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 breast reconstruction after breast cancer surgery in hospitals in China.Methods:This study was a cross-sectional study using convenience sampling. A self-designed survey questionnaire was used to investigate nurses of department of breast diseases in China from May to August 2023. The content of the questionnaire included four aspects: identification information, basic hospital information, the implementation situation of breast reconstruction after breast cancer surgery, and the situation of medical and nursing human resources for breast reconstruction, with a total of 39 items. Statistical analysis was performed using SPSS 26.0 software. The non-normally distributed measurement data were expressed as M( Q1, Q3), and the Mann-Whitney U test was used for comparison between groups. Numeric data were expressed as frequency and percentage, and comparisons between groups were made using the χ2-test or Fisher’s exact probability method. P<0.05 indicated that the difference was statistically significant. Results:A total of 212 public hospitals from 31 provinces, autonomous regions and municipalities participated in the survey. Two hundred and three hospitals (95.8%) returned valid data, including 155 Grade Ⅲ Level A hospitals, 19 Grade Ⅲ Level B and C hospitals, and 29 Grade Ⅱ hospitals. There were 157 general hospitals, 32 specialized cancer hospitals, and 14 other hospitals. Thirty-nine hospitals did not perform breast reconstruction surgery. A total of 164 hospitals (80.8%) had already carried out breast reconstruction surgery, among which the proportion of breast reconstruction in Grade Ⅲ Level A hospitals [90.3% (140/155)] was significantly higher than that in Grade Ⅲ Level B and C hospitals [52.6% (10/19)] and Grade Ⅱ hospitals [48.3% (14/29)] ( P<0.01). The proportion of breast reconstruction in specialized cancer hospitals [96.9% (31/32)] was significantly higher than that in general hospitals [79.0% (124/157)] and other types of hospitals [64.3% (9/14)] ( P<0.05). Among the 164 hospitals, 310 (150, 637.5) patients underwent breast cancer surgery and 30 (10, 100) patients underwent breast reconstruction in 2022. The proportion of patients undergoing breast reconstruction surgery among breast cancer surgery patients was 13.3% (4.0%, 20.0%). The number of patients receiving immediate breast reconstruction was 11 (2.5, 46.5) cases, and the number of those receiving delayed breast reconstruction was 5 (0, 18.5) cases. Among 203 hospitals, the median proportions of breast oncoplastic surgeons and specialized nurses among healthcare providers in breast surgery departments were 28.6% (2/7) and 75.0% (12/16), respectively. In comparison of the 164 hospitals offering breast reconstruction surgery and 39 hospitals not, the median numbers of breast oncoplastic surgeons were 3 (1, 8) versus 1 (0, 3), and qualified breast reconstruction nurses were 12 (6, 16) versus 1 (0, 8), respectively. All differences were statistically significant (all P<0.01). Conclusion:About 80% of hospitals in China have offered breast reconstruction procedures after breast cancer surgery, and the proportion of Grade Ⅲ Level A hospitals and specialized cancer hospitals is higher than that of other types of hospitals. The proportion of patients undergoing breast reconstruction after breast cancer surgery is relatively low, and there is a considerable potential of improvements. Breast oncoplastic surgeons and nurses are insufficient, so it is necessary to strengthen the training of specialized medical staff and improve surgical techniques and the level of nursing services simultaneously, so as to improve the quality of life of breast cancer patients.

Post-stroke cognitive impairment (PSCI) is a common complication of stroke, which seriously affects the quality of life of patients. Therefore, early and accurate prediction of PSCI is crucial for implementing targeted intervention measures. Quantitative electroencephalography (qEEG), as a non-invasive and objective neurophysiological technique, can provide objective basis for early prediction and targeted intervention of PSCI during the critical period of 72 hours to 1 month after stroke onset. This article reviews the current application status of qEEG in predicting PSCI, aiming to provide theoretical basis for early identification of patients with high-risk PSCI.

