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 compare knowledge graphs (KGs) constructed from standardized clinical pathways and actual examination records within 24 hours of emergency care for acute gastrointestinal hemorrhage (AGH), acute myocardial infarction (AMI), and intracerebral hemorrhage (ICH), and to visually analyze discrepancies between guideline recommendations and real-world practice, thereby exploring a novel methodology for clinical pathway optimization.Methods:KGs were developed using clinical pathway standards and actual examination data collected within the first 24 hours of emergency treatment for AGH, AMI, and ICH. Entity attributes were weighted to visually represent the frequency and extent of examination usage through variable node sizes in the KG. The constructed KGs were used to compare and analyze the differences in type and frequency of examinations performed relative to pathway standards.Results:The proportion of examination items with >50% adherence to clinical pathway standards within 24 hours was 76.92% for AGH, 44.44% for AMI, and 78.57% for ICH. Items from the clinical pathways that were not performed in over 50% of patients accounted for 15.38%, 27.78%, and 21.43% of cases, respectively. Non-pathway examinations increased by 9, 7, and 4 items for each condition, of which 17 items (85%) were performed at least once in more than half of the patients. Visualization via KGs revealed a reduction in redundant examinations by 38.64% between AGH and AMI, 35.00% between AGH and ICH, and 37.50% between AMI and ICH. Overall, a 54.84% reduction in redundant examinations was achieved across all three critical conditions.Conclusions:The visual KG approach effectively integrates both guideline-recommended and experience-driven examinations, serving as a correlational analysis tool to assess deviations between actual clinical practice and standardized pathways. It provides a quantitative foundation for optimizing clinical pathways, with potential for greater efficiency gains as more critical conditions are incorporated into the graph.

Abstract Ferroptosis , a novel , non-apoptotic form of cell death discovered in 2012 , has garnered significant at- tention. It is implicated in the pathogenesis and progression of various intestinal diseases , including colorectal canc- er, intestinal ischemia-reperfusion injury , functional gastrointestinal disorders , and inflammatory bowel disease. These processes involve multiple pathological mechanisms such as inflammation , immune dysregulation , and intesti- nal epithelial dysfunction. By reviewing and summarizing recent literature on ferroptosis-related mechanisms in in- testinal diseases , this article explores the roles and effects of ferroptosis in different intestinal pathologies.

Objective To develop a postoperative self-management question prompt list for adult liver transplant recipients and conduct preliminary application,aiming to provide an effective tool for facilitating their engagement in postoperative self-management.Methods From August to September 2024,the first draft of the postoperative self-management question prompt list for adult liver transplant recipients was developed through literature search and qualitative interviews,including 9 primary items and 50 secondary items.From October to November 2024,16 experts from Qingdao,Jinan,Beijing,and Fuzhou were interviewed on the Delphi method for 2 rounds to revise the question prompt list.From February to March 2025,19 patients after liver transplantation were selected for the preliminary application of the question prompt list.Results The response rates in the 2 rounds of consultations were both 100％and the authority coefficients of experts were both 0.88.The Kendall's W in the 2 rounds was 0.336 and 0.344(P＜0.001),respectively.The final question prompt list includes 9 primary items and 49 secondary items.The study showed that QPL demonstrated high clinical practicability in helping patients systematically understand the self-management framework after liver transplantation,promoting doctor-patient communication,and enhancing the initiative of self-management.Conclusion The question prompt list of postoperative self-management for adult liver transplant recipients established in this study is scientific,reliable,and practical,which is helpful for patients to obtain information about self-management from medical staff.

Objective:To investigate the effective ingredients and molecular mechanisms of Qizao oral liquid in the treatment of lead poisoning through network pharmacology and molecular docking technology.Methods:December 2023, the effective ingredients and their corresponding targets of Qizao oral liquid were searched from the TCM Systems Pharmacology database. Swiss Target Prediction was used to predict corresponding potential target genes of compounds. Targets associated with lead poisoning were obtained from GeneCards and OMIM databases. Cytoscape 3.10.1 software was employed to construct a components and corresponding target network as well as a components and corresponding target network, followed by visualization and cluster analysis. GO and KEGG enrichment analyses were conducted using the Metascape database, resulting in the generation of a signaling pathway-target network diagram. Molecular docking analysis between the principal compounds and target proteins was performed using Autodock 4.2.6 and Pymol 2.2.0 software to validate their underlying molecular mechanisms.Results:A total of 114 active chemical components, 361 potential targets, 2501 lead poisoning targets, and 191 intersection targets of "Qizao oral liquid and lead poisoning" were screened. Further analysis revealed that there were 2091 entries for GO biological processes and 202 KEGG signaling pathways. Enrichment analysis showed that the key targets were mainly enriched in cancer, lipid and atherosclerosis, PI3K-Akt signaling pathways. Molecular docking showed that there were 14 combinations with binding energy<-5 kcal/mol, among which PIK3R1-β-sitosterol binding energy was -9.71 kcal/mol.Conclusion:The primary active components found in Qizao oral liquid, such as β-sitosterol, nuciferine, stephanine, and stigmasterol, have the potential to modulate key targets including PIK3R1, AKT1, TP53, and NFKB1. These components are capable of influencing the PI3K-Akt signaling pathway as well as lipid and atherosclerosis pathways in order to mitigate the adverse effects of lead exposure.

