1α expression (by Western blot) and expression of HIF-1α and aHIF-1α mRNA in hippocampal tissues (using polymerase chain reaction).Apoptosis rate was calculated.Results Compared with group S,the NDS at each time point and apoptosis rate of hippocampal neurons at T4 were significantly increased,and the expression of HIF-1α protein and mRNA and 5'aHIF-1α mRNA was up-regulated in R and D groups (P＜O.05).Compared with group R,the NDS at T2.4 and apoptosis rate of hippocampal neurons at T4 were significantly decreased,the expression of 5'aHIF-1α mRNA was down-regulated,and the expression of HIF-1α protein and mRNA was up-regulated in group D (P ＜ 0.05).Conclusion The mechanism by which dexmedetomidine reduces brain injury after asphyxial cardiac arrest and resuscitation is related to down-regulation of 5'aHIF-1α expression in rats.

Objective To explore the value of the plasma miR-193a-5p level on diagnosis and monitoring the response to treatment in acute myeloid leukemia (AML). Methods Peripheral blood samples were obtained from AML patients enrolled in hematology department of the Second Hospital of Shanxi Medical University from July 2015 to December 2015, including 30 de novo AML patients, 9 patients in complete remission (CR) and 6 patients in relapse. Peripheral blood samples from 15 healthy people were randomly choosed as the health control group. Plasma miR-193a-5p expression levels were detected by using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). Results The plasma miR-193a-5p relative expression level of AML patients group [0.465 6 (0.103 1-5.000 2)] was obviously lower than that of health control group [0.766 1 (0.052 1-3.134 4)] (U= 122, P= 0.018 7). The plasma miR-193a-5p relative expression levels of de novo group and relapse AML group were significantly lower than those of CR group and health control group (P<0.05), and there was no significant difference between the CR group and health control group (U= 56, P= 0.511 9). No significant correlation was found between the plasma miR-193a-5p level and age, gender, blast percentage of the bone marrow, peripheral blood leukocyte count, platelet count, CD34+cells'percentage and so on. Conclusion The decreased plasma miR-193a-5p expression level can be served as a new and noninvasive biomarker for the evaluation of diagnosis and treatment in AML.