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 observe the value of whole brain CT perfusion(CTP)-derived arterial phase images combined with artificial intelligence iterative reconstruction(AIIR)for evaluating acute ischemic stroke(AIS).Methods Fifty AIS patients were prospectively enrolled,and whole brain CTP followed by routine CT angiography(CTA)were performed.CTP images were reconstructed using AIIR(CTP-AIIR group)and hybrid iterative reconstruction(HIR,CTP-HIR group),respectively,and CTA images were derived from CTP at the arterial phase.Meanwhile,routine CTA images were obtained using HIR(CTA-HIR group).Then image quality was subjectively evaluated with a 5-point scale.The noise of basilar artery trunk,cavernous segment of internal carotid artery,M1 segment of middle cerebral artery and the brain parenchyma were calculated,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the above 3 arteries were measured.Taken digital subtraction angiography as the reference standard,the accuracy of CTP and CTA for localizing the responsible vessel of AIS was assessed.Results In CTP-AIIR group,the subjective scoring of 4 subjective metrics,including image noise,sharpness of vessel margin,small vessel visibility and overall diagnosability were significantly higher than,the noise of 3 arteries and brain parenchyma were lower than,and SNR and CNR of 3 arteries were higher than those in CTP-HIR group and CTA-HIR group(all P＜0.017).The diagnostic accuracy of responsible vessel based on CTP-AIIR group and CTA-HIR group were both 96.00％ (48/50),not significantly different with that in CTP-HIR group(44/50,88.00％ )(P=0.142).Conclusion Whole brain CTP-derived arterial phase CTA combined with AIIR could achieve comparable image quality and diagnostic performance of routine CTA for evaluating AIS.

BACKGROUND: The proportion of patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations is relatively high in China. However, these patients currently lack significant benefits from available neoadjuvant treatment options. This study aims to explore the potential application value of neoadjuvant targeted therapy by evaluating its efficacy and safety in patients with EGFR-mutant resectable lung adenocarcinoma. METHODS: A multicenter retrospective study was used to analyze the treatment effect of patients with stage IIA-IIIB EGFR-mutant lung adenocarcinoma who underwent surgical resection after receiving neoadjuvant targeted therapy from July 2019 to October 2024. RESULTS: A total of 24 patients with EGFR-mutant lung adenocarcinoma from three centers were included in this study. All patients successfully underwent surgery and achieved R0 resection of 100.0%. The objective response rate (ORR) was 83.3% (20/24) . The major pathologic response (MPR) rate was 37.5% (9/24), with 2 patients (8.3%) achieving pathological complete response (pCR). During neoadjuvant therapy, 13 out of 24 patients (54.2%) experienced adverse events of grade 1-2, with no occurrences of ≥ grade 3. The most common treatment-related adverse events were rash (n=4, 16.7%), mouth sores (n=2, 8.3%), and diarrhea (n=2, 8.3%). The median follow-up time was 33.0 months, no deaths occurred in all patients, and the overall survival (OS) rate was 100.0%. The 1-year disease-free survival (DFS) rate was 91.1%, and the 2-year DFS rate remained at 86.2%. CONCLUSIONS The application of neoadjuvant targeted therapy in patients with EGFR-mutant resectable lung adenocarcinoma is safe and feasible, and is expected to become a highly promising neoadjuvant treatment option for the patients with EGFR-mutant lung adenocarcinoma.
Humans ; ErbB Receptors/metabolism* ; Male ; Female ; Middle Aged ; Adenocarcinoma of Lung/surgery* ; Neoadjuvant Therapy ; Lung Neoplasms/surgery* ; Aged ; Retrospective Studies ; Mutation ; Adult

