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.

ObjectiveTo investigate the optimal ratio of goat horn replacing antelope horn in Fufang Lingjiao Jiangya pills and the blood pressure-lowering mechanism of this medicine. MethodsThe blood pressure-lowering efficacy of Fufang Lingjiao Jiangya pills with varying proportions of goat horn replacing antelope horn was evaluated on spontaneous hypertensive rats （SHR）. In this experiment， 50 SHR rats were randomly grouped as follows： model （n=8）， captopril （0.01 g·kg^-1） （n=6）， low-dose blank Fufang Lingjiao Jiangya pills （0.342 g·kg^-1） （n=6）， high-dose blank Fufang Lingjiao Jiangya pills （0.684 g·kg^-1） （n=6）， low-dose antelope horn-containing Fufang Lingjiao Jiangya pills （0.378 g·kg^-1） （n=6）， high-dose antelope horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1） （n=6）， low-dose goat horn-containing Fufang Lingjiao Jiangya pills （0.378 g·kg^-1） （n=6）， and high-dose goat horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1） （n=6）. Additionally， 8 WKY rats were used as the normal group. Drugs were administered by gavage for 4 weeks while an equal volume of distilled water was administered for the normal and model groups. Blood pressure was measured before administration， 3 h post administration， and biweekly thereafter. In the experiment for Fufang Lingjiao Jiangya pills with goat horn replacing antelope horn in different proportions， 48 SHR rats were randomly grouped as follows： model， blank Fufang Lingjiao Jiangya pills （0.684 g·kg^-1）， antelope horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1）， 2× goat horn-containing Fufang Lingjiao Jiangya pills （0.824 g·kg^-1）， 4× goat horn Fufang Lingjiao Jiangya pills （0.969 g·kg^-1）， and 6× goat horn Fufang Lingjiao Jiangya pills （1.112 g·kg^-1）. The normal group included 8 WKY rats， and the normal group and model group received an equal volume of distilled water. The treatment lasted for 2 weeks， and blood pressure was recorded at various time points （pre-administration， 3 h post administration， and on days 4， 7， 10， and 14 of administration）. Serum levels of angiotensin-converting enzyme （ACE）， angiotensin Ⅱ（Ang Ⅱ）， renin， and interleukin-6 （IL-6） were measured by enzyme-linked immunosorbent assay. Histopathological changes in the heart， kidney， and thoracic aorta were observed by hematoxylin-eosin staining. The protein levels of ACE2， angiotensin Ⅱ type 1 receptor （AT1R）， and angiotensinogen （AGT） in the kidney tissue were determined by Western blot， while the expression of nuclear factor （NF）-κB p65 and Toll-like receptor 4 （TLR4） in the thoracic aorta tissue was assessed by immunohistochemistry. ResultsCompared with the model group， all treatment groups showed lowered blood pressure （P<0.05， P<0.01）， and the 6× goat horn-containing Fufang Lingjiao Jiangya pills group showed consistent blood pressure-lowering effect with the antelope horn-containing Fufang Lingjiao Jiangya pills group. Compared with the normal group， the model group showed elevated serum levels of ACE， Ang Ⅱ， renin， and IL-6， while the elevations were declined in the Fufang Lingjiao Jiangya pills groups （P<0.05， P<0.01）. Pathological changes in the heart， kidney， and thoracic aorta were alleviated in all the treatment groups， with the 6× goat horn- and antelope horn-containing Fufang Lingjiao Jiangya pills groups exhibited the best effect. Western blot and immunohistochemistry results showed that all the treatment groups exhibited down-regulated protein levels of AT1R， AGT， NF-κB p65， and TLR4 and up-regulated protein levels of ACE2 （P<0.05， P<0.01） compared with model group， with the 6×goat horn- and antelope horn-containing Fufang Lingjiao Jiangya pills groups showcasing the best effect. ConclusionReplacing antelope horn with 6×goat horn in Fufang Lingjiao Jiangya pills can achieve consistent blood pressure-lowering effect with the original prescription. The prescription may exert the effect by inhibiting the renin-angiotensin-aldosterone system （RAAS） and TLR4/NF-κB signaling pathways.

