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 sirtuin 3(SIRT3)on the oxidative stress response and hypoxia inducible factor-1α(HIF-1α)expression in lung cancer cells through reactive oxygen species(ROS)under hypoxic conditions and its mechanism.Methods Human non-small cell lung cancer A549 cells were exposed to hypoxia for 0 h,12 h,24 h and 48 h.The mRNA and protein expressions of HIF-1α and SIRT3 were detected by RT-PCR and Western blot to determine the optimal time of hypoxia induction.A549 cells were divided into 5 groups:control group,hypoxia group,hypoxia+ROS inhibitor n-acetylcysteine(NAC)group,hypoxia+(SIRT3 overexpression)SIRT3-OE group and hypoxia+SIRT3-OE+NAC group.Cell proliferation was detected by MTT assay.Cell apop-tosis was detected by flow cytometry.The mRNA and protein expressions of HIF-1 α and SIRT3 in each group were detected by RT-PCR and Western blot.ROS content in each group was detected by flow cytometry.The contents of malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione(GSH)in the cells of each group were detected by biochemical kits.Results The optimal induction time of hypoxia was 24 h.Compared with the control group,the apoptosis rate,SIRT3 mRNA and protein levels,SOD and GSH contents in the hypoxia group signifi-cantly decreased(P＜0.01),the cell proliferation ability,HIF-1 α mRNA and protein levels,ROS and MDA con-tent in cells significantly increased(P＜0.01).Compared with the hypoxia group,the apoptosis rate,SIRT3 mR-NA and protein levels,SOD and GSH contents in the hypoxia+NAC and hypoxia+SIRT3-OE groups increased(P＜0.05),the cell proliferation ability,HIF-1 α mRNA and protein levels,ROS and MDA content in cells de-creased(P＜0.05).Compared with the hypoxia+NAC group,the apoptosis rate,SIRT3 mRNA and protein lev-els,SOD and GSH contents in the hypoxia+SIRT3-OE+NAC group significantly increased(P＜0.01),the cell proliferation ability,HIF-1 α mRNA and protein levels,ROS and MDA content in cells significantly decreased(P＜0.01).Conclusion Under hypoxic conditions,SIRT3 can promote cell apoptosis and inhibit lung cancer pro-gression by mediating ROS to inhibit oxidative stress response and HIF-1 α expression in lung cancer cells.

Objective To compare the diagnostic accuracy of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for preoperative endoscopic assessment of the invasion depth of colorectal laterally spreading tumour(LST).Methods Data of 104 cases of colorectal LST were included.With the final pathological diagnosis as the golden standard,the accuracies of MCE and EUS for preoperative assessment of the invasion depth of colorectal LST were compared.Results The diagnostic accuracies of MCE and EUS for evaluating the invasion depth of LST were 89.4％ (93/104) and 73.1％ (76/104),respectively(P＜0.05).The lesion size and the endoscopist could affect the accuracy of the EUS evaluation (P=0.017,OR=3.561;P=0.035,OR =1.399).The accuracy of EUS seemed to show a downward trend for colorectal LST of larger diameters.Conclusion Both MCE and EUS are effective for evaluating the invasion depth of colorectal LST,but the accuracy of MCE may be higher than that of EUS.Large diameter of the lesion and the doctor's experience inadequacy may be the risk factors for the accuracy of EUS.

Objective: To analyze the clinical features of perianal condyloma acuminatum in HIV infected men who have sex with men (MSM) and assess the effects of combined treatment of microwave and photodynamic therapy. Methods: Clinical and laboratory data of 260 male patients with perianal condyloma acuminatum were collected and microwave combined with photodynamic therapy was applied on them. Results: The majority of the patients with perianal condyloma acuminatum were young people (243/260). Warts were mainly located in the anus or from the outside to inside of the anus (245/260). Among them, the proportion of warts position of extraanal in HIV-infected group (8/220) was lower than that of non-HIV-infected group (7/40). HPV types 11 (70/118), 6 (44/118) and 16 (40/118) were the most common types of HPV infection. People with HIV infection were more likely to develop high-risk, mixed types HPV infection and multiple HPV infection than those without HIV infection. More than half of the patients (146/260) needed only 1-3 sessions of photodynamic treatments. There was no significant difference in the times of photodynamic treatments and the numbers of photosensitizers required between the HIV-infected and non-HIV-infected groups. The recurrence rate of HIV-infected group (13.6%, 30/220) was also similar to that of non-HIV-infected group (15.0%, 6/40), but far lower than those who underwent microwave therapy alone (45%, 18/40). Conclusions The combination therapy significantly reduced the recurrence rate of perianal condyloma acuminatum in HIV infected MSM.

