In tracheal resection and reconstruction, a technically demanding, complex, and high-risk procedure, management of the anastomotic site significantly impacts postoperative outcomes and long-term quality of life. However, comprehensive studies detailing perioperative anastomotic management strategies in tracheal reconstruction remain scarce. This review summarizes perioperative management strategies for tracheal reconstruction, covering preoperative assessment, surgical techniques, and other key aspects. It also highlights future research directions and challenges, aiming to provide clinicians with a systematic guide to perioperative management in tracheal reconstruction.

Objective: To investigate the prevalence of human T-lymphotropic virus (HTLV) infection among blood donors in Hunan Province from 2022 to 2024. Methods: A total of 1 830 342 blood donors from 14 prefecture-level blood centers in Hunan Province over the past three years were screened for anti-HTLV-Ⅰ/Ⅱ using enzyme-linked immunosorbent assay (ELISA). Initially reactive samples were further tested with Line Immunoassay (LIA )/MP-Western blot and RT-PCR nucleic acid test for confirmation. Blood donors confirmed positive for HTLV were tracked and followed up. Results: From 2022 to 2024, the initial ELISA reactive rate for anti-HTLV-I/II among blood donors in Hunan Province was 1.36 per 10 000 (249/1 830 342). The confirmed positive rate was 0.20 per 10 000 (37/1 830 342), accounting for 14.86% of the initially reactive donors. The follow-up success rate for confirmed HTLV-positive blood donors was only 18.92%, while that for HTLV-indeterminate donors was 54.17%. Conclusion: The confirmed HTLV infection rates in Yueyang, Loudi, Shaoyang, Yiyang, and Zhuzhou cities were higher than the provincial (0.20 per 10 000). Chenzhou, Yongzhou, Zhangjiajie, and Xiangxi were identified as low prevalence areas, with an infection rate of 0. The overall follow-up success rate was low, indicating significant difficulties and bottlenecks in follow-up work. The comprehensive screening for HTLV and follow-up studies in Hunan provide valuable data to further improve blood safety testing strategies and risk warning mechanisms.

BACKGROUND: The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories. METHODS: This cross-sectional study involving 11833 Chinese adults aged 20 years and older. Covariance analysis, adjusted for age, compared the percentage of regional fat (trunk, leg, or arm fat divided by whole-body fat) between metabolically healthy and unhealthy participants. Trends in regional fat percentage with the number of metabolic abnormalities were assessed by the Jonckheere-Terpstra test. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression models. All analyses were performed separately by sex. RESULTS: In non-obese individuals, metabolically unhealthy participants exhibited higher percent trunk fat and lower percent leg fat compared to healthy participants. Additionally, percent trunk fat increased and percent leg fat decreased with the number of metabolic abnormalities. After adjustment for demographic and lifestyle factors, as well as BMI, higher percent trunk fat was associated with increased odds of being metabolically unhealthy [highest vs. lowest quartile: ORs (95%CI) of 1.64 (1.35, 2.00) for men and 2.00 (1.63, 2.46) for women]. Conversely, compared with the lowest quartile, the ORs (95%CI) of metabolically unhealthy phenotype in the highest quartile for percent arm and leg fat were 0.64 (0.53, 0.78) and 0.60 (0.49, 0.74) for men, and 0.72 (0.56, 0.93) and 0.46 (0.36, 0.59) for women, respectively. Significant interactions between BMI and percentage of trunk and leg fat were observed in both sexes, with stronger associations found in individuals with normal weight and overweight. CONCLUSIONS Trunk fat is associated with a higher risk of metabolically unhealthy phenotype, while leg and arm fat are protective factors. Regional fat distribution assessments are crucial for identifying metabolically unhealthy phenotypes, particularly in non-obese individuals.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Adipose Tissue ; Body Fat Distribution ; Body Mass Index ; China/epidemiology* ; Cross-Sectional Studies ; Health Surveys ; Phenotype

