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 the therapeutic effects of combination regimens based on omadacycline or tigecycline in the treatment of patients with carbapenem-resistant acinetobacter baumannii (CRAB) pneumonia.Methods:A retrospective analysis was performed on the case data of 92 patients diagnosed with CRAB pneumonia who were admitted to the Intensive Care Unit (ICU) of Jinhua Municipal Central Hospital between January 2022 and March 2024. Among these cases, 49 patients received combination therapy with omadacycline as the foundation (hereafter referred to as the omadacycline group),A total of 43 cases were treated with tigecycline-based combination therapy (hereafter referred to as the tigecycline group). The demographic and clinical data of the two patient groups, including pre- and post-treatment improvements in inflammatory markers, bacterial clearance rates, ventilator weaning success rates, and 28-day survival rates, were compared.Results:No significant differences were observed in the baseline characteristics between the two patient groups.The body temperature, white blood cell count, C-reactive protein levels, and procalcitonin concentrations in both groups of patients showed significant improvement after 72 hours of treatment.The differences observed were statistically significant ( P<0.05).Following the completion of the treatment regimen, the bacterial clearance rates in the omadacycline and tigecycline groups were 69.4% and 44.2%, respectively ( P = 0.015). Moreover, the success rates for weaning patients from ventilator support were 71.4% and 51.2%, respectively ( P = 0.046).However, no statistically significant difference was observed in the 28-day survival rate.No serious adverse drug reactions were observed in either of the groups. Conclusions:Both omadacycline- and tigecycline-based combination therapies have demonstrated significant efficacy in improving inflammatory markers in patients with CRAB pneumonia. There was no statistically significant difference in the 28-day survival rate between the two patient groups. Furthermore, combination therapy utilizing omadacycline can significantly enhance the efficacy of promoting negative conversion of the etiological agent,minimize the duration of mechanical ventilation.

Objective To investigate the changes in coagulation system in acute decompensated cirrhosis(ADC)patients with or without sepsis and the association of these changes with short-term prognosis.Methods A prospective study was conducted among 116 ADC patients who were hospitalized in Nanfang Hospital from January 2021 to July 2023,among whom there were 86 patients with sepsis and 30 patients without sepsis,and 54 patients with sepsis alone who had no chronic liver disease were enrolled as control group.Thromboelastography(TEG)and other conventional coagulation parameters were used to comprehensively evaluate the coagulation function of patients.The data including TEG results and short-term prognosis were collected,and a correlation analysis was performed.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Spearman correlation coefficient was calculated to investigate the correlation between different variables.The Logistic regression model was used to perform the univariate and multivariate analyses.Results For the ADC patients with sepsis,the lungs and bloodstream were the main infection sites,and bacteria were the main pathogenic microorganism.TEG results showed that compared with the patients with sepsis alone,the patients with ADC and sepsis had a significant reduction in median maximum amplitude(MA),a significant increase in coagulation time(K time),and a significant reduction in α angle(all P<0.05);the patients with ADC and sepsis had a significantly longer reaction time(R time)than those with ADC alone(P=0.02),and the patients with sepsis alone had a significantly longer R time than those with ADC and sepsis(P=0.04).There was no correlation between MA and platelet count in the patients with ADC and sepsis(r=-0.133,P=0.057),while there was a significant correlation between MA and platelet count in the patients with sepsis alone(r=0.595,P=0.001).SOFA score was negatively correlated with MA in sepsis patients with or without ADC(r=-0.503 and-0.561,both P<0.001),and for the patients with ADC and sepsis,R time,K time,and α angle were weakly correlated with SOFA score and had a relatively strong correlation with APTT(all P<0.05).The patients with ADC alone all survived within 90 days,and compared with the death group,the patients with sepsis alone who survived had significantly higher values of MA and α angle(all P<0.05);there was a significant difference in α angle on day 90 between the survival group and the death group,no matter whether the patients were comorbid with ADC or not(both P<0.01),while for the patients with ADC and sepsis,there was no significant difference in MA value on day 90 between the survival group and the death group(P>0.05).Conclusion For ADC patients comorbid with sepsis,coagulation function assessment and monitoring should be taken seriously in clinical practice,and TEG parameters and SOFA score should be monitored when necessary to develop individualized treatment regimens.