Objective To determine the value of CT and MRI in the evaluation of littoral cell angioma(LCA) of spleen.Methods Two experienced radiologists retrospectively analyzed the clinical data,CT and MRI findings of 12 patients with pathology proven LCA of spleen.The patients underwent noncontrast enhanced CT scan,then enhanced CT (n =10) and MRI (n =3) were performed.Results The majority of patients (8/12) showed splenomegaly,with no obvious signs and symptoms of hypersplenism.The majority of patients (10/12) had the uncountable hypodense lesions,a few (2/12) had only a single lesion.None of the lesions contained any calcification or envelopement.On CT,the majority (7/10) of the lesions demonstrated well circumscribed border,with some lesions (3/10) demonstrating a less distinct border.The enhanced scan for low-density nodules demonstrated slow progressive enhancement.On MRI,all the LAC had well circumscribed borders,and demonstrated T1-hypointense and T2-hyperintense signalswith punctual hypointense in the T2 WI,and progressive enhancement on the post contrast images.DWI showed an increased diffusion of the lesions compared to the normal appearing splenic tissue.Conclusion CT and MR imaging of littoral cell angioma of spleen has certain imaging characteristics,those particular findings may potentially aid in the diagnosis.

Objective To investigate the expression of pattern recognition receptor (PRR)of immune cells from the patients with enterovirus 71 ( EV 71 ) infection and the changes of cytokines. Methods Seventy-one patients and 20 age-matched healthy children were enrolled in the study. The patients were divided into three groups according to the critical degree: 20 mild patients, 25 severe patients and 26 critical patients. Real-time PCR were used to evaluate the levels of retinoic acidinducible gene Ⅰ ( RIG- Ⅰ ), melanoma differentitation-associated gene 5 ( MDA5 ) and cytokines IL-12, IFN-α mRNA expression in peripheral blood mononuclear cells (PBMC). The proportions of Toll like receptors(TLRs) on monocytes/macrophages (MC) , myloiddentritic cells (mDC) and plasmacytoiddentritic cells (pDC) were analyzed by flow cytometry. The concentrations of plasma cytokines( IL-12, IFN-α) were measured by ELISA. Results ( 1 ) The proportion of TLR7 is the unique TLR which is increased in mild patients and it was significantly elevated in MC, mDC and pDC in severe group (P＜0.05), TLR2, TLR3 and TLR4 also had an enhanced expression in MC and mDC. The enhanced expression of TLRs mentioned above had a decreased trend in critical patients. (2)Transcription levels of RIG- Ⅰ and MDA5 was significantly elevated in EV71 infected children.(3)The expression levels of DC-associated cytokines gene( IL-12 and IFN-α) have an increased trend in mild cases and these cytokines were remarkably increased in severe patients (P＜0.05), whereas decreased in critical cases (P＜0.05). ConclusionTLR7 might be the main PRR recognizing EV71 in immune cells and RIG-Ⅰ/MDA5 might also take part in the recognition of EV71. The exogenous or endogenous ligands released from bacterial infection and cell destruction could result in the activation of TLR2 or TLR4, inducing the inflammatory response.

