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 evaluate the clinical efficacy of electroacupuncture at acupoints distributed on conception vessel(CV)and governor vessel(GV)in treating ischemic stroke(AIS)complicated with dysphagia and explore its potential mechanism.Methods A total of 120 patients diagnosed with AIS complicated with dysphagia at Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University from December 2020 to December 2023 were enrolled and randomly divided into an observation group and a control group,with 60 patients per group.The control group received conventional swallowing training,while the observation group received additional electroacupuncture at acupoints distributed on CV and GV.The treatment lasted for 4 weeks.After 1 month of treatment,clinical efficacy was assessed,and the changes in Standardized Swallowing Assessment(SSA)scores,National Institutes of Health Stroke Scale(NIHSS)scores,hyolaryngeal mobility(thyroid cartilage anterior/superior displacement,hyoid bone anterior/superior displacement),and KubotaWater Swallowing Test scores were observed.Cerebral microcirculation parameters and the Chinese version of the Eating/Drinking Quality of Life(EDQoL)questionnaire were also compared.Safety and adverse events were evaluated.Results(1)The total effective rate in the observation group was 95.00%(57/60),compared to 76.67%(46/60)in the control group,demonstrating statistically superior therapeutic efficacy in the observation group(P＜0.05).(2)After treatment,both groups showed significant improvements in SSA scores and NIHSS scores(P＜0.05),with the observation group exhibiting markedly better enhancement in both SSA and NIHSS scores compared to the control group,showing statistically significant differences(P＜0.05).(3)After intervention,significant improvements were observed in anterior displacement of thyroid cartilage,superior displacement of thyroid cartilage,anterior displacement of hyoid bone,and superior displacement of hyoid bone in both groups(P＜0.05).The observation group outperformed the control group in all these laryngeal kinematic parameters with statistically significant differences(P＜0.05).(4)Both groups demonstrated significant improvement in Kubota Water Swallowing Test scores after treatment(P＜0.05),with the observation group displaying statistically greater improvement than the control group(P＜0.05).(5)Cerebral arterial parameters including peak systolic velocity(Vs),mean velocity(Vm),and resistance index(RI)were significantly improved in both groups after treatment(P＜0.05).The observation group showed superior enhancement in these cerebrovascular hemodynamic indices compared to the control group(P＜0.05).(6)Significant improvements in EDQoL scores were observed in both groups after treatment(P＜0.05),with the observation group achieving statistically greater improvement than the control group(P＜0.05).(7)The total incidence of adverse reactions was 1.67%(1/60)in the observation group versus 11.67%(7/60)in the control group,indicating a statistically significant lower adverse event rate in the observation group(P＜0.05).Conclusion Electroacupuncture at acupoints distributed on CV and GV effectively alleviates dysphagia and neurological impairment,improves hyolaryngeal mobility and cerebral microcirculation,enhances quality of life,and reduces adverse events such as aspiration pneumonia in AIS patients complicated with dysphagia.

Objective To investigate the mechanism by which lectin-like oxidized low density lipoprotein receptor-1(LOX-1)regulates hyperglycemic-induced myocardial fibroblast(CFs)fibrosis through the glycogen synthase kinase-3β(GSK-3β)/signal transducer and activator of transcription 3(STAT3)pathway.Methods CFs were isolated,cultured and identified.LOX-1 RNAi lentiviral vector was constructed and infected CFs.The experimental groups were as follows:Normal control(NC)group,High glucose(HG)group,LV-LOX-1,LV-Con group,Hypertonic(HPG)group.After LV-LOX-1 and LV-Con were infected with CFs,adding 25 mmol/L glucose to culture CFs for 24 h,they were denoted as HG+LV-LOX-1 group and HG+LV-Con group.Cells in HG+LV-LOX-1 group and HG+LV-Con group were treated with 10 μ mol/L SB216763 and 10 μ mol/L STATTIC for 24 h,respectively,and then they were recorded as HG+LV-LOX-1+SB216763 group,HG+LV-Con+SB216763 group,HG+LV-LOX-1+STATTIC group and HG+LV-Con+STATTIC group.CCK-8 was used to detect the activity of CFs,and the expression levels of mRAN and protein of LOX-1,collagen type I(COL-I),thioredoxin 5(TXNDC5),GSK-3β,STAT3,p-GSK-3β and p-STAT3 were detected by qRT-PCR and Western blot.Results CFs infected with LOX-1 RNAi lentiviral vector were obtained,which showed green under fluorescence microscopy.Compared with HG and HG+LV-Con groups,the mRNA expressions of LOX-1,COL-I and TXNDC5 were decreased in HG+LV-LOX-1 group(P<0.05).Compared with HG+LV-LOX-1 group,mRNA expressions of COL-I and TXNDC5 were decreased in HG+LV-LOX-1+SB216763 and HG+LV-LOX-1+STATTIC groups(P<0.05).Compared with HG and HG+LV-Con groups,p-GSK-3β protein expression was increased in HG+LV-LOX-1 group(P<0.05),while LOX-1,p-STAT3,COL-I,TXNDC5 protein expression was decreased in HG+LV-LOX-1 group(P<0.05).Compared with HG+LV-LOX-1 group,p-GSK-3β protein expression was increased in HG+LV-LOX-1+SB216763 group(P<0.05),while the protein expressions of p-STAT3,COL-I and TXNDC5 were decreased in HG+LV-LOX-1+SB216763 and HG+LV-LOX-1+STATTIC groups(P<0.05).Conclusion LOX-1,GSK-3β,STAT3,TXNDC5,and COL-I are involved in high glucose induced CFs fibrosis.LOX-1 promotes the expression of TXNDC5 and COL-I through GSK-3β/STAT3 pathway,and inhibition of LOX-1 can inhibit high glucose induced CFs fibrosis.