OBJECTIVE To analyze the incidence of infectious diseases in a certain department from 2015 to 2022,to provide scientific basis for formulating health and epidemic prevention measures.METHODS Descriptive epide-miological methods were used to analyze the incidence of infectious diseases.RESULTS Over the eight-year period,a total of 3,635 cases of 35 types of infectious diseases were reported.The top five diseases in terms of incidence were chickenpox,influenza,tuberculosis,viral hepatitis and acute febrile respiratory diseases.From the perspec-tive of transmission routes,respiratory infectious diseases were the most common,followed by blood-borne and sexually transmitted diseases,and gastrointestinal infectious diseases.Regarding time distribution,the high-est number of cases occurred in the first quarter,with the least in the third quarter.From the perspective of popu-lation distribution,soldiers have the highest incidence of the disease,followed by military officers,with age of on-set ranging from 17 to 25 years old.CONCLUSIONS Respiratory infectious diseases are the primary cause of the epidemic,with an obvious seasonal distribution characteristics,and sexually transmitted diseases show a slow growth trend.It is imperative to strengthen monitoring,early warning and timely disposal of respiratory infectious diseases;meanwhile health education and intervention for risk factors related to sexually transmitted diseases should be strengthened.

Objective:To evaluate the efficacy and safety of the CLAE (cladribine + cytarabine + etoposide) regimen in refractory/relapsed T cell acute lymphoblastic leukemia/lymphoma (R/R T-ALL/LBL) .Methods:Patients with R/R T-ALL/LBL received the CLAE regimen in a prospective, multicenter, single-arm clinical study or compassionate use. From March 2019 to August 2024, data from 25 patients (18 in the study across five centers and 7 receiving compassionate treatment in Peking University Third Hospital) were collected. Outcomes included objective response rate, complete response (CR) rate, partial response (PR) rate after 1–2 cycles, bridging to allo-HSCT, progression-free survival (PFS), overall survival (OS), and treatment-related adverse effects.Results:Median age was 29 years (range, 13–63) ; 17 were male. Among the 24 evaluable patients, CR rate was 33.3% overall and 41.2% among enrolled patients. Median OS and PFS time were 199 (46–1 310) and 49 (28–1 310) days, respectively. Cumulative OS rate at 6 months, 1 year, and 2 years was (52.1±10.2) %, (29.7±9.3) %, and (27.1±9.1) %, respectively; cumulative PFS rate was (32.6±9.6) %, (24.9±8.9) %, and (23.8±8.7) %, respectively. Among patients achieving CR or PR (8 cases), median OS and PFS were not reached. Cumulative OS rate at 6 months, 1 year, and 2 years was (86.8±12.0) %, (78.3±14.6) %, and (72.9±15.7) %, respectively, and the cumulative PFS rate was (86.4±12.1) %, (74.8±15.3) %, and (72.9±15.7) %, respectively. Adverse events were mainly hematologic; no treatment-related mortality occurred. Seven patients achieving CR were bridged to allo-HSCT, with 5 remaining in continuous remission.Conclusion:The CLAE regimen is safe and effective for R/R T-ALL/LBL, facilitating CR as a bridge to allo-HSCT and potentially improving patient prognosis.