Objective To investigate the efficacy and safety of hypertonie saline enhanced radiofrequency ablation (RFA) in the treatment of liver cancer. Methods The clinical data of 42 patients with primary liver cancer (n = 28) or metastatic liver eancer (n = 14) who had been admitted to First Affiliated Hospital of Nanjing Medical University from September 2001 to December 2007 were collected. Forty-eight lesions were detected with a diameter ranging from 1.2 cm to 7.5 cm. RFA electrode and 20G needle were pricked into the target lesion under the guidance of B ultrasound or computed tomography (CT) through percutaneoas puncture or open approaches. An amount of 5-10 ml hypertonie saline was infused through the needle at regular intervals during RFA. All patients were followed up for 3-79 months. Contrast-enhanced ultrasound and CT scanning were performed postoperatively to determine the efficacy of RFA. The levels of alpha-fetoprotein (AFP) before and after treatment were compared using t test, and the survival of the patients were analyzed using a Kaplan-Meier survival curve. Results The AFP expression changed to negative in 14 out of the 18 AFP-positive patients, with statistical difference (t =7.703, P <0.05). The complete necrosis rate of tumors was 94% (45/48), and the necrosis rate of tumors with diameter of ≤4.0 cm reached 100% (35/35). The incidence of complication was 5% (2/42). No perioperative mortality occurred. The 1-, 2-, 3-year survival rates were 91%, 85% and 70%, respectively. Conclusions Hypertonic saline enhanced RFA in the treatment of liver cancer was proved to be safe and effective.

The objective of this comparative study is to determine the MDCT features of solitary pulmonary tuberculous cavity and malignant cavity and to analyze the advantages there-of in differential diagnosis. The clinical data and MDCT findings of 51 cases of pulmonary tuberculous cavities and 39 cases of malignant cavities were reviewed retrospectively, which include the general aspects of patients, the manifestation of cavity and the changes of adjacent structures. The results revealed that the tuberculous cavity tends to locate in the upper lobe or the superior segment of lower lobe, and it is usually acompanied with cavity wall calcification, satellite lesions, peripheral inflammation, lymph node calcification, small diameter and thin wall thickness. The malignant cavities, showing no disposition to locate in a lobe or segment, are characterized by mural nodules, off-center cavity, lobulation, coarse speculation, lymph node enlargement, vascular clustering sign, big diameter and thick wall. In conclusion, with multiplanar reconstruction on multi-detector row CT, we could elaborate the cavities and the accompained lesions, thus contributing to a correct diagnosis in most cases.
Adenocarcinoma ; diagnostic imaging ; pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Spiral Computed ; methods ; Tuberculosis, Pulmonary ; diagnostic imaging ; pathology ; Young Adult

The objective of this study was to investigate the specific contrast-enhanced MSCT features and predominant anatomic distribution of mediastinal malignant lymphoma. Contrast-enhanced MSCT in 31 cases of mediastinal malignant lymphomas were retrospectively evaluated by analyzing the features of size, morphology, attenuation and anatomic distribution in accordance to the ATS classification of intrathoracic lymph nodes. Nine cases of Hodgkin Disease (HD) and 22 cases of Non-Hodgkin Disease (NHL) were included. The enlarged nodes were found to be homogeneous (HD 72.7%, NHL 88.9%) and partly homogeneous with necrosis (HD 27.3%, NHL 11.1%). HD involved predominantly the lymph nodes in the areas of 2R (77.8%), 3 (55.6%), 4R (88.9%), 4L (55.6%), 5 (66.7%), 6 (55.6%), 7 (66.7%) and 10R (55.6%), while NHL often involved the areas of 2R (68.2%), 3 (54.5%) 4R (59.1%), 4L (50%), 5 (54.5%), 6 (54.5%), 7 (54.5%) and 8 (50%). The following extranodal organs were involved: pericardium (19.4%), pleura (19.4%), great vessels (6.4%), lung (6.4%), chest wall (3.2%) and breast (3.2%). Mediastinal malignant lymphoma had some characteristic manifestations and predominant anatomic distribution shown on contrast-enhanced MSCT, which can provide imaging evidences for diagnosis and for determining the tumor stage.
Adult ; Aged ; Contrast Media ; Female ; Hodgkin Disease ; diagnostic imaging ; pathology ; Humans ; Lymph Nodes ; pathology ; Lymphoma, Non-Hodgkin ; diagnostic imaging ; pathology ; Male ; Mediastinal Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Tomography, Spiral Computed ; methods

0.05).Conclusion The segmental bronchus were visualized reliably by low-dose multi- detector-row CT with 17 mAs. Low-dose CT can be adapted to CT screening for early lung cancer.