Endovascular treatment is currently the most targeted therapeutic approach for acute ischemic stroke, which can recanalize the occluded blood vessels, restore the perfusion of ischemic penumbra, and reduce the size of infarct area. At present, evaluation of the ischemic penumbra mainly relies on imaging examinations; however, these examinations are difficult to fully reflect the cellular pathophysiological changes of brain tissues and lack unified standards; therefore, a more accurate method is urgently needed for evaluating the ischemic penumbra. This article summarizes the current dilemmas faced by imaging examinations in evaluating the ischemic penumbra and research status of biological markers in assessing the ischemic penumbra, proposing that volume of brain tissues that can be salvaged and biological markers as shown by imaging should be simultaneously focused during stroke treatment, so as to accurately evaluate the ischemic penumbra and improve the clinical prognosis to the greatest extent.

An 87-year-old female patient went to a hospital in Nanshan District on July 18, 2023 because of "vomiting and diarrhea for 2 days". She lived in a nursing home, where 43 similar cases were found within 8 days, including 31 elderly people and 12 caregivers. On July 23, 2023, 13 anal swab samples of the elderly patients were collected, to further find the source of infection, 89 anal swab samples of related nursing assistants and 9 environmental swab samples were collected at the same time. The pathogen was identified by reverse transcription polymerase chain reaction, a total of 22 out of 102 anal swab specimens were positive for Norovirus GⅡ, and the positive rate was 12/13 in the elderly people and 11.23% (10/89) in the caregivers, and one norovirus GⅡ positive sample among 9 environmental smear samples. The polymerase region and partial gene sequences of the capsid VP1 region were amplified and sequenced for the Norovirus-positive specimens, among which 20 strains were successfully sequenced and showed GⅡ.4[P16] under the Norovirus online typing tool. The sequences of 11 elderly people were highly homologous to those of 9 caregivers, with a homology of 95% in the polymerase region and 99% in the capsid VP1 region, which had sequence homology of 99% compared with the Genbank reference sequences of OP009779 (2022 Chengdu strain), OQ930719 (2023 Nanjing strain), and OL336359 (2021 Beijing strain).

An 87-year-old female patient went to a hospital in Nanshan District on July 18, 2023 because of "vomiting and diarrhea for 2 days". She lived in a nursing home, where 43 similar cases were found within 8 days, including 31 elderly people and 12 caregivers. On July 23, 2023, 13 anal swab samples of the elderly patients were collected, to further find the source of infection, 89 anal swab samples of related nursing assistants and 9 environmental swab samples were collected at the same time. The pathogen was identified by reverse transcription polymerase chain reaction, a total of 22 out of 102 anal swab specimens were positive for Norovirus GⅡ, and the positive rate was 12/13 in the elderly people and 11.23% (10/89) in the caregivers, and one norovirus GⅡ positive sample among 9 environmental smear samples. The polymerase region and partial gene sequences of the capsid VP1 region were amplified and sequenced for the Norovirus-positive specimens, among which 20 strains were successfully sequenced and showed GⅡ.4[P16] under the Norovirus online typing tool. The sequences of 11 elderly people were highly homologous to those of 9 caregivers, with a homology of 95% in the polymerase region and 99% in the capsid VP1 region, which had sequence homology of 99% compared with the Genbank reference sequences of OP009779 (2022 Chengdu strain), OQ930719 (2023 Nanjing strain), and OL336359 (2021 Beijing strain).

Endovascular treatment is currently the most targeted therapeutic approach for acute ischemic stroke, which can recanalize the occluded blood vessels, restore the perfusion of ischemic penumbra, and reduce the size of infarct area. At present, evaluation of the ischemic penumbra mainly relies on imaging examinations; however, these examinations are difficult to fully reflect the cellular pathophysiological changes of brain tissues and lack unified standards; therefore, a more accurate method is urgently needed for evaluating the ischemic penumbra. This article summarizes the current dilemmas faced by imaging examinations in evaluating the ischemic penumbra and research status of biological markers in assessing the ischemic penumbra, proposing that volume of brain tissues that can be salvaged and biological markers as shown by imaging should be simultaneously focused during stroke treatment, so as to accurately evaluate the ischemic penumbra and improve the clinical prognosis to the greatest extent.