OBJECTIVE: To explore the potential role of mRNA m7G modification in the pathogenesis of human adenocarcinoma of esophagogastric junction (AEG). METHODS: Pathological tissue specimens from four AEG patients who underwent surgical treatment at the People's Hospital Affiliated to Jiangsu University between 2018 and 2019 were selected. Tumor tissues and adjacent normal tissues were collected from these patients. RNA was extracted from both tissue types and subjected to m7G methylated RNA immunoprecipitation sequencing (m7G-MeRIP-seq) to analyze the patterns of m7G modification, the characteristics of differential m7G modification sites, the differentially expressed mRNA, and the correlation between m7G modification and mRNA expression levels. Differential m7G-modified genes (MSH6, BRCA1, and SOX9) were further validated using methylated RNA immunoprecipitation quantitative PCR (MeRIP-qPCR), while the expression of METTL1 and WDR4 genes was examined by real-time quantitative PCR (RT-qPCR). This study was approved by the Medical Ethics Committee of the People's Hospital Affiliated to Jiangsu University (Ethics No. 20150083). RESULTS: m7G-MeRIP-seq analysis revealed that m7G modifications in both AEG and adjacent normal tissues were predominantly located in the GC-rich region surrounding the internal start codon of mRNA. Differential m7G modification sites between the two groups were closely associated with cancer-related genes. mRNA library analysis showed that differentially expressed mRNA were predominantly upregulated in AEG tissues and downregulated in adjacent normal tissues. Cross-analysis indicated that genes with hypermethylation tended to exhibit upregulated expression, while genes with hypomethylation were typically downregulated in AEG tissues. MeRIP-qPCR validation confirmed that the mRNA expression of MSH6, BRCA1, and SOX9 were significantly upregulated in AEG tissues compared to adjacent normal tissues (AEG vs. normal, P < 0.05). RT-qPCR results demonstrated that the mRNA expression levels of METTL1 and WDR4 were also upregulated in AEG tissues (AEG vs. normal, P < 0.000 5). CONCLUSION These findings suggest that mRNA m7G modification plays a significant role in the development of AEG. Furthermore, proteins as METTL1 and WDR4 may facilitate AEG progression by regulating mRNA m7G modification. These results provide valuable insights into the molecular mechanisms underlying AEG and may inform future therapeutic strategies for this malignancy.
Humans ; RNA, Messenger/metabolism* ; Adenocarcinoma/pathology* ; Esophagogastric Junction/metabolism* ; Esophageal Neoplasms/metabolism* ; Gene Expression Regulation, Neoplastic ; Female ; Male ; Middle Aged ; DNA Methylation ; Methyltransferases/metabolism* ; Stomach Neoplasms/genetics*

Objective To explore the clinical effect of endoscopic sclerosing agent and tissue glue injection combined with ligation in the treatment of rectal ectopic varices(EV)bleeding.Method A retrospective analysis was conducted on 60 patients with rectal EV bleeding who received endoscopic treatment from January 2017 to January 2022.According to the surgical method,the patients were divided into two groups,with 30 cases in the control group receiving endoscopic ligation treatment;30 cases in the observation group were treated with endoscopic scleroing agent and tissue glue injection combined with ligation.Follow up was conducted according to a cycle of 1,3,6 and 12 months after surgery,and the following indicators were compared between the two groups of patients:successful surgical hemostasis rate,incidence of postoperative complications,mortality rate,improvement of postoperative varicose vein diameter,and postoperative response rate.Result The success rate of surgical hemostasis in the observation group was 93.3%,significantly higher than 66.7%in the control group,the incidence of abdominal pain and fever in the observation group was 10.0%and 10.0%,respectively,significantly lower than 33.3%and 36.7%in the control group,there were 2 deaths in the observation group and 9 deaths in the control group,the mortality rate in the observation group was 6.7%,significantly lower than the 30.0%in the control group,the preoperative venous diameter of the observation group was(1.60±0.36)cm,and the postoperative diameter continued to decrease,at the 12th month after surgery,the diameter was(0.78±0.31)cm,while in the control group,the preoperative venous diameter was(1.52±0.26)cm,the postoperative diameter continued to increase,and at the 12th month after surgery,the diameter was(1.55±0.36)cm,the postoperative effective rate of the observation group was significantly better than that of the control group,the differences were statistically significant(P<0.05).Conclusion The combination of endoscopic scleroing agent and tissue glue injection combined with ligation for the treatment of rectal EV bleeding has a higher success rate and effective rate of surgical hemostasis,fewer postoperative complications,lower mortality rate during follow-up observation,and satisfactory clinical efficacy.It is worth further promoting and applying in clinical practice.