Objective:To explore the impact of noise and dust exposure in the mechanical manufacturing industry on the risk of hypertension and abnormal electrocardiogram in workers, and their combined effects, in order to provide support for the prevention and treatment of occupational related diseases among workers.Methods:In January 2024, A convenience sampling method was used to study 2802 on-the-job workers who underwent occupational health check-ups from January 2023 to December 2023 at a machinery manufacturing enterprise in Baotou, Inner Mongolia. Blood pressure and electrocardiogram results were analyzed in the noise group, dust group, dust noise group and control group according to the exposure factors. For count data, the chi-square test was employed to analyze differences among groups. Additionally, a binary logistic regression model was utilized to assess the impact of dust and noise exposure on the prevalence of hypertension and electrocardiogram abnormalities.Results:The stratified analysis results showed that the differences in hypertension prevalence among the four groups were statistically significant ( P<0.001) in males, age groups >30-40 years, >40-50 years, >50 years, different exposure durations, and different enterprise sizes. For ECG abnormalities, significant differences were observed among the four groups ( P<0.001) in males, the age group >30-40 years, different enterprise sizes, and those with exposure durations ≤15 years. The trend test for hypertension prevalence across different age groups revealed that as age increased, the prevalence of hypertension showed an upward trend in the noise-exposed group, dust-exposed group, and combined dust-noise-exposed group ( χ2=10.76, 4.25, 6.60, P<0.001, 0.039, 0.010) . Binary regression model analyses revealed that the the risk of hypertension in the noise group, dust group and dust noise group was 2.63 times ( OR=2.63, 95% CI: 1.89~3.67, P<0.001) , 2.36 times ( OR=2.36, 95% CI: 1.76~3.16, P<0.001) and 2.69 times ( OR=2.69, 95% CI: 2.14~3.38, P<0.001) . Using ECG abnormalities as the dependent variable and incorporating the statistically significant variables from Table 1 as independent variables into the binary logistic regression model, the results showed no statistically significant differences in the risk of ECG abnormalities in the dust-exposed, noise-exposed, and combined dust-noise-exposed groups compared to the control group ( P> 0.05) . Conclusion:Combined exposure to dust and noise increases the risk of hypertension in workers and has a combined effect.

Objective:To investigate the status and influencing factors of substantial weight retention in patients with gestational diabetes mellitus (GDM) in early postpartum.Methods:This cross-sectional study employed a convenience sampling method to select 373 patients with GDM who underwent a 6-week postpartum health check at the Postpartum Health Clinic of Women′s Hospital of Nanjing Medical University from February to July in 2023. According to postpartum weight retention (PPWR) on the survey day, the participants were divided into a substantial PPWR group (≥5 kg, 139 cases) and a non-substantial PPWR group (<5 kg, 234 cases). Independent sample t-tests and χ2 tests were used to compare differences in demographic data, clinical data, and biochemical indicators between the two groups. Binary logistic regression was used to analyze the influencing factors of early substantial postpartum weight retention in patients with GDM. Results:A total of 37.27% (139/373) of GDM patients experienced substantial postpartum weight retention at 6 weeks postpartum. The rates of diabetes in family history, excessive gestational weight gain, gestational hypertension, and infant neonatal intensive care unit (NICU) admission in substantial PPWR group were all significantly higher than those in the non-substantial PPWR group (32.37% vs 23.08%, 73.38% vs 20.09%, 13.67% vs 5.56%, 21.58% vs 9.83%) (all P<0.05); but the proportion of overweight or obese before pregnancy and postpartum self-monitoring of blood glucose were both lower in the substantial PPWR group than those in the non-substantial PPWR group (25.18% vs 41.03%, 17.99% vs 27.78%)(all P<0.05). Binary logistic regression indicated that family history of diabetes ( OR=2.826, 95% CI: 1.517-5.265), excessive gestational weight gain ( OR=19.240, 95% CI: 10.360-35.732), and infant NICU admission ( OR=2.447, 95% CI: 1.150-5.205) were positively related to the occurrence of substantial weight retention in patients with GDM in early postpartum, whereas pre-pregnancy overweight or obesity ( OR=0.189, 95% CI: 0.100-0.360) was negatively correlated to substantial weight retention in patients with GDM in early postpartum (all P<0.05). Conclusion:Substantial weight retention is prevalent among GDM patients in early postpartum, which is significantly influenced by family history of diabetes, pre-pregnancy overweight or obesity, excessive gestational weight gain, and infant NICU admission history.

