With the increasing incidence of esophagogastric junction carcinoma, the application rate of proximal gastrectomy has been rising annually. There is a wide variety of methods for digestive tract reconstruction after proximal gastrectomy, and some of these reconstruction methods have been introduced relatively recently, with limited clinical experience, which led to a lack of standardization. Such a situation will inevitably result in inconsistent clinical outcomes of proximal gastrectomy with digestive tract reconstruction. To promote the standardization of digestive tract reconstruction after proximal gastrectomy, improve the clinical efficacy of proximal gastrectomy, and reduce the occurrence of postoperative complications, this article elaborates on the indications, surgical steps and technical points of the four methods after proximal gastrectomy recommended by the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy (2020 edition)", such as double tract, side overlap, double flaps and gastric tube reconstruction, providing guidance for the application of digestive tract reconstruction after proximal gastrectomy.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Astrocytes(AS)are the most abundant glial cells in the central nervous system and are involved in many physiological and pathological processes in the nervous system.Alterations in their phenotype are particularly important for the health of the CNS.Epigenetic mechanisms,including DNA methylation,histone modification,non-coding RNA regulation,and chromatin remodeling,are closely linked to alterations in AS proliferation,differentiation,inflammation,and other phenotypic features,but how these mechanisms function needs to be explored and summarized.By reviewing the recent advances in the role of epigenetic mechanisms in AS under various physiological and pathological states,we aim to provide new ideas for the understanding and treatment of related diseases.

With the increasing incidence of esophagogastric junction carcinoma, the application rate of proximal gastrectomy has been rising annually. There is a wide variety of methods for digestive tract reconstruction after proximal gastrectomy, and some of these reconstruction methods have been introduced relatively recently, with limited clinical experience, which led to a lack of standardization. Such a situation will inevitably result in inconsistent clinical outcomes of proximal gastrectomy with digestive tract reconstruction. To promote the standardization of digestive tract reconstruction after proximal gastrectomy, improve the clinical efficacy of proximal gastrectomy, and reduce the occurrence of postoperative complications, this article elaborates on the indications, surgical steps and technical points of the four methods after proximal gastrectomy recommended by the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy (2020 edition)", such as double tract, side overlap, double flaps and gastric tube reconstruction, providing guidance for the application of digestive tract reconstruction after proximal gastrectomy.

Carotid artery stenosis is an important cause of ischemic stroke, and its mechanism is mainly associated with the formation of atherosclerotic plaques. Head and neck radiotherapy may accelerate plaque formation, leading to carotid artery stenosis. In addition, radiotherapy can also cause the damage to the intima and adventitia of blood vessels, exacerbating the degree of carotid artery stenosis. This carotid artery stenosis caused by radiotherapy is different from atherosclerotic carotid artery stenosis in etiology, pathogenesis, prevention and treatment. Therefore, a thorough understanding of the pathogenic mechanism is crucial for selecting appropriate prevention and treatment methods.

Vascular cognitive impairment (VCI) is the second most common type of dementia after Alzheimer's disease. As the pathway between the central nervous system and gastrointestinal tract, brain-gut axis has become one of the research hotspots in the pathogenesis of many diseases. Intestinal flora imbalance may mediate or affect vascular risk factors such as atherosclerosis, hypertension, metabolic diseases, and ischemic stroke, and finally accelerate the occurrence and development of VCI. This article reviews the literature on intestinal flora and VCI as well as its main risk factors, in order to provide new ideas for the prevention and treatment of VCI.

Objective:To explore the status of unplanned extubation (UE) in hospitalized patients.Methods:A retrospective research method was used to select 189 UE patients from Fuxing Hospital affiliated to Capital Medical University from 2014 to 2019 as the research object. The general data, extubation and restraint of UE patients were analyzed.Results:The age of 189 UE patients was (79.69±10.62) years old, and the proportion of medical UE patients accounted for 62.43% (118/189) . The state of consciousness was mainly awake (46.03%, 87/189) and confusion (39.15%, 74/189) . The types of pipelines were mostly nutrition (56.99%, 110/189) and blood (22.80%, 44/189) . Most of the people found were medical and nursing staff (60.32%, 114/189) , and most of UE occurred for the first time (85.71%, 162/189) . There were statistically significant differences in the restraint of UE patients with different nursing levels, state of consciousness, self-care ability, department, nutrition pipeline, blood pipeline, drainage pipeline and re-intubation ( P<0.05) . Conclusions:Factors such as the patient's state of consciousness and the type of pipelines should be monitored, and physical restraint should be used cautiously. At the same time, a UE risk warning system should be established, and intelligent equipment should be used to monitor high-risk groups in real time to prevent the occurrence of UE.

Stroke is one of the most important diseases in the world with high mortality and disability rate. Acute ischemic stroke (AIS) is more than 80% in total. At present, the main treatments for AIS include intravenous thrombolysis and endovascular mechanical thrombectomy. Cognitive impairment is a common or potentially disabling effect of stroke, but the optimal treatment of post-stroke cognitive impairment remains controversial. This article reviews the effects of treatments for acute ischemic stroke on cognitive function.

Objective:To investigate the risk factors for anterior circulation and posterior circulation symptomatic intracranial atherosclerotic stenosis (sICAS).Methods:The clinical data of patients admitted to Hebei General Hospital for ischemic stroke or transient ischemic attack (TIA) and diagnosed with sICAS by digital subtraction angiography from May 2019 to May 2020 were retrospectively included. The patients were divided into anterior circulation group and posterior circulation group according to the stenosis sites, and the distribution of sICAS and its risk factors were analyzed.Results:A total of 134 patients with sICAS were enrolled, including 82 males (61.2%) and 52 females (38.8%). Their age was 60.28±11.46 years; 115 (85.8%) had ischemic stroke and 19 (14.2%) had TIA. There were 92 patients (68.7%) in the anterior circulation group and 42 (31.3%) in the posterior circulation group. Body mass index (BMI), systolic and diastolic blood pressure levels, as well as the proportion of patients with hypertension, diabetes, smoking and drinking in the posterior circulation group were significantly higher than those in the anterior circulation group (all P<0.05). Multivariate logistic regression analysis showed that higher BMI (odds ratio [ OR] 1.191, 95% confidence interval [ CI] 1.029-1.379; P=0.019), hypertension ( OR 4.073, 95% CI 1.135-14.616; P=0.031) and diabetes ( OR 2.783, 95% CI 1.149-6.738; P=0.023) were independently correlated with the posterior circulation sICAS. Conclusions:Compared with anterior circulation, high BMI, hypertension and diabetes are the independent risk factors for posterior circulation sICAS.

Mechanical thrombectomy is an effective treatment for acute ischemic stroke. Direct aspiration thrombectomy is one of the operating methods of mechanical thrombectomy. Compared with stent thrombectomy, it has the characteristics of simple operation and quick opening of the occluded blood vessels. This article reviews the related research of direct aspiration thrombectomy for the treatment of acute ischemic stroke.