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 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 explore the effect of ubiquitin-specific protease 42(USP42)on osteogenic differentiation of human adipose-derived stem cells(hASCs)in vivo and in vitro.Methods:A combina-tion of experiments was carried out with genetic depletion of USP42 using a lentiviral strategy.Alkaline phosphatase(ALP)staining and quantification,alizarin red S(ARS)staining and quantification were used to determine the osteogenic differentiation ability of hASCs under osteogenic induction between the experimental group(knockdown group and overexpression group)and the control group.Quantitative re-verse transcription PCR(qRT-PCR)was used to detect the expression levels of osteogenesis related genes in the experimental group and control group,and Western blotting was used to detect the expression levels of osteogenesis related proteins in the experimental group and control group.Nude mice ectopic im-plantation experiment was used to evaluate the effect of USP42 on the osteogenic differentiation of hASCs in vivo.Results:The mRNA and protein expressions of USP42 in knockdown group were significantly lower than those in control group,and those in overexpression group were significantly higher than those in control group.After 7 days of osteogenic induction,the ALP activity in the knockdown group was sig-nificantly higher than that in the control group,and ALP activity in overexpression group was significantly lower than that in control group.After 14 days of osteogenic induction,ARS staining was significantly deeper in the knockdown group than in the control group,and significantly lighter in overexpression group than in the control group.The results of qRT-PCR showed that the mRNA expression levels of ALP,os-terix(OSX)and collagen type Ⅰ(COL Ⅰ)in the knockdown group were significantly higher than those in the control group after 14 days of osteogenic induction,and those in overexpression group were signifi-cantly lower than those in control group.The results of Western blotting showed that the expression levels of runt-related transcription factor 2(RUNX2),OSX and COL Ⅰ in the knockout group were significant-ly higher than those in the control group at 14 days after osteogenic induction,while the expression levels of RUNX2,OSX and COL Ⅰ in the overexpression group were significantly lower than those in the control group.Hematoxylin-eosin staining of subcutaneous grafts in nude mice showed that the percentage of osteoid area in the knockdown group was significantly higher than that in the control group.Conclusion:Knockdown of USP42 can significantly promote the osteogenic differentiation of hASCs in vitro and in vi-vo,and overexpression of USP42 significantly inhibits in vivo osteogenic differentiation of hASCs,and USP42 can provide a potential therapeutic target for bone tissue engineering.

Objective:To improve the performance of ECG arrhythmia classification algorithm and provide auxiliary basis for clinical ECG diagnosis.Methods:The one-dimensional ECG data was segmented according to the R point, and the segmented data was generated into a 2D image. The samples were expanded by data augmentation technology, and the image features were extracted by the 2D convolutional layer, 2D maximum pooling layer, Flatten layer and fully connected layer in 2D-CNN. Then, the samples were classified with Softmax classifier. The loss function with weight coefficients was used to enhance the model's learning of class S and class V. The MIT-BIH data set was used for model training and algorithm performance evaluation.Results:Sample expansion and the use of loss functions with weight coefficients can improve the recall rate and specificity index of the model, while maintaining the model's accuracy index of the classificatio on VEB and SVEB.Conclusions:The accuracy of the proposed model is 99.02%, and the recall rate of SVEB is 96.4%, indicating that this classification method can assist medical staff in diagnosing heart diseases.

Objective To evaluate the clinical value of 3D reconstruction in the single utility-port thoracoscopic segmentectomy of early stage NSCLC by propensity score matching (PSM). Methods We retrospectively analyzed clinical data of 150 early stage NSCLC patients undergoing single utility-port thoracoscopic segmentectomy. The patients were divided into reconstruction group (n=58) and non-reconstruction group (n=92) according to 3D reconstruction. PSM was performed on two groups to compare perioperative outcomes. Results Procedures were successfully completed on all patients, without perioperative death. In each group, 43 patients were successfully matched after PSM on the basis of 8 confounding factors, age, gender, smoking status, BMI, maximum tumor diameter on CT, tumor location, % FEV1 and type of planned segmentectomy. After PSM, in complex segmentectomy, the patients in the reconstruction group had shorter operation time (155.77±30.17 vs. 212.94±66.49min, P < 0.001) and less blood loss (46.00±25.94 vs. 88.79±68.36ml, P=0.002), compared with the non- reconstruction group. Conclusion Preoperative 3D reconstruction could help improve the efficiency of single utility-port thoracoscopic surgery for complex segmentectomy and reduce intraoperative bleeding.

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.

ObjectiveTo investigate the role of OPN in human breast cancer cell line ( MDA-MB-231) by using small interfering RNA to specifically knockdown OPN expression. MethodsOPN ShRNA expression vector was stably transfected to MDA-MB-231 cell line.The expression of OPN mRNA and protein were analyzed using reverse transcription polymerase chain reaction (RT-PCR)and Western blot,respectively.The growth of MDA-MB-231 cells were observed by MTT.The effect of OPN siRNA on the transplanted tumor growth and tumor hypoxia were assessed in nude mice. ResultsThe expression level of OPN in MDA-MB-231 cells were significantly lower under hypoxia or normoxia(P ＜ 0.05 ).OPN silence with RNAi significantly inhibited the invasion ability and proliferation of MDA-MB-231 cell lines (P ＜ 0.01 ).Inhibition of OPN with RNAi significantly inhibited the growth ability of MDA-MB-231 cells in vivo(P ＜0.05).The tumor hypoxia significantly decreased(P ＜ 0.05). ConclusionsOPN silence with RNAi can effectively inhibit cell proliferation and tumor growth of MDA-MB-231 cells,and decrease the bypoxia level of MDA-MB-231 transplanted tumor in nude mice.

Objective To study the clinicopathological features of primary and metastatic hepatic neuroendocrine carcinoma.Methods The records of 35 patients with primary hepatic neuroendocrine carcinoma and 35 patients with metastatic hepatic neuroendocrine carcinoma were retrospectively reviewed.These patients served as the primary group(priNET,n=35)and the metastasis group (metNET,n=35),respectively.Results There were significant differences between the two groups of patients in gender,site,size and number of tumor(P＜0.05).Although there was no significant difference between the two groups in the distribution of the tumors in the two lobes of liver (P＞0.05),priNET had more tumors localized to one lobe of liver while metNET had more tumors involving both lobes of liver(P＜0.05).Conclusions Gender,size,site and number of tumor may play an important role in the differentiation of primary or metastatic hepatic neuroendocrine tumor.