Objective To investigate the molecular mechanism of lectin-like oxidized low-density lipoprotein receptor 1(LOX-1)in the regulation of high glucose induced phagocytosis dysfunction of mouse microglia(BV2 microglia).Methods BV2 cells were cultured in vitro,lentivirus LOX-1RNAi vector(LV-LOX-1)and lentivirusempty vector(LV-Con)were constructed and divided into normal control(NC)group,HG group,LV-LOX-1 group and LV-Con group.After infecting BV2 cells with LV-LOX-1 and LV-Con,the cells were cultured with 25 mmol/L glucose for 24 h,and then divided into HG+LV-LOX-1 group and HG+LV-Con group.After treatment of HG+LV-LOX-1 and HG+LV-Con infected BV2 microglia with 15 μmol/L FH535(β-catenin inhibitor)and AEBSF(ATF6α inhibitor)for 24 h,respectively,they were denoted as HG+LV-LOX-1+FH535 group,HG+LV-Con+FH535 group,HG+LV-LOX-1+AEBSF group,and HG+LV-Con+AEBSF group.Transfection efficiency was determined by fluorescence microscopy,RT-PCR and Western blot.Cell viability was detected b CCK-8.RT-PCR and Western blot were used to detect the mRNA and protein expression of LOX-1,β-catenin,ATF6α and milk fat globular-surface growth factor Ⅷ(MFG-E8)in each group.Results After 72 h of LV-LOX-1 infection,the cells in LV-LOX-1 and LV-Con groups showed a lot of green fluorescence,but not in NC group.Compared with NC group,the mRNA and protein expression of LOX-1 and ATF6α were increased(P<0.05),while the mRNA and protein expression of MFG-E8 and β-catenin decreased in HG group(P<0.05).Compared with HG+LV-Con group,the mRNA and protein expression of LOX-1 and ATF6α were decreased(P<0.05),while the mRNA and protein expression of MFG-E8 and β-catenin increasedin HG+LV-LOX-1 group(P<0.05).Compared with HG+LV-LOX-1 group,the mRNA and protein expressions of MFG-E8 and β-catenin were decreased(P<0.05),and the mRNA and protein expressions of ATF6α and p-β-catenin and p-ATF6α were increased in HG+LV-LOX-1+FH535 group(P<0.05).Compared with HG+LV-LOX-1 group,the mRNA and protein expression were increased(P<0.05),ATF6α mRNA and protein expression and p-ATF6α protein expression were decreased MFG-E8 in HG+LV-LOX-1+AEBSF group(P<0.05).Conclusions LOX-1,MFG-E8,β-catenin and ATF6α are involved in the regulation of phagocytosis of BV2 cells.LOX-1 promotes the phagocytosis dysfunction of BV2 microglia induced by high glucose through β-catenin/ATF6α signaling pathway.

