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*

Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. Results A total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.

With global climate change, the frequency and intensity of extreme weather events have increased, and the possibility of multiple extreme weather events occurring simultaneously or continuously forming compound extreme events has also significantly increased, bringing catastrophic damage to the ecological environment, socio-economic and human health. This study reviewed the changing trends and health risks of consecutive compound heavy precipitation and heatwave extremes. There is currently no unified definition for these types of events, which could be divided into two subcategories: heavy precipitation-heatwave and heatwave-heavy precipitation. Their historical frequency and intensity have increased, and future estimates are also on the rise. The majority of current studies on single extreme events such as heatwaves or heavy precipitation revealed significant adverse health effects. However, few studies focused on the association between compound events of heavy precipitation and heatwave and human health risk. This paper further summarized the current shortcomings in this field and proposed suggestions for future research directions.

Antipsychotics, lithium preparations can cause a variety of renal side effects, most of which occur insidiously. The paper reports a 46-year-old female patient developing fatigue and soft paresis after taking lithium carbonate for 17 years. Laboratory tests showed hypokalemia, distal renal tubular acidosis (dRTA), and renal calculus. After discontinuation of lithium carbonate, partial remission of hypokalemia and dRTA were observed. Combined with literature review, in addition to dRTA, the renal side effects of lithium preparations also include acute toxic kidney injury, nephrogenic diabetes insipidus and various glomerulopathy.

With global climate change, the frequency and intensity of extreme weather events have increased, and the possibility of multiple extreme weather events occurring simultaneously or continuously forming compound extreme events has also significantly increased, bringing catastrophic damage to the ecological environment, socio-economic and human health. This study reviewed the changing trends and health risks of consecutive compound heavy precipitation and heatwave extremes. There is currently no unified definition for these types of events, which could be divided into two subcategories: heavy precipitation-heatwave and heatwave-heavy precipitation. Their historical frequency and intensity have increased, and future estimates are also on the rise. The majority of current studies on single extreme events such as heatwaves or heavy precipitation revealed significant adverse health effects. However, few studies focused on the association between compound events of heavy precipitation and heatwave and human health risk. This paper further summarized the current shortcomings in this field and proposed suggestions for future research directions.

Objective:To explore the application of anterior esophageal wall full layer fixation and gastric tube guidance in total laparoscopic overlap method for intracorporeal esophagojejunostomy.Methods:Overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance is suitable for patients with advanced gastric cancer (clinical stage: cT1b~4aN0~3M0) and esophageal invasion <3 cm, who underwent radical total gastrectomy+ overlap esophagojejunostomy. The main operation procedure was performed as follows: A titanium clip was used for fixation of the full anterior wall of esophagus before overlap esophagojejunostomy, and the side‐to‐side esophagojejunostomy was performed with the linear stapler under the guidance of gastric tube. Then the titanium clip was removed after confirming that the correct cavity was entered. Finally, the common outlet was closed by two barbed sutures. A descriptive case series study was conducted. The clinical data of patients who underwent laparoscopic radical gastrectomy and overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance in Guangdong Provincial Hospital of Chinese medicine and the First Affiliated Hospital of Guangzhou University of Chinese medicine from May 2021 to June 2023 were retrospectively analyzed.Results:A total of 42 patients were collected, and all of them were successfully completed laparoscopic total radical gastrectomy without conversion to laparotomy or perioperative death. The esophagojejunostomy time, operative time, intraoperative blood loss was 17(5‐25) minutes, (258.8±38.0) minutes and 50(20‐200) ml, respectively. The incidence of esophageal false lumen was 0%, and there were no intraoperative complications. The time of gastric tube removal, initial fluid diet intake and the duration of postoperative hospital were 2(1‐5) , 4(1‐8) and 8(4‐21) days, respectively. There were no postoperative anastomotic hemorrhage, anastomotic stenosis and other related complications. One patient (2.38%) developed a Clavien‐Dindo IIIb complication, which was abdominal hemorrhage after operation. The second surgical exploration confirmed that the patient was bleeding due to gastroduodenal artery rupture. After intraoperative suture hemostasis, fluid expansion, blood transfusion and other treatments, the patient was discharged on the 15th day after the operation. Three patients (7.14%) developed Clavien‐Dindo grade II complications, including anastomotic leakage, chylous leakage and pulmonary infection, and were discharged after conservative treatment such as anti‐infection and prolonged retention of drainage tube.Conclusions:Laparoscopic overlap method for intracorporeal esophagojejunostomy with anterior esophageal wall fixation and gastric tube guidance can shorten the time of esophagojejunostomy and prevent the occurrence of false lumen, and do not increase anastomose‐related complications.