Objective:To investigate the current status of breast reconstruction after breast cancer surgery in hospitals in China.Methods:This study was a cross-sectional study using convenience sampling. A self-designed survey questionnaire was used to investigate nurses of department of breast diseases in China from May to August 2023. The content of the questionnaire included four aspects: identification information, basic hospital information, the implementation situation of breast reconstruction after breast cancer surgery, and the situation of medical and nursing human resources for breast reconstruction, with a total of 39 items. Statistical analysis was performed using SPSS 26.0 software. The non-normally distributed measurement data were expressed as M( Q1, Q3), and the Mann-Whitney U test was used for comparison between groups. Numeric data were expressed as frequency and percentage, and comparisons between groups were made using the χ2-test or Fisher’s exact probability method. P<0.05 indicated that the difference was statistically significant. Results:A total of 212 public hospitals from 31 provinces, autonomous regions and municipalities participated in the survey. Two hundred and three hospitals (95.8%) returned valid data, including 155 Grade Ⅲ Level A hospitals, 19 Grade Ⅲ Level B and C hospitals, and 29 Grade Ⅱ hospitals. There were 157 general hospitals, 32 specialized cancer hospitals, and 14 other hospitals. Thirty-nine hospitals did not perform breast reconstruction surgery. A total of 164 hospitals (80.8%) had already carried out breast reconstruction surgery, among which the proportion of breast reconstruction in Grade Ⅲ Level A hospitals [90.3% (140/155)] was significantly higher than that in Grade Ⅲ Level B and C hospitals [52.6% (10/19)] and Grade Ⅱ hospitals [48.3% (14/29)] ( P<0.01). The proportion of breast reconstruction in specialized cancer hospitals [96.9% (31/32)] was significantly higher than that in general hospitals [79.0% (124/157)] and other types of hospitals [64.3% (9/14)] ( P<0.05). Among the 164 hospitals, 310 (150, 637.5) patients underwent breast cancer surgery and 30 (10, 100) patients underwent breast reconstruction in 2022. The proportion of patients undergoing breast reconstruction surgery among breast cancer surgery patients was 13.3% (4.0%, 20.0%). The number of patients receiving immediate breast reconstruction was 11 (2.5, 46.5) cases, and the number of those receiving delayed breast reconstruction was 5 (0, 18.5) cases. Among 203 hospitals, the median proportions of breast oncoplastic surgeons and specialized nurses among healthcare providers in breast surgery departments were 28.6% (2/7) and 75.0% (12/16), respectively. In comparison of the 164 hospitals offering breast reconstruction surgery and 39 hospitals not, the median numbers of breast oncoplastic surgeons were 3 (1, 8) versus 1 (0, 3), and qualified breast reconstruction nurses were 12 (6, 16) versus 1 (0, 8), respectively. All differences were statistically significant (all P<0.01). Conclusion:About 80% of hospitals in China have offered breast reconstruction procedures after breast cancer surgery, and the proportion of Grade Ⅲ Level A hospitals and specialized cancer hospitals is higher than that of other types of hospitals. The proportion of patients undergoing breast reconstruction after breast cancer surgery is relatively low, and there is a considerable potential of improvements. Breast oncoplastic surgeons and nurses are insufficient, so it is necessary to strengthen the training of specialized medical staff and improve surgical techniques and the level of nursing services simultaneously, so as to improve the quality of life of breast cancer patients.

OBJECTIVE To investigate the intervention effect of kushenol F （KSC-F） on ulcerative colitis （UC） mice. METHODS Totally 30 male C57BL/6J mice were randomly divided into the normal group， model group， positive drug group （sulfasalazine， 703 mg/kg）， KSC-F 50 mg/kg group （KSC-F50 group）， and KSC-F 100 mg/kg group （KSC-F100 group）， with 6 mice in each group. Except for the normal group， the mice in the remaining groups were given 3% dextran sulfate sodium solution continuously for 7 days to induce UC model. Concurrently， administration groups received corresponding drug solution intragastrically， once a day， for 10 consecutive days. During the experiment， the changes in body weight and bowel movements of the mice were observed. Disease activity index scoring was performed after the last administration. The histopathological morphology of colonic tissue was examined. The levels of inflammatory factors in the serum and colon tissue were measured. Additionally， the mRNA expression of inflammatory factors， and the protein expressions of inflammation-related proteins [interleukin-1β （IL-1β）， forkhead box O1（FOXO1）， phosphoinositide 3-kinase（PI3K）， phosphorylated PI3K（p-PI3K）， p38 mitogen-activated protein kinase（p38 MAPK）， phosphorylated p38 MAPK（p-p38 MPAK） and phosphorylated protein kinase B（p- Akt）] were determined in colonic tissue. RESULTS KSC-F could alleviate weight loss and colonic tissue damage in UC mice. KSC- F reduced the levels of IL-1β， IL-6， IL-8 and tumor necrosis factor-α （TNF-α） in serum， as well as IL-1β， IL-6， IL-17 and TNF- α in colonic tissue to varying degrees and increased the levels of IL-10 in both serum and colonic tissue （P＜0.05 or P＜0.01）. Moreover， KSC-F decreased the expression levels of IL-1β， IL-17 and TNF-α mRNA， as well as p-PI3K， p-p38 MAPK， and p- Akt proteins in colonic tissue to varying degrees， and increased the expression levels of IL-10 mRNA and FOXO1 protein in colonic tissue （P＜0.05 or P＜0.01）. CONCLUSIONS KSC-F effectively alleviates UC symptoms in mice by inhibiting PI3K， Akt and p38 MAPK activation， mitigating the release of pro-inflammatory factors such as IL-1β， IL-6， TNF- α，promoting the anti-inflammatory factor IL-10 secretion， and reducing inflammation-induced colonic tissue damage.