Objective: To examine the association between serum vitamin D level and thyroid function indicators among elderly patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for the prevention and treatment of thyroid function abnormality among elderly patients with T2DM. Methods: Inpatients aged 60 years and older and admitted to the department of endocrinology of Zhejiang Hospital were selected as the study subjects. Gender, age, course of disease and other basic information were collected through questionnaire surveys. The serum 25-hydroxyvitamin D[25-(OH) D], thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), and total thyroxine (TT4) were measured. The correlation between serum vitamin D level and thyroid function indicators in elderly patients with T2DM was evaluated by a multiple linear regression model. Results: A total of 402 elderly patients with T2DM were surveyed, including 210 males (52.24%) and 192 females (47.76%), and had a median age of 70.00 (interquartile range, 12.00) years and a median course of disease of 14.00 (interquartile range, 14.00) years. There were 162 patients with insufficiency of vitamin D (40.30%) and 182 patients with deficiency (45.27%). The levels of TSH and glycated hemoglobin in the vitamin D deficiency group were (2.34±1.66) μIU/mL and (8.83±2.14) %, respectively, which were higher than those in the normal group [(1.74±1.10) μIU/mL and (8.11±1.75) %; P<0.05]. The levels of FT3 and FT3/FT4 in the vitamin D deficiency group were (2.86±0.48) μIU/mL and 2.85±0.71, respectively, which were lower than those in the vitamin D insufficiency group [(3.09±0.47) pg/mL and 3.14±0.81, P<0.05]. Multiple linear regression analysis showed a negative correlation between 25- (OH) D and TSH (β'=-0.159, P=0.001). Conclusion The vitamin D deficiency may be associated with the increase of TSH level among the elderly patients with T2DM.

Magneto-acoustic-electric tomography (MAET) boasts high resolution in ultrasound imaging and high contrast in electrical impedance imaging, making it of significant research value in the fields of early tumor diagnosis and bioelectrical monitoring. In this study, a method was proposed that combined high conductivity liquid metal and maximum length sequence (M sequence) coded excitation to improve the signal-to-noise ratio. It was shown that, under rotational scanning, the liquid metal significantly improved the signal-to-noise ratio of the inter-tissue magneto-acoustic-electric signal and enhanced the quality of the reconstructed image. The signal-to-noise ratio of the signal was increased by 5.6, 11.1, 21.7, and 45.7 times under the excitation of 7-, 15-, 31-, and 63-bit M sequence code, respectively. The total usage time of 31-bit M sequence coded excitation imaging was shortened by 75.6% compared with single-pulse excitation when the same signal-to-noise ratio was improved. In conclusion, the imaging method combining liquid metal and M-sequence coding excitation has positive significance for improving MAET image quality.
Contrast Media ; Electricity ; Electric Conductivity ; Acoustics ; Tomography

Different microorganisms can cause intraperitoneal infection. This study was to distinguish different microbial infections by urine analysis. Rats were intraperitoneally injected with Escherichia coli, Staphylococcus aureus, and Candida albicans, separately. Urine samples were collected from rats at 0, 12, 36 and 72 h after infection. Urinary proteins were profiled using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Compared with the control (without infection), a total of 69 differential proteins were identified in rats injected with E. coli. A total of 31 differences proteins were identified in rats injected with S. aureus. A total of 38 differential proteins were identified in rats injected with C. albicans. Urine proteome was different when rats were infected by different microorganisms, suggesting that urine may have the potential for differential diagnosis of different intraperitoneal infections.
Animals ; Chromatography, Liquid ; Escherichia coli ; Proteome ; Rats ; Staphylococcus aureus ; Tandem Mass Spectrometry

Objective:To investigate the effect of follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes of patients with endometriosis (EMS). Methods:This retrospective cohort study was carried out from July 1st 2015 to June 30th 2019 and enrolled 383 young patients with EMS who underwent the first IVF/ICSI. According to the controlled ovarian hyperstimulation protocols, patients were classified into three groups: follicular phase long-acting GnRH agonist long protocol group (group A), short-acting GnRH agonist long protocol group (group B) and GnRH antagonist protocol group (group C). The clinical outcomes of IVF/ICSI were compared among the groups by using univariate and multivariate logistic regression analyses.Results:The patients with EMS in group A had significantly higher duration of stimulation and total dosage of gonadotrophin (Gn) used [11 (9,13) d, 2700 (2250, 3200) IU] than those in group B and group C [9 (8,10) d, 1875 (1575, 2250) IU; 8 (8,9) d, 1800 (1425, 2250) IU] (all P<0.001). Serum levels of luteinizing hormone (LH) [0.64 (0.35, 0.99) IU/L vs. 1.78 (1.42, 2.05) IU/L vs. 5.00 (3.63, 6.46) IU/L; 0.89 (0.37, 1.33) IU/L vs. 2.48 (1.76, 3.25) IU/L vs. 2.46 (1.66, 3.67) IU/L] and estradiol [6.70 (5.00,16.90) μg/L vs. 7.93 (6.50, 7.93) μg/L vs. 34.05 (22.99, 45.58) μg/L; 1.82 (1.11, 2.75) μg/L vs. 2.97 (2.16,4.24) μg/L vs. 2.03 (1.49, 2.96) μg/L) on Gn initiation day and human chorionic gonadotropin (hCG) injection day were significantly lower in group A (all P<0.001). Group A had significantly higher clinical pregnancy rate [76.53% (75/98)], implantation rate [54.10% (99/183)] and live birth rate [66.33% (65/98)] compared with those in group B and group C [61.39% (62/101) and 54.39% (31/57), P=0.010; 42.63% (81/190), and 40.19% (43/107), P=0.029; 53.47% (54/101), and 47.37% (27/57), P=0.046]. Conclusion:Follicular phase long-acting GnRH agonist protocol could improve IVF/ICSI outcomes of patients with EMS compared with short-acting GnRH agonist long protocol and GnRH antagonist protocol.