Objective:To explore the effects of apigenin on apoptosis and hypoxia inducible factor-1α (HIF-1α)/nuclear factor κB (NF-κB) signaling pathway in renal cancer A498 cells.Methods:Human renal cell carcinoma A498 cells were cultured in vitro and divided into different concentrations of apigenin (10, 20, 40 μmol/L) groups, apigenin (40 μmol/L)+ HIF-1α agonist dimethylenediaminoacetic acid (DMOG) group, HIF-1α inhibitor rifiximab (YC-1) group, and control group. Cell proliferation was detected using cell counting kit-8 (CCK-8) assay and plate clone formation assay, apoptosis was detected using Hoechst 33258 staining and flow cytometry, and expression of apoptotic proteins and HIF-1/NF-B pathway proteins was detected using Western blot assay.Results:Celery extract significantly inhibited the proliferation of A498 cells, and the inhibitory effect was concentration dependent ( P<0.001). Compared with the control group, the apoptosis rates of A498 cells in the 10, 20, and 40 μmol/L apigenin groups and YC-1 groups were significantly increased [(4.35±1.04)% vs (10.06±1.13)%, (18.52±2.58)%, (32.17±2.63)%, (26.94±2.41)%], as well as the expression levels of B lymphocyte tumor 2 related protein (Bax) and Cleaved Caspase-3 protein, while the expression levels of B lymphocyte tumor 2 (Bcl-2) were significantly reduced (all P<0.001). Compared with the control group, the HIF-1α protein expression levels (0.85±0.08 vs 0.63±0.06, 0.31±0.03, 0.16±0.02) and p-NF-κB p65/NF-κB p65 ratio (0.82±0.08 vs 0.51±0.05, 0.30±0.03, 0.13±0.01) of A498 cells in the 10, 20, and 40 μmol/L apigenin groups were significantly reduced (all P<0.001). Compared with the apigenin group, the apoptosis rate of A498 cells in the apigenin+ DMOG group was significantly reduced [(32.17±2.63)% vs (14.85±1.62)%], and the expression levels of Bax and Cleared Caspase-3 proteins were significantly reduced, while the expression levels of Bcl-2 proteins were significantly increased (all P<0.001). Conclusions:Apigenin may promote apoptosis in renal cancer A498 cells by inhibiting the activation of the HIF-1α/NF-κB signaling pathway.