Objective To develop a refined printer management system based on the PDCA cycle,aiming to improve both operational cost efficiency and medical service quality through full-process management.Methods A total of 400 printers in use at the Third Affiliated Hospital of Sun Yat-sen University(Zhaoqing Hospital)were included from June 2024 to May 2025.The period from June to November 2024 was designated as the pre-refinement phase(under conventional management),while December 2024 to May 2025 served as the post-refinement phase(under PDCA-based refined management).A fishbone diagram was used to identify root causes of previous management inefficiencies,and targeted measures were developed and implemented.Outcomes were compared between the two phases.Results After implementing the PDCA cycle,the average equipment utiliza-tion rate increased by 5.41％,indicating optimized resource allocation.The average page yield per drum increased by 3.51％,reflecting improved consumable efficiency and reduced operational costs.The incidence of driver failures decreased by 34.71％,and operational issues dropped by 7.25％,demonstrating enhanced device reliability and system stability.Consultation-related work orders increased by 78.68％,and routine maintenance tasks rose by 30.62％,signaling a shift from reactive repairs to pro-active preventive maintenance.Conclusion The PDCA-based refined management model effectively enhances printer operational efficiency,reduces resource waste,and improves device reliability.This approach reinforces a patient-centered service philosophy by increasing the accuracy and efficiency of medical documentation output,thereby supporting safer and more efficient healthcare delivery.

Objective To develop a refined printer management system based on the PDCA cycle,aiming to improve both operational cost efficiency and medical service quality through full-process management.Methods A total of 400 printers in use at the Third Affiliated Hospital of Sun Yat-sen University(Zhaoqing Hospital)were included from June 2024 to May 2025.The period from June to November 2024 was designated as the pre-refinement phase(under conventional management),while December 2024 to May 2025 served as the post-refinement phase(under PDCA-based refined management).A fishbone diagram was used to identify root causes of previous management inefficiencies,and targeted measures were developed and implemented.Outcomes were compared between the two phases.Results After implementing the PDCA cycle,the average equipment utiliza-tion rate increased by 5.41％,indicating optimized resource allocation.The average page yield per drum increased by 3.51％,reflecting improved consumable efficiency and reduced operational costs.The incidence of driver failures decreased by 34.71％,and operational issues dropped by 7.25％,demonstrating enhanced device reliability and system stability.Consultation-related work orders increased by 78.68％,and routine maintenance tasks rose by 30.62％,signaling a shift from reactive repairs to pro-active preventive maintenance.Conclusion The PDCA-based refined management model effectively enhances printer operational efficiency,reduces resource waste,and improves device reliability.This approach reinforces a patient-centered service philosophy by increasing the accuracy and efficiency of medical documentation output,thereby supporting safer and more efficient healthcare delivery.

Objective To observe the value of whole brain CT perfusion(CTP)-derived arterial phase images combined with artificial intelligence iterative reconstruction(AIIR)for evaluating acute ischemic stroke(AIS).Methods Fifty AIS patients were prospectively enrolled,and whole brain CTP followed by routine CT angiography(CTA)were performed.CTP images were reconstructed using AIIR(CTP-AIIR group)and hybrid iterative reconstruction(HIR,CTP-HIR group),respectively,and CTA images were derived from CTP at the arterial phase.Meanwhile,routine CTA images were obtained using HIR(CTA-HIR group).Then image quality was subjectively evaluated with a 5-point scale.The noise of basilar artery trunk,cavernous segment of internal carotid artery,M1 segment of middle cerebral artery and the brain parenchyma were calculated,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the above 3 arteries were measured.Taken digital subtraction angiography as the reference standard,the accuracy of CTP and CTA for localizing the responsible vessel of AIS was assessed.Results In CTP-AIIR group,the subjective scoring of 4 subjective metrics,including image noise,sharpness of vessel margin,small vessel visibility and overall diagnosability were significantly higher than,the noise of 3 arteries and brain parenchyma were lower than,and SNR and CNR of 3 arteries were higher than those in CTP-HIR group and CTA-HIR group(all P＜0.017).The diagnostic accuracy of responsible vessel based on CTP-AIIR group and CTA-HIR group were both 96.00％ (48/50),not significantly different with that in CTP-HIR group(44/50,88.00％ )(P=0.142).Conclusion Whole brain CTP-derived arterial phase CTA combined with AIIR could achieve comparable image quality and diagnostic performance of routine CTA for evaluating AIS.