In recent years, the recurrence rate of stroke has gradually increased, and recurrent stroke is usually more disabling and lethal than first-ever stroke. More than half of stroke patients in China have sleep disorders, which may increase the risk of stroke recurrence and death, but are often overlooked in reality. This article mainly discusses the relationship between stroke-related sleep disorders, stroke recurrence, and mortality risk, possible mechanisms, treatment methods, and therapeutic effects.

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.

Objective:To investigate the alteration of glymphatic system based on diffusion tensor image-analysis along the perivascular space(DTI-ALPS)in bipolar disorder Ⅰ(BD-Ⅰ).Methods:A total of 44 BD-Ⅰ patients(BD-Ⅰ group) admitted to the Affiliated Brain Hospital of Guangzhou Medical University from January 2012 to December 2017 were selected.In addition, totally 30 healthy controls (HC group) were recruited. The diffusion tensor image data were analyzed retrospectively, and along the perivascular space (ALPS) index was calculated. Hamilton anxiety scale (HAMA), 17-item Hamilton depression rating scale (HAMD-17), Young mania rating scale (YMRS) and global assessment function (GAF) were used to evaluate the severity of anxiety, depression, mania and social function respectively. SPSS 25.0 software was used for t-test, Z-test and chi-square test, and the differences in clinical data and DTI-ALPS index between the two groups were compared. The partial correlation test was used to analyze the correlations between DTI-ALPS index and the clinical indicators such as HAMA, HAMD-17, YMRS and GAF. Results:The DTI-ALPS indexes in left(1.69±0.17), right(1.44±0.15) and bilateral cerebral hemispheres(1.56±0.15) of BD-Ⅰ group were lower than those in HC group ((1.71±0.15), (1.46±0.13) and (1.58±0.12)), but the differences were not statistically significant ( t=-0.441, -0.545, -0.556, all P>0.05). After controlling for gender, age, years of education and course of disease, there were significant negative correlations between bilateral average DTI-ALPS index and somatic anxiety ( r=-0.334, P=0.038), as well as between right DTI-ALPS index and somatic anxiety( r=-0.349, P=0.030) in BD-Ⅰ group. Conclusion:The dysfunction of cerebral glymphatic system is not obvious in BD-Ⅰ patients, but their anxiety may be related to dysfunction cerebral glymphatic system.

Post-stroke cognitive impairment (PSCI) refers to a clinical syndrome that occurs after a stroke and meets the diagnostic criteria for cognitive impairment, lasting for more than 6 months, and seriously affecting the daily life of patients. The complement system has been confirmed to be associated with PSCI. This article reviews the correlation between complement system and PSCI, as well as the possibility of complement system as an intervention target for PSCI.

Poria cocos is a classic Chinese medicine with homology of food and medicine,which is beneficial to water infiltration,spleen and stomach,calming the heart and calming the mind,etc.It is known as"nine Poria cocos in ten prescriptions".Poria cocos contains polysaccharide,triterpenoids and steroids,among them polysaccharide and triterpenoid are considered as the main active components.Modern studies have shown that Poria cocos polysaccharide triterpenes display pharmacological activities such as anti-tumor,immunomodulatory and anti-oxidation.The dissolution rate of poria cocos and triterpenes was low in the traditional decocting process,and the oral absorption rate of poria cocos was low,but the activity of poria cocos and triterpenes was still very good,indicating the high activity of poria cocos and triterpenes.Therefore,this paper systematically reviews the extraction and separation,structural identification,content determination,structural modification,biosynthesis,pharmacological activity and potential product development value of Poria cocos polysaccharide and triterpenoids,in order to provide literature reference for the development of Poria cocos grand health industry.