Objective:To investigate the relationship between serum homocysteine (Hcy), mannose-binding lectin (MBL), triglyceride glucose (TyG) index and homeostasis model assessment-insulinresistance (HOMA-IR) and adverse pregnancy outcomes in patients with second-trimester gestational diabetes mellitus (GDM).Methods:Ninety-eight patients with GDM in the second trimester of pregnancy admitted to the Obstetrics Department of Zhongshan People′s Hospital from April 2020 to June 2022 were retrospectively selected. Serum Hcy and MBL were detected by enzyme-linked immunosorbent assay before intervention, HOMA-IR was evaluated according to homeostasis model, and fasting blood glucose (FBG) was detected by oxidase method. The level of triglyceride (TG) was detected by automatic chemiluminescence immunoassay and TyG index was calculated. The patients were given health education, dietary guidance, insulin and other treatment, followed up until delivery and pregnancy outcomes were recorded. The patients were divided into adverse pregnancy outcome group and no adverse pregnancy outcome group based on pregnancy outcomes. The factors influencing adverse pregnancy outcomes in GDM patients in the second trimester were analyzed, and the predictive value of blood glucose control, serum Hcy, MBL and TyG index on adverse pregnancy outcomes in GDM patients in the second trimester was analyzed by receiver operating characteristics (ROC) curve.Results:After intervention, there were 24 cases (24.49%) of adverse pregnancy outcomes in GDM patients in the second trimester, including 2 cases of polyhydramnios, postpartum hemorrhage, neonatal hypoglycemia, 4 cases of premature membranes breaking, 4 cases of premature delivery, 6 cases of fetal macrosomia, 3 cases of low birth weight, and 1 case of neonatal hyperbilirubinemia. There were statistically significant differences in the proportion of poor glycemic control, Hcy level, TyG index, HOMA-IR and MBL level between the GDM group with adverse pregnancy outcome and the GDM group without adverse pregnancy outcome (all P<0.05). By binary logistic regression analysis, Hcy, TyG index, HOMA-IR and poor glycemic control during pregnancy were risk factors for adverse pregnancy outcomes in GDM patients in the second trimester, and MBL was protective factor for adverse pregnancy outcomes in GDM patients in the second trimester (all P<0.05). The sensitivity of poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR alone and in combination to predict adverse pregnancy outcomes of GDM patients in the second trimester were 75.00%, 79.17%, 70.83%, 75.00%, 66.67% and 91.67%, respectively. The specificity was 74.32%, 78.38%, 71.62%, 75.68%, 71.62% and 91.89%, respectively. Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR combined to predict adverse pregnancy outcomes in GDM patients during the second trimester were of high value (all P<0.05). Pearson correlation analysis showed that Hcy and TyG were positively correlated with HOMA-IR ( r=0.712, P<0.001, r=0.649, P=0.023), while MBL was negatively correlated with HOMA-IR ( r=-0.682, P=0.006). Conclusions:Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR are associated with adverse pregnancy outcomes in patients with GDM in the second trimester. Combined detection can predict adverse pregnancy outcomes in patients with GDM in the second trimester early.

Objective To study the changes in serum immunoglobulin levels in children with thalassemia who undergo repeated blood transfusions and explore their correlation with delayed hemolytic transfusion reactions(DHTR).Methods Serum samples from children with thalassemia who received blood transfusion treatment from June 2022 to April 2023(ob-servation group)and healthy children who underwent physical examination(control group)in our hospital were collected.The levels of serum immunoglobulins(IgG subtype,IgM,IgA,IgE and IgD)were detected using flow cytometry CBA multi-factor quantitative detection technology,and the differences between the two groups were compared.The children were divided into 4 groups according to different transfusion numbers:≤10 numbers,11-30 numbers,31-50 numbers and＞50 numbers,and the differences between different blood transfusion numbers and serum immunoglobulin levels in each group were compared using one-way analysis of variance(ANOVA).Children with thalassemia with DHTR were in the hemolysis group,and children with thalassemia who did not experience DHTR were in the non-hemolysis group.The changes in serum immunoglobulins(IgG subtypes,IgM,IgA,IgE and IgD)between the two groups were compared to explore the correlation between serum immunoglobulins in thalassemia children with repeated transfusion and DHTR.Results The levels of IgG1,IgG3,IgG4 and IgA in the observation group were significantly higher than those in the control group,with the increase of(2.07±2.12),(0.67±2.03),(0.30±0.37)and(6.04±11.40)mg/mL,respectively,while the level of IgD in observation group was significantly lower than that in the control group,with a decrease of(0.03±0.01)mg/mL,P＜0.05.No significant difference was noticed in IgG2,IgM and IgE between the groups(P＞0.05).IgG1 and IgG4 both significantly increased with the number of blood transfusions.The IgG1 in the 4 groups increased sequentially as(0.30±0.62),(0.41±0.51)and(3.60±3.48)mg/mL,and IgG4 increased sequentially as(0.12±0.13),(0.22±0.07)and(0.21±0.38)mg/mL.IgG2,IgM and IgD showed a significant decrease,with IgG 2,IgM,and IgD in four groups decreased as(0.91±1.50),(0.14±0.10)and(0.05±0.05)mg/mL,respectively,showing significant differences with the number of blood transfusions(P＜0.05).No sig-nificant difference was found in IgG3,IgA and IgE with different number of transfusions(P＞0.05).IgG1,IgG3 and IgG4 in the hemolysis group were significantly higher than those in the non-hemolysis group,with an increase of(4.44±3.41),(0.73±1.26)and(0.52±0.40),respectively(P＜0.05).IgD in the hemolysis group was significantly lower than that in the non-hemolysis group,with a decrease of(0.00±0.06)mg/mL,P＜0.05.No significance was noticed in IgG2,IgM,IgA and IgE between the hemolysis group and the non-hemolysis group(P＞0.05).Conclusion The serum immunoglobulin levels of children with thalassemia who undergo repeated blood transfusions are abnormal.There are differences in correlation between the number of blood transfusions and serum immunoglobulin levels among children with thalassemia who undergo repeated blood transfusions.The relevant serum immunoglobulins for DHTR in children with thalassemia who undergo repeated blood transfusions are IgG1,IgG3 and IgG4.