Objective To explore the diagnostic value of serum neuronal Per-Arnt-Sim domain protein 4(NPASDP-4)and myelin basic protein(MBP)expression in patients with Parkinson's disease in relation to cognitive impairment(CI)and severity.Methods Selected and 138 Parkinson's disease patients admitted to the 909th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China as the Parkinson's disease group,and 69 healthy people in the physical examination center of the hospital were in the healthy control group.Patients with Parkinson's disease were divided into normal cognitive function group(n=55),mild CI group(n=51)and dementia group(n=32)according to whether CI occurred and its severity.General data of subjects was collected,the serum levels of NPASDP-4 and MBP were detected by ELISA,correlation analysis was adopted by Spearman rank correlation or Pearson linear correlation,diagnostic value was analyzed by ROC curve,and influencing factors were analyzed by multivariate Logistic regression.Results Compared with the healthy control group,the levels of serum NPASDP-4(6.75±0.48 ng/ml vs 2.38±0.31 ng/ml)and MBP(8.34±0.65 μg/L vs 3.54±0.42 μg/L)in the Parkinson's disease group were increased with statistical significance(r=68.751,55.761,all P＜0.05).There were significant differences in H-Y stage among the normal cognitive function group,mild CI group and dementia group(x2=7.788,P＜0.05).Compared with the group with normal cognitive function(47.92±11.63 score),the mild CI group(50.78±13.69 score)and the dementia group(41.95±10.36 score)showed an increase in UPDRS-Ⅲ scores,and the differences were statistically significant(H=6.672,all P＜0.05).In normal cognitive function group,mild CI group and dementia group,the course of disease,and serum NPASDP-4(5.89±0.40,6.83±0.55,8.12±0.54 ng/ml)and MBP(6.65±0.56,8.94±0.69,10.27±0.70μg/L)levels were significantly increased(H=207.950,355.594,allP＜0.05),while MMSE score(28.47±0.94,24.51±1.35,17.09±2.57 score),MoCA score(27.45±1.03,20.18±1.92,11.75±2.53 score)and GPCOG total score(13.47±0.69,10.25±1.04,8.97±0.82 score)were significantly decreased,and the differences were statistically significant(H=515.005,775.933,327.584,all P＜0.05),respectively.The serum levels of NPASDP-4 and MBP in Parkinson's disease patients were significantly positively correlated with the course of disease(r=0.316,0.358),H-Y stage(r=0.345,0.384)and UPDRS-Ⅲ score(r=0.371,0.396),and significantly negatively correlated with MMSE score(r=-0.468,-0.517),MoCA score(r=-0.504,-0.569)and GPCOG total score(r=-0.527,-0.538)(all P＜0.05),respectivey.The areas under the curve(AUC)of the serum levels of NPASDP-4,MBP and their combination in diagnosing of Parkinson's disease were 0.850,0.930 and 0.960,respectively.The AUC of the serum levels of NPASDP-4 and MBP and their combination in diagnosing the severity of CI in patients with Parkinson's disease were 0.866,0.803 and 0.933,respectively.H-Y stage metaphase[OR(95％CI):4.725(1.742～12.814)],H-Y stage advanced[OR(95％CI):5.083(1.919～13.464)],UPDRS-Ⅲ score[OR(95％CI):3.257(1.464～7.246)],NPASDP-4[OR(95％CI):5.324(1.516～18.701)]and MBP[OR(95％CI):5.769(2.459～13.533)]were the influential factors for CI in patients with Parkinson's disease(all P＜0.05).NPASDP-4[OR(95％CI):4.768(2.382～9.543)]and MBP[OR(95％CI);5.846(3.141～10.882)]were the influential factors for the severity of CI in patients with Parkinson's disease(all P＜0.05).Conclusion The serum levels of NPASDP-4 and MBP in patients with Parkinson's disease were high,and they were closely related to CI and its severity,which may have certain clinical diagnostic value.

OBJECTIVES: Platelet-to-lymphocyte ratio (PLR) has recently been investigated as a new inflammatory marker in many inflammatory diseases, including systemic lupus erythematosus and immunoglobulin A vasculitis. However, there were very few reports regarding the clinical role of PLR in patients with anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis. This study was thus undertaken to investigate the relationship between inflammatory response and disease activity in Chinese patients with myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis. Furthermore, we evaluated whether PLR predicts the progression of end stage of renal disease (ESRD) and all-cause mortality. METHODS: The clinical, laboratory and pathological data, and the outcomes of MPO-ANCA associated vasculitis patients were collected. The Spearman correlation coefficient was computed to examine the association between 2 continuous variables. Cox regression analysis was used to estimate the association between PLR and ESRD or all-cause mortality. RESULTS: A total of 190 consecutive patients with MPO-ANCA associated vasculitis were included in this study. Baseline PLR was positively correlated with CRP (r=0.333, P<0.001) and ESR (r=0.218, P=0.003). PLR had no obvious correlation with Birmingham Vasculitis Activity Score (BVAS). Patients having PLR≥330 exhibited better cumulative renal survival rates than those having PLR<330 (P=0.017). However, there was no significant difference in the cumulative patient survival rates between patients with PLR≥330 and those with PLR<330 at diagnosis (P>0.05). In multivariate analysis, PLR is associated with the decreased risk of ESRD (P=0.038, HR=0.518, 95% CI 0.278 to 0.963). We did not find an association between PLR with all-cause mortality using multivariate analysis (HR=1.081, 95% CI 0.591 to 1.976, P=0.801). CONCLUSIONS PLR is positively correlated with CRP and ESR. Furthermore, PLR may independently predict the risk of ESRD.
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis* ; Antibodies, Antineutrophil Cytoplasmic/analysis* ; China/epidemiology* ; Humans ; Kidney Failure, Chronic/complications* ; Lymphocytes ; Peroxidase ; Retrospective Studies

