Objective To longitudinally investigate the characteristics of postoperative weight changes in patients with esophageal cancer and analyze its influencing factors, which can provide certain guidance for nutritional intervention in patients with esophageal cancer. Methods Patients with esophageal cancer who underwent surgical treatment at the Sichuan Cancer Hospital from December 2020 to February 2022 were prospectively included. The general information questionnaire and body composition analyzer were used to longitudinally investigate the patients’ weight and body composition before surgery (T0), 1 month after surgery (T1), 3 months after surgery (T2) and 6 months after surgery (T3), and the change characteristics were analyzed. The generalized estimating equation was used to analyze the influencing factors for postoperative weight changes in patients with esophageal cancer. Results A total of 130 patients were enrolled, including 110 males and 20 females, aged 42-79 (63.33±8.16) years. The weight and body composition of patients with esophageal cancer showed a continuous slow downward trend within 6 months after surgery. The weight loss rate of patients at 1, 3, and 6 months after surgery was 5.10%, 7.76%, and 9.86%, respectively. The analysis results of the influencing factors for postoperative weight showed that patients with the following characteristics had more weight loss: female (β=−7.703, P=0.001), ≥60 years (β=−3.657, P=0.010), smoking (β=4.622, P=0.010), low tumor differentiation degree (β=4.314, P=0.039), and high frequency of eating (β=−3.400, P=0.008). Conclusion Weight loss is an important health problem for patients with esophageal cancer after surgery, and patients have a continuous downward trend in weight within 6 months after surgery. Medical staff should pay special attention to the patients who are female, ≥60 years, having smoking history and low tumor differentiation degree.

Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease around the world, and pharmacotherapy is the foremost treatment method currently. In recent decades, with the rapid development of bronchoscopic interventional therapy, endoscopic physical ablation technology presents a therapeutic effect in treating COPD, with few treatment-related side effects, showing excellent application prospects in treating COPD. Since ablation techniques in this field are emerging technologies with low patient acceptance, they are not widely used in the clinical treatment of COPD. This article reviews the development process of physical ablation techniques. Moreover, their current application status and the prospects in the field of COPD treatment are also summarized and analyzed. We hope to promote the application of physical ablation in the clinical treatment of COPD and provide practical references and a theoretical basis for the clinical treatment of COPD.

Metabolic dysfunction-associated fatty liver disease （MAFLD） has the core pathological feature of liver lipid accumulation， which is closely associated with the factors such as lipid metabolism disorders， insulin resistance， and inflammation， and abnormal lipid accumulation can exacerbate these factors and further intensify lipid accumulation， thereby forming a vicious circle. Huanglian Wendan decoction has shown unique advantages in alleviating lipid accumulation associated with MAFLD， but its mechanism of action is relatively complex. With reference to the latest literature evidence， this article systematically summarizes the mechanism of action of Huanglian Wendan decoction in improving lipid accumulation by regulating lipid metabolism， ameliorating insulin resistance， and exerting an anti-inflammatory effect， as well as the pharmacological actions of related active components， in order to provide a theoretical basis for the clinical application of Huanglian Wendan decoction in the management of MAFLD.

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 performance of three mainstream large language models (LLMs) in the review of drug reimbursement indications in hospitals, and to explore their potential in improving audit quality and efficiency, thereby safeguarding the medical insurance fund.Methods:A total of 3 247 outpatient prescription records were retrospectively collected from a specialized oncology hospital between January 2, 2022, and June 30, 2023. Manual assessment of the consistency between clinical diagnoses and drug reimbursement indications was used as the gold standard. Three LLMs, Baidu′s ERNIE Bot, Alibaba′s Tongyi Qianwen, and OpenAI′s ChatGPT-4o, were evaluated on the same task. Performance metrics included accuracy, precision, sensitivity, specificity, F1 score, and area under the curve (AUC).Results:The ERNIE Bot model returned 3 242 valid data, which took 314 min; The Tongyi Qianwen model returned a total of 3 162 valid data, taking 384 min; The ChatGPT-4o model returned a total of 3 218 valid data, taking 150 min. ChatGPT-4o demonstrated the best performance, with an accuracy of 88.41%, precision of 60.48%, sensitivity of 78.75%, specificity of 90.24%, F1 score of 0.68, and an AUC of 0.88.Conclusions:LLMs demonstrate stable performance in determining whether prescriptions align with reimbursement indications, with ChatGPT-4o approaching human-level accuracy and exhibiting more conservative specificity. These findings suggest that LLMs have practical value as auxiliary tools in drug indication reviews, contributing to improved audit efficiency and more refined management of medical insurance funds.