Objective:To investigate the effect of follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes of patients with endometriosis (EMS). Methods:This retrospective cohort study was carried out from July 1st 2015 to June 30th 2019 and enrolled 383 young patients with EMS who underwent the first IVF/ICSI. According to the controlled ovarian hyperstimulation protocols, patients were classified into three groups: follicular phase long-acting GnRH agonist long protocol group (group A), short-acting GnRH agonist long protocol group (group B) and GnRH antagonist protocol group (group C). The clinical outcomes of IVF/ICSI were compared among the groups by using univariate and multivariate logistic regression analyses.Results:The patients with EMS in group A had significantly higher duration of stimulation and total dosage of gonadotrophin (Gn) used [11 (9,13) d, 2700 (2250, 3200) IU] than those in group B and group C [9 (8,10) d, 1875 (1575, 2250) IU; 8 (8,9) d, 1800 (1425, 2250) IU] (all P<0.001). Serum levels of luteinizing hormone (LH) [0.64 (0.35, 0.99) IU/L vs. 1.78 (1.42, 2.05) IU/L vs. 5.00 (3.63, 6.46) IU/L; 0.89 (0.37, 1.33) IU/L vs. 2.48 (1.76, 3.25) IU/L vs. 2.46 (1.66, 3.67) IU/L] and estradiol [6.70 (5.00,16.90) μg/L vs. 7.93 (6.50, 7.93) μg/L vs. 34.05 (22.99, 45.58) μg/L; 1.82 (1.11, 2.75) μg/L vs. 2.97 (2.16,4.24) μg/L vs. 2.03 (1.49, 2.96) μg/L) on Gn initiation day and human chorionic gonadotropin (hCG) injection day were significantly lower in group A (all P<0.001). Group A had significantly higher clinical pregnancy rate [76.53% (75/98)], implantation rate [54.10% (99/183)] and live birth rate [66.33% (65/98)] compared with those in group B and group C [61.39% (62/101) and 54.39% (31/57), P=0.010; 42.63% (81/190), and 40.19% (43/107), P=0.029; 53.47% (54/101), and 47.37% (27/57), P=0.046]. Conclusion:Follicular phase long-acting GnRH agonist protocol could improve IVF/ICSI outcomes of patients with EMS compared with short-acting GnRH agonist long protocol and GnRH antagonist protocol.

Objective: To detect the vascular paths in the lateral wall of maxillary sinus using cone beam computer tomography (CBCT), and to retrospect the surgical managements of avoiding bleeding complication during the lateral approach maxillary sinus elevation.Methods: The documents of 71 consecutive patients with 81 sides maxillary sinus elevation surgery were collected.The vascular paths in the lateral wall of maxillary sinus were detected by the preoperative CBCT, and the messages about the vascular in surgical records were analyzed.Results: The paths of the vascular could be detected in 77 (95.1%) sides maxillary sinus in the reconstruction panoramic images of CBCT.At the position of the first molar, the paths of the vascular of the lateral maxillary sinus walls could be detected in 54 sides (66.7%) in the reconstruction coronal images of CBCT, and the other 27 sides (33.3%) could not be detected.Two approximately parallel paths of the vascular were found in 3 sides (3.7%) of the lateral maxillary sinus walls.The different diagnoses occurred in 6 sinuses between two observers.The kappa of diagnostic consistency of the two observers was 0.842 (P<0.001).The mean distance between the lower border of the vascular path to the plane of the alveolar crest of 54 sides maxillary sinuses was about (13.0±4.7) mm.The mean distance between lower border of vascular path to the plane of the floor of the sinus was (9.3±4.8) mm.The vascular path was located in the floor wall in 1 sinus.During the lateral approach maxillary sinus elevation operation, intraosseous vessels were dissected in 4 sides sinus lateral wall, the vascular path was avoided consciously in 3 sides, and the sinus elevation surgery had to be given up in 1 side for the vessel was torn and bleeding.There were no vascular related messages in 73 sides of the lateral approach maxillary sinus elevation operation records.Conclusion: The vascular paths of maxillary sinus wall could be detected by CBCT in most cases.Preoperative CBCT examination was proved to be reliable.The vascular paths of maxillary sinus wall should be examined carefully.It was helpful to make the surgical design perfectible and reduce the risk of tearing the vessel in operation.