This study was aimed at preliminarily assessing the prevalence of latent tuberculosis infection(LTBI)among cattle farming and slaughterhouse workers across Wuxue,Xianning,and Yichang Cities in Hubei Province,and exploring associated risk factors.Data on cattle farming and slaughterhouse workers were gathered via a questionnaire.LTBI detection was performed with a tu-berculin skin test and interferon-gamma release assay,and influencing factors were subsequently analyzed.The LTBI prevalence among cattle farming and slaughterhouse personnel in the three cities was 30.50%,and a higher rate was observed in slaughterhouse workers(39.01%)than cattle farmers(21.63%)(P<0.01).Multifactor analysis indicated that working in slaughterhouses(95%CI:1.582-3.878),having a history of tuberculosis(95%CI:1.377-25.057)or BCG vaccination(95%CI:1.229-3.285),and having a college education or above(95%CI:0.303-0.859)were significant factors influencing LTBI positivity in these personnel.Having more than 30 years of work experience(95%CI:1.303-18.782)was a risk factor for personnel at cattle breeding farms.Among slaugh-terhouse personnel,having a college education or above(95%CI:0.164-0.894),11-20 years of work experience(95%CI:0.122-0.994),or a history of tuberculosis(95%CI:1.661-64.397);performing logistics work(95%CI:3.234-126.424);and working in slaughter-related positions(95%CI:1.209-19.639)were associated with LTBI positivity.Therefore,the slaughterhouse workers in the three cities had higher LTBI rates than the cattle farming workers,thus underscoring the need for increased attention to personnel in logistics and slaughter-related positions.

Objective:To understand the current status of family resilience in children with autism and explore its influencing factors, providing a basis for developing intervention measures to improve family resilience in these families.Methods:Convenience sampling was used to select children with autism and their caregivers who underwent rehabilitation training at the Department of Child Developmental Behavior, Third Affiliated Hospital of Zhengzhou University from March to September 2023. A cross-sectional survey was conducted using a general information questionnaire, the Chinese version of the Family Resilience Assessment Scale, the Chinese version of the Parenting Burnout Scale, and the Caregiver Stress Scale.Results:A total of 280 questionnaires were distributed, and 271 valid questionnaires were collected. Among the 271 children with autism, 210 were male and 61 were female, with the majority aged 3-5 years old (169 cases). Among the 271 caregivers, 21 were male and 250 were female, with the majority aged 30-39 years old (149 cases). The total score of the Chinese version of the Family Resilience Assessment Scale was (70.59 ± 14.08) points, with scores of (49.96 ± 10.23) points for family communication and problem-solving, (7.13 ± 1.62) points for social resource utilization, and (13.52 ± 3.31) points for maintaining a positive attitude. Multiple linear regression analysis showed that the child′s age, disease duration, reimbursement method, parenting burnout, and caregiver stress were influencing factors of family resilience in children with autism ( t values were -10.40-3.48, all P<0.05). Conclusions:The level of family resilience in children with autism needs improvement. Higher levels of parenting burnout and caregiver stress are associated with lower levels of family resilience. Future interventions should be developed based on these influencing factors to promote the physical and mental health of children with autism and their caregivers.

Sesquiterpenes are natural terpenes containing 15 carbon atoms. They are widely used in the perfume, pharmaceutical, and biofuel industries due to their remarkable biological activities. The traditional production of sesquiterpenes relies on chemical synthesis or plant extraction, which has the disadvantages of low yields and waste of resources. The construction of microbial cell factories for the efficient synthesis of sesquiterpenes by means of synthetic biology provides a new option. In recent years, with the development of metabolic engineering and synthetic biology, the heterologous synthesis of a variety of sesquiterpenes has been successfully achieved by metabolic engineering of the oleaginous yeast, Yarrowia lipolytica. In this paper, we review the research progress in the heterologous synthesis of different sesquiterpenes by Y. lipolytica, discuss the synthetic biology strategies commonly used in this field, and make an outlook on the research directions and engineering approaches to further enhance the sesquiterpene yield in this host. This paper provides a reference for strategies such as synergistic optimization of synthetic biology and metabolic engineering, enhanced precursors, and opens up new directions for the application of synthetic biology in green chemistry and sustainable production.
Yarrowia/genetics* ; Sesquiterpenes/metabolism* ; Metabolic Engineering/methods* ; Synthetic Biology/methods*