OBJECTIVE To investigate the molecular epidemiological characteristics of clinical isolates of carbapen-em-resistant Klebsiella pneumoniae(CRKP)resistant to ceftazidime/avibactam(CZA).METHODS From Jan.2022 to Dec.2023,totally 63 strains of non-repetitive CZA-resistant CRKP that were isolated for the first time from hospitalized patients of the First Affiliated Hospital of Nanchang University were enrolled in the study,and 50 strains of CZA-sensitive CRKP were randomly chosen as the research subjects.The drug susceptibility rates of the strains were observed.The drug resistance genes,virulence genes and capsular serotypes of the strains were detected by means of polymerase chain reaction(PCR).The molecular epidemiological characteristics of the strains were observed by using molecular biological techniques such as pulse field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).RESULTS Among the CZA-resistant CRKP strains,45(71.43％)were iso-lated from sputum.The result of drug susceptibility testing showed that the drug resistance rates of the CZA-re-sistant strains to amikacin,aztreonam and minocycline were lower than those of the CZA-sensitive strains(P＜0.05),and the drug resistance rates of the CZA-resistant strains to tigecycline was higher than that of the CAZ-sensitive strains(P＜0.05).The carrying rates of blaKPC,blaNDM,blaSHV-1,blaTEM-1,blaCTX-M,blaqnrS,blaacc(6')-Ib and blarmtB genes of the CZA-resistant strains were relatively high.Among the detected capsular serotypes,K64(n=18,28.57％)was dominant.ST11(n=25,39.68％)was predominant strain among the CZA-resistant CRKP strains.CONCLUSIONS ST11 is dominant among the CZA-resistant CRKP strains.The strains carry with multiple drug resistance genes and virulence genes.The drug resistance rate of the CZA-resistant strains to tigecycline is higher than that of the CZA-sensitive strains,and it is necessary to attach great importance during the clinical treatment.

Objective:To investigate the current status of clinical nurses' knowledge, attitudes, and practices (KAP) regarding geriatric frailty syndrome in a general hospital and to analyze the influencing factors.Methods:Using convenience sampling, 319 clinical nurses from the First Affiliated Hospital of Wenzhou Medical University, were recruited between May and September 2024. A KAP questionnaire on geriatric frailty syndrome was developed through literature review and the Delphi method. Data were collected with a demographic questionnaire and the KAP questionnaire. Multiple linear regression was performed to identify factors influencing KAP levels.Results:The finalized KAP questionnaire consisted of three dimensions and 27 items. Cronbach's α coefficients for the total scale and the knowledge, attitudes, and practices subscales were 0.974, 0.981, 0.974, and 0.967, respectively. The overall KAP score among 319 nurses was (96.65±20.83). The average scores for each dimension were (4.08±0.82) for attitudes, (3.84±0.84) for practices, and (3.12±1.00) for knowledge. Multiple linear regression indicated that age and positions were respective significantly influenced the total KAP score and attitudes score ( P<0.05) ; frailty-related training was also a significant factor for KAP score and dimension scores ( P<0.05) . Conclusions:Clinical nurses demonstrated a moderate overall KAP level regarding geriatric frailty syndrome, with relatively high attitudes but insufficient professional knowledge. Hospital managers should provide effective education and training for frontline nurses to improve KAP levels and to promote early identification, assessment, and intervention of geriatric frailty.

To explore the feasibility of using UAV-LiDAR for measuring the leaf area index (LAI) of crop canopies, we employed UAV-LiDAR to scan sugarcane canopies during the tillering and elongation stages, acquiring canopy point cloud data. Subsequently, features such as average row height, projected row area, point cloud density at different canopy layers, and the ratios between these parameters were extracted. Three feature selection methods-partial least squares regression (PLSR), XGBoost feature importance (XGBoost-FI), and random forest-recursive feature elimination (RF-RFE)-were adopted to evaluate and identify the optimal input variables for modeling. With these selected variables, LAI inversion models were developed based on random forest (RF) and adaptive boosting (AdaBoost) algorithms, and their performance was assessed. Among the extracted features, the projected row area S_p and the total row point count C_total exhibited strong correlations with LAI, with correlation coefficients of 0.73 and 0.72, respectively. The AdaBoost-based LAI inversion model, using the projected row area S_p, average height H_avg, mid-layer point cloud density C_m, and total row point count C_total as input variables, achieved the best performance, with a coefficient of determination (R_v²) of 0.713 and a root mean square error (RMSE_v) of 0.25 on the validation set. This study provides an effective method for high-throughput acquisition of LAI in field crops, offering valuable scientific support for sugarcane field management and breeding efforts.
Plant Leaves/growth & development* ; Saccharum/growth & development* ; Algorithms ; Unmanned Aerial Devices ; Remote Sensing Technology/methods* ; Crops, Agricultural/growth & development*