Isopentenyl flavonoids are a class of characteristic components in Sophora flavescens Ait. (S. flavescens). They have biological activities such as anti-tumor, anti-bacteria, anti-inflammol/ Lation and anti-oxidation. In this paper, the structural types, toxicology and pharmacological effects of isopentenyl flavonoids from S. flavescens were briefly reviewed. Furthermore, the worth of further study on pharmacokinetics, pharmacodynamics, toxicology, action targets, molecular mechanisms and structure-function relationships of isopentenyl flavonoids were proposed. The deep exploration on functional characterastics of isopentenyl flavonoids of S. flavescens and their application on development of innovative drugs are of great significance to further improve the added value of isopentenyl flavonoids and expand their application fields.

Objective To study the clinical significance of the novel tumor marker Cytokerantin?19?fragment( CYFRA 21?1) of peripheral blood in patients with esophageal cancer. Methods The CYFRA 21?1 level in peripheral blood of 72 patients with benign tumor of esophagus or reflux esophagitis and 60 patients with esophageal cancer was examined before and 7 days after operation by enzyme?linked immuno sorbent assay ( ELISA) . At the same time, patients with esophageal cancer were followed up for 3 years, and the level of CYFRA21?1 was examined. Results (1)Before the operation,the level of CYFRA 21?1 was 0-3. 30 μg/L in 51. 67%( 31/60 ) of the patients with esophageal cancer, higher than that of the control group ( 16. 67%(12/72),χ2=3. 88,P<0. 05). (2)Before the operation,the level of CYFRA21?1 in patients with esophageal cancer,stage Ⅰ,Ⅱ and stage Ⅲ,Ⅳ were (3. 27±0. 33) μg/L and (4. 88±1. 21) μg/L,and of the control group was (2. 24±1. 17) μg/L. The levle of CYFRA21?1 in patients with esophageal cancer,stage Ⅰ,Ⅱ andⅢ,Ⅳ were significantly higher than that of the control group( t=2. 37,2. 00,P<0. 05) . ( 3) On the 7th day after operation,the level of CYFRA21?1 was (2. 26±1. 16) μg/L,and the difference was not significant compared with the control group(t=0. 95,P>0. 05). The level of CYFRA21?1 with the palliative resection of esophageal cancer was (3. 31±0. 66) μg/L,and the difference was significant compared with the control group(t=4. 33,P<0. 05) . ( 4 ) After 3 years of follow?up, the factors affecting the survival rate of esophageal cancer were as following:the pathologic stages of tumor(OR 4. 423,95%CI 1. 943-4. 972,P<0. 05),types of operation(OR 0. 023,95%CI 0. 012-0. 036,P<0. 05),the level of CYFRA21?1 before operation(OR 6. 798,95%CI 4. 328-8. 105,P<0. 05),and the decreased level of CYFRA21?1 after operation(OR 0. 117,95%CI 0. 074-0. 202,P<0. 05) . ( 5) During the follow?up period,the level of CYFRA21?1 in patients with local recurrence and distant metastasis of esophageal carcinoma was (7. 97±0. 44) μg/L,significantly more than that of the control group(t=5. 11,P <0. 05) . Conclusion CYFRA21?1 is a useful tumor marker in the positive rate of preoperative diagnosis of esophageal cancer, postoperative monitoring of recurrence, distant metastasis and prediction of prognosis.