Objective:To investigate the relationship between serum homocysteine (Hcy), mannose-binding lectin (MBL), triglyceride glucose (TyG) index and homeostasis model assessment-insulinresistance (HOMA-IR) and adverse pregnancy outcomes in patients with second-trimester gestational diabetes mellitus (GDM).Methods:Ninety-eight patients with GDM in the second trimester of pregnancy admitted to the Obstetrics Department of Zhongshan People′s Hospital from April 2020 to June 2022 were retrospectively selected. Serum Hcy and MBL were detected by enzyme-linked immunosorbent assay before intervention, HOMA-IR was evaluated according to homeostasis model, and fasting blood glucose (FBG) was detected by oxidase method. The level of triglyceride (TG) was detected by automatic chemiluminescence immunoassay and TyG index was calculated. The patients were given health education, dietary guidance, insulin and other treatment, followed up until delivery and pregnancy outcomes were recorded. The patients were divided into adverse pregnancy outcome group and no adverse pregnancy outcome group based on pregnancy outcomes. The factors influencing adverse pregnancy outcomes in GDM patients in the second trimester were analyzed, and the predictive value of blood glucose control, serum Hcy, MBL and TyG index on adverse pregnancy outcomes in GDM patients in the second trimester was analyzed by receiver operating characteristics (ROC) curve.Results:After intervention, there were 24 cases (24.49%) of adverse pregnancy outcomes in GDM patients in the second trimester, including 2 cases of polyhydramnios, postpartum hemorrhage, neonatal hypoglycemia, 4 cases of premature membranes breaking, 4 cases of premature delivery, 6 cases of fetal macrosomia, 3 cases of low birth weight, and 1 case of neonatal hyperbilirubinemia. There were statistically significant differences in the proportion of poor glycemic control, Hcy level, TyG index, HOMA-IR and MBL level between the GDM group with adverse pregnancy outcome and the GDM group without adverse pregnancy outcome (all P<0.05). By binary logistic regression analysis, Hcy, TyG index, HOMA-IR and poor glycemic control during pregnancy were risk factors for adverse pregnancy outcomes in GDM patients in the second trimester, and MBL was protective factor for adverse pregnancy outcomes in GDM patients in the second trimester (all P<0.05). The sensitivity of poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR alone and in combination to predict adverse pregnancy outcomes of GDM patients in the second trimester were 75.00%, 79.17%, 70.83%, 75.00%, 66.67% and 91.67%, respectively. The specificity was 74.32%, 78.38%, 71.62%, 75.68%, 71.62% and 91.89%, respectively. Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR combined to predict adverse pregnancy outcomes in GDM patients during the second trimester were of high value (all P<0.05). Pearson correlation analysis showed that Hcy and TyG were positively correlated with HOMA-IR ( r=0.712, P<0.001, r=0.649, P=0.023), while MBL was negatively correlated with HOMA-IR ( r=-0.682, P=0.006). Conclusions:Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR are associated with adverse pregnancy outcomes in patients with GDM in the second trimester. Combined detection can predict adverse pregnancy outcomes in patients with GDM in the second trimester early.