AIM:To construct a network calcula-tor based on machine learning(ML)models to pre-dict the risk of delayed awakening from anaesthesia in breast cancer(BC)patients.METHODS:A total of 435 BC patients surgically treated at our hospital from January 2023 to June 2024 were selected.The Boruta algorithm was used to screen for important characteristic variables for the risk of delayed awak-ening from anaesthesia.All patients were randomly assigned to a training set(n=261)and a test set(n=174)based on a 3:2 ratio and nine ML models were constructed and trained.Nine ML models were evaluated on the basis of receiver operating charac-teristic(ROC)curves for a random sample of 10 sub-jects and the clinical utility of the models was as-sessed using decision curve analysis.Combined with SHapley Additive exPlanations(SHAP)bar graphs,summary graphs and force diagrams additional in-terpretation and visualization of the ML model.Con-struction of a network calculator for predicting the risk of delayed awakening from anesthesia in BC pa-tients using the R package.RESULTS:Of the 435 BC patients,25.1%experienced delayed awakening from anesthesia.Boruta algorithm screened seven feature variables.The ROC curve shows that the XG-Boost model has the highest area under the curve(AUC)for 10 random samples among the 9 ML mod-els,and the decision curve shows that the XGBoost model has a significant clinical net benefit.The SHAP bar graph shows the importance of ASA classi-fication,surgery time,anesthesia time,intraopera-tive blood loss,propofol,preoperative anemia,and intraoperative hypothermia,and the SHAP summa-ry graph reflects the distribution of the ranges of in-fluence of the seven important characteristic vari-ables,which are"separated at the ends."The SHAP force diagram visualization XGBoost model predict-ed the risk of delayed awakening from anesthesia for individual patients with a predictive value of 0.998 for patients with delayed awakening from an-esthesia and 0.008 91 for patients without delayed awakening from anesthesia.A web-based calculator(https://xz-nomogram.shinyapps.io/DE_web/)based on an interpretable XGBoost model effective-ly predicts the risk of delayed awakening from anes-thesia in BC patients.CONCLUSION:ASA classifica-tion,surgery time,propofol,intraoperative blood loss,anaesthesia time,preoperative anaemia and intraoperative hypothermia are important charac-teristic variables for the risk of delayed awakening from anaesthesia in BC patients.The network calcu-lator based on the interpretable XGBoost model can accurately and quickly quantify the risk of de-layed awakening from anaesthesia,which can help clinicians to effectively adjust the treatment strate-gy and better improve the prognosis of patients.