Accurately obtaining the crop quantity and density is not only crucial for the demand-based input of water and fertilizer in the field but also vital for ensuring the yield and quality of crops. Aerial photography by unmanned aerial vehicles (UAVs) can quickly acquire the distribution image information of crops over a large area. However, the accurate recognition of a single type of dense targets is a huge challenge for most recognition algorithms. Taking banana seedlings as an example in this study, we captured the images of banana plantations by UAVs from high altitudes to explore an efficient recognition method for dense targets. We proposed a strategy of "cut-recognition-stitch" and constructed a counting method based on the improved Faster R-CNN algorithm. First, the images containing highly dense targets were cropped into a large number of image tiles according to different sizes (simulating different flight altitudes), and the Contrast Limited Adaptive Histogram Equalization (CLAHE) algorithm was adopted to improve the image quality. A banana seedling dataset containing 36 000 image tiles was constructed. Then, the Faster R-CNN network with optimized parameters was used to train the banana seedling recognition model. Finally, the recognition results were reversely stitched together, and a boundary deduplication algorithm was designed to correct the final counting results to reduce the repeated recognition caused by image cropping. The results show that the recognition accuracy of the Faster R-CNN with optimized parameters for banana image datasets of different sizes can reach up to 0.99 at most. The deduplication algorithm can reduce the average counting error for the original aerial images from 1.60% to 0.60%, and the average counting accuracy of banana seedlings reaches 99.4%. The proposed method effectively addresses the challenge of recognizing dense small objects in high-resolution aerial images, providing an efficient and reliable technical solution for intelligent crop density monitoring in precision agriculture.
Musa/growth & development* ; Crops, Agricultural/growth & development* ; Algorithms ; Neural Networks, Computer ; Unmanned Aerial Devices ; Seedlings/growth & development* ; Image Processing, Computer-Assisted/methods* ; Photography ; Agriculture/methods*

Objective To investigate the risk factors for acute respiratory failure in immunocompromised patients with Pneumocystis jirovecii pneumonia(PJP).Methods Clinical data of 123 immunocompromised patients complicated with PJP hospitalized at Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2021 to December 2023 were retrospectively collected and analyzed.SPSS 22.0 statistical software package was used to perform multivariate binary logistic regression analysis to identify risk factors for acute respiratory failure in PJP patients.Results Among the 123 PJP patients,77 were HIV-positive,and 46 were HIV-negative.HIV-negative PJP patients were more likely to have comorbidities such as hypertension(P＜0.001),diabetes mellitus(P＜0.001),coronary heart disease(P=0.034),chronic kidney disease(P＜0.001),chronic liver disease(P=0.019),chronic lung disease(P=0.011),and malignant tumor(P＜0.001).They were also more prone to respiratory failure(P＜0.001)and ICU admission(P＜0.001).The HIV-positive patients had significantly lower CD4+T lymphocyte counts and albumin levels(P＜0.001).Forty patients developed acute respiratory failure,and six patients died.Multivariate analysis showed that high neutrophil-to-lymphocyte ratio(NLR)(P=0.031),non-HIV infection(P=0.002),and concomitant infections with other pathogens(P＜0.001)were independent risk factors for incidence of respiratory failure.ROC curve analysis revealed that the area under the curve(AUC)was 0.686(0.584,0.789)for non-HIV infection,0.731(0.637,0.826)for concomitant infections with other pathogens,0.648(0.546,0.750)for NLR.The predicted probability was 0.845(0.778,0.912).Conclusions Non-HIV infection,high NLR,and concomitant infections with other pathogens are independent risk factors for incidence of respiratory failure in PJP patients.The panel combining these factors provides a higher predictive value for respiratory failure.Timely assessment of patient condition and early treatment are vital for better outcomes.