Objective:Bacterial liver abscess is one of the common infectious diseases of the digestive system.Invasive Klebsiella pneumoniae liver abscess syndrome(IKLAS)refers to cases where,in addition to liver abscess,there are migratory infections foci or other invasive manifestations.The clinical characteristics and risk factors of IKLAS are not fully elucidated,and there is a lack of research on the effectiveness and cost-effectiveness of different treatment methods.This study aims to compare the clinical characteristics of patients with IKLAS and non-IKLAS,and explore effective and economical treatment methods. Methods:This retrospective study collected medical records of patients with Klebsiella pneumoniae liver abscess treated at Xiangya Hospital of Central South University from January 2010 to December 2023.A total of 201 patients were included,dividing into an IKLAS group(n=37)and a non-IKLAS group(n=164).Differences in demographics,symptoms and signs,laboratory indicators,imaging characteristics,comorbidities,treatment methods,treatment outcomes,and direct treatment costs between 2 groups were analyzed.The study also compared the effectiveness and costs of different treatment methods. Results:Compared with the non-IKLAS group,the proportion of patients with diabetes,Quick Sequential Organ Failure Assessment(qSOFA)≥2,immune deficiency,anemia,and thrombocytopenia in the IKLAS group was higher,and the level of procalcitonin at the onset in the IKLAS group was also higher(all P<0.05).In terms of symptoms and signs,the IKLAS group had a higher proportion of visual abnormalities and a lower proportion of complaints of abdominal pain(both P<0.05).In terms of complications,the incidence of combined pleural effusion,pulmonary infection,acute renal failure,respiratory failure,and multiple organ failure was higher in the IKLAS group(all P<0.05).The IKLAS group had a higher proportion of patients treated with antibiotics alone(24.32%vs 11.59%),while the non-IKLAS group had a higher proportion of patients treated with antibiotics combined with puncture and drainage(86.59%vs 64.86%,both P<0.05).The overall effective rate of the IKLAS group(83.78%)was lower than that of the non-IKLAS group(95.73%),and the treatment and drug costs were higher(all P<0.05).The treatment method of antibiotics combined with surgical resection of infectious foci showed a 100%improvement rate,antibiotics combined with abscess puncture and drainage had an 84.9%improvement rate,and in antibiotics alone had an 82.1%improvement rate,with statistical differences among the 3 treatment methods(P<0.05).In terms of treatment costs,antibiotics alone were the most expensive(P<0.05). Conclusion:Patients with IKLAS have poorer prognosis and higher direct medical costs.The combination of abscess puncture and drainage or surgery has a higher improvement rate and lower hospitalization costs compared to antibiotics alone,suggesting that surgical intervention may reduce antibiotic costs and save medical expenses.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Clinical pharmacists participated in the drug therapy and monitoring of a patient with Crohn's disease complicated with erythema multiforme.The patient,who had a previous diagnosis of Crohn's disease for many years and had been treated with infliximab to date,was admitted to the hospital with a scattered rash on the peripheral skin,normal stools,and fecal calprotectin＞1 800 μg-g-1,by collecting the patient's medical history,reviewing domestic and foreign literature,the clinical pharmacist assisted the physician in ruling out drug factors,and making a definitive diagnosis of Crohn's disease complicated with extraintestinal manifestations.Taking into account the patient's condition and guideline recommendations,the clinical pharmacist assisted doctors to adjust medication regimen,and determined that the next step in the patient's treatment program was ustekinumab combined with glucocorticoids therapy,and continuously monitoring the patient's condition.The patient's condition was effectively controlled immediately before discharge,with marked improvement in erythema multiforme,and the patient was followed up 3 months later with complete disappearance of erythema multiforme,normal bowel movements,and no specific discomfort.Since the extraintestinal manifestations of Crohn's disease are often similar to the adverse reactions caused by medications used in the treatment or other systemic diseases and disorders,it is necessary for the clinical pharmacist to assist the physician in screening.The case was studied and compiled with a view to providing references for the diagnosis and pharmacological treatment of such patients.

Objective:To identify the risk factors for postoperative pulmonary complications (PPCs) in pediatric patients undergoing malignant tumor resection.Methods:Medical records of pediatric patients who underwent open abdominal malignant tumor resection at Children′s Hospital affiliated to Zhejiang University School of Medicine from August 2019 to July 2023, with length of hospital stay ≥48 h, were retrospectively collected. Patients were divided into PPC group and non-PPC group based on the occurrence of PPCs within 7 days postoperatively. Variables with P<0.05 in the univariate analysis were included in the binary logistic regression analysis to identify the risk factors for PPCs. Results:A total of 605 pediatric patients who underwent abdominal malignant tumor resection were finally included, among which 391 children developed PPCs, with an incidence of 64.6%. Binary logistic regression analysis showed that body weight ( P=0.001), American Society of Anesthesiologists Physical Status classification ( P<0.001), preoperative hypoalbuminemia ( P=0.013), preoperative chemotherapy ( P=0.003), tumor compression/encasement of major abdominal vessels ( P=0.002), anesthesia duration ( P<0.001), intraoperative fluid intake (ml·kg -1·h -1, P<0.001), intraoperative use of hypotensive agents ( P=0.047), and concurrent resection of mediastinal tumors via abdominal approach ( P<0.001) were risk factors for PPCs in children undergoing malignant tumor resection. Age ( P<0.001) was identified as a protective factor for PPCs. Conclusions:Body weight, American Society of Anesthesiologists Physical Status classification, preoperative chemotherapy, preoperative hypoalbuminemia, tumor compression/encasement of major abdominal vessels, anesthesia duration, intraoperative fluid intake, intraoperative use of hypotensive agents, and concurrent resection of mediastinal tumors via abdominal approach are risk factors for PPCs in pediatric patients undergoing open abdominal malignant tumor resection, whereas age is a protective factor for PPCs.

Orthostatic myoclonus (OM) is not an independent disease but rather a clinical syndrome often associated with neurodegenerative disorders and systemic diseases. Its hallmark features include jerking movements in the lower limbs when standing, accompanied by instability and gait disturbances. Symptoms tend to alleviate or resolve upon relieving weight-bearing. OM can be easily confused with orthostatic tremor. This review focuses on the clinical features, electrophysiological characteristics, differential diagnosis, and treatment of OM, aiming to enhance clinicians′ awareness of OM.