Objective:To analyze the cost and structural impact of the new technology"transhysteroscopic mechanical rotary excision of abnormal uterine tissues"on the DRG group of"surgery for intrauterine lesions"under the DRG payment method,and to provide clinical data for supporting the development of the exclusion policy for the new technology and new items.Methods:Cases in which transhysteroscopic mechanical rotary excision of abnormal uterine tissues was used in the gynecology day unit of the Peking Union Medcial College Hospital from March 2022 to November 2023,which were paid for under the DRG group of"surgery for intrauterine pathology",were retrospectively analyzed for the impact of the new technology on the cost and structure of the cases.Results:The price of"transhysteroscopic mechanical rotary excision of abnormal uterine tissues"in the Beijing Medical Service Price Item Specification is 8 000 yuan(Class C out-of-pocket expenses),which is higher than the payment standard of 6 866 yuan for the NE19 group,and the use of this new technology significantly increased the total hospitalization medical cost,the out-of-pocket ratio of the patients and the surgical cost,which led to an increase in the burden of the patients and the loss of the hospitals.Conclusion:"Transhysteroscopic mechanical rotary excision of abnormal uterine tissue"has the advantages of improving patients'prognosis and accelerating recovery,shortening operation time,avoiding intraoperative thermal injuries,and shortening the learning curve of doctors,etc.Policy makers should take into account cost control,patients'prognosis and the development of medical technology,scientifically and prudently formulate the exclusion policy of the new technology,reasonably determine the payment standard,and make good use of the exclusion policy and the payment standard.

Objective To explore the immediate impact of acute vision changes in hemiplegic patients on their gait.Methods Thirty visually normal hemiplegic patients were recruited.Plane mirrors(0°),concave lenses(+150°,+450°)were selected to simulate normal vision,moderate myopia,and high myopia scenarios for straight line walking tests.The Qualisys three-dimensional(3D)motion capture system and Kistler 3D force platform were employed to collect kinematic and dynamic parameters of the patients,and the differences in related indicators before and after visual intervention were compared.Results Visual intervention affected the step length,walking speed,and joint angles of hemiplegic patients.Especially after acute vision changes,there was a significant difference in the stride length and ankle joint angles on the patient's affected side.Under high myopia,the step length and step length symmetry were better than those under moderate myopia,but at the expense of gait speed.Visual intervention led to asymmetric trends in step the length symmetry and joint angle symmetry.There were very significant differences in center of pressure(COP)and COP symmetry between normal vision and high myopia.Conclusions Acute vision changes can affect the gait of hemiplegic patients,especially in individuals with high myopia presenting both a notable decrease in walking speed and an increased ankle range of motion,and an increase in walking speed with moderate myopia.Meanwhile,the symmetry of the COP decreases,indicating that acute vision changes lead to a higher risk of falls for patients.Reasonable vision assessment and corresponding intervention measures are expected to improve walking ability and life quality of the patients.

Eight new diterpenoids, Isodons A-H (1-8), comprising seco-abietane and abietane-type structures, together with 13 known analogues (9-21), were isolated from Isodon lophanthoides (Buch.-Ham. ex D. Don) Hara. The compounds (+)-3/(-)-3, (+)-4/(-)-4, and (+)-5/(-)-5 were identified as three enantiomeric pairs. The planar structures and absolute configurations of 1-8 were determined through high-resolution electrospray ionization mass spectrometry (HR-ESI-MS), 1D & 2D nuclear magnetic resonance (NMR) spectroscopy, electronic circular dichroism (ECD) calculations, and X-ray diffraction crystallography. A cholesterol 7α-hydroxylase (Cyp7a1) luciferase reporter assay revealed significant anti-cholestatic activities for compounds 1, (+)-4, 6, 7, 12-14, and 16. Additionally, compound 6 demonstrated anti-cholestatic effects through the farnesoid X receptor (FXR)-associated signaling pathways in vitro and in vivo. These findings suggest potential applications for I. Lophanthoides in pharmaceutical development.
Abietanes/pharmacology* ; Molecular Structure ; Animals ; Isodon/chemistry* ; Humans ; Diterpenes/pharmacology* ; Plant Extracts/chemistry*

Spectral computed tomography (CT) has triggered a technological revolution in radiodiagnosis while demonstrating its increasing application value in radiotherapy. Employing dual-energy techniques for material decomposition, spectral CT provides optimized solutions for several critical aspects of radiotherapy. Based on a review of the application situation of spectral CT in radiotherapy, this study delved into spectral CT′s significant advantages in image quality improvement, precise dose calculation, and comprehensive quantitative assessment. Furthermore, this study envisioned the development orientations and application prospects of spectral CT.