Robotic surgery is applied in gastrointestinal surgery for their flexible and safe operation, especially in the narrow space of the pelvic cavity for radical surgery of rectal cancer, which has obvious advantages. Natural orifice specimen extraction surgery (NOSES) is a hot surgical technique that has developed rapidly in gastrointestinal surgery in recent years. The integration of robotic surgery and NOSES surgery has pushed minimally invasive surgery for rectal cancer to a new level. Robotic NOSES surgery for rectal cancer can be divided into two types based on the different extraction methods: transrectal and transvaginal specimen extraction. The selection and flexibility of surgical procedures are the keys to the standardized, healthy, and orderly development of robotic NOSES for rectal cancer. Based on domestic and foreign literature and guidelines and combined with the team′s practical experience, the authors elaborate on the selection strategy of robotic NOSES for rectal cancer, in order to provide reference for more scientific and safe implementation of robotic NOSES for rectal cancer.

Objective:To explore the application of anterior esophageal wall full layer fixation and gastric tube guidance in total laparoscopic overlap method for intracorporeal esophagojejunostomy.Methods:Overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance is suitable for patients with advanced gastric cancer (clinical stage: cT1b~4aN0~3M0) and esophageal invasion <3 cm, who underwent radical total gastrectomy+ overlap esophagojejunostomy. The main operation procedure was performed as follows: A titanium clip was used for fixation of the full anterior wall of esophagus before overlap esophagojejunostomy, and the side‐to‐side esophagojejunostomy was performed with the linear stapler under the guidance of gastric tube. Then the titanium clip was removed after confirming that the correct cavity was entered. Finally, the common outlet was closed by two barbed sutures. A descriptive case series study was conducted. The clinical data of patients who underwent laparoscopic radical gastrectomy and overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance in Guangdong Provincial Hospital of Chinese medicine and the First Affiliated Hospital of Guangzhou University of Chinese medicine from May 2021 to June 2023 were retrospectively analyzed.Results:A total of 42 patients were collected, and all of them were successfully completed laparoscopic total radical gastrectomy without conversion to laparotomy or perioperative death. The esophagojejunostomy time, operative time, intraoperative blood loss was 17(5‐25) minutes, (258.8±38.0) minutes and 50(20‐200) ml, respectively. The incidence of esophageal false lumen was 0%, and there were no intraoperative complications. The time of gastric tube removal, initial fluid diet intake and the duration of postoperative hospital were 2(1‐5) , 4(1‐8) and 8(4‐21) days, respectively. There were no postoperative anastomotic hemorrhage, anastomotic stenosis and other related complications. One patient (2.38%) developed a Clavien‐Dindo IIIb complication, which was abdominal hemorrhage after operation. The second surgical exploration confirmed that the patient was bleeding due to gastroduodenal artery rupture. After intraoperative suture hemostasis, fluid expansion, blood transfusion and other treatments, the patient was discharged on the 15th day after the operation. Three patients (7.14%) developed Clavien‐Dindo grade II complications, including anastomotic leakage, chylous leakage and pulmonary infection, and were discharged after conservative treatment such as anti‐infection and prolonged retention of drainage tube.Conclusions:Laparoscopic overlap method for intracorporeal esophagojejunostomy with anterior esophageal wall fixation and gastric tube guidance can shorten the time of esophagojejunostomy and prevent the occurrence of false lumen, and do not increase anastomose‐related complications.

Objective:To observe the effects of three different blood purification modes on nutritional status and insulin resistance in patients with end-stage diabetes nephropathy (DN).Methods:From January 2019 to January 2022, 150 patients with end-stage DN admitted to the First Affiliated Hospital of Xinjiang Medical University were retrospectively selected. All patients were divided into three groups according the treatment methods, the group A was treated with high-throughput hemodialysis, the group B was treated with sequential hemodialysis, the group C was treated with hemodialysis combined with hemoperfusion, with 50 patients in each group. After 3 months of treatment with different blood purification modes, the nutritional status, insulin resistance, inflammatory factors and adverse reactions of the patients in the three groups were evaluated.Results:After treatment, the levels of serum prealbumin (PA) and albumin (ALB) in the group C were higher than those in the group A and group B: (328.19 ± 34.82) mg/L vs. (241.87 ± 23.75), (246.35 ± 24.06) mg/L; (36.82 ± 9.51) g/L vs. (30.07 ± 8.73), (29.54 ± 8.14) g/L, there were statistical differences ( P<0.05). After treatment, the levels of fasting insulin (FINS), fasting blood glucose (FBG) and homeostatic model assessment insulin resistance index (HOMA-IR) in the group C were lower than those in the group A and group B: (6.82 ± 1.46) mU/L vs. (8.79 ± 1.1), (8.34 ± 1.08) mU/L; (7.57 ± 1.13) mmol/L vs. (9.51 ± 1.25), (9.28 ± 1.21) mmol/L; 2.29 ± 0.75 vs. 4.11 ± 0.84, 3.81 ± 0.79, there were statistical differences ( P<0.05). After treatment, the levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) in the group C were lower than those in the group A and group B: (9.28 ± 2.96) μg/L vs. (16.34 ± 3.13), (17.52 ± 4.08) μg/L; (5.17 ± 1.1) mg/L vs. (7.81 ± 1.25), (7.36 ± 1.21)mg/L; (36.06 ± 4.7) ng/L vs. (42.07 ± 5.84), (43.23 ± 5.79) ng/L, there were statistical differences ( P<0.05). After treatment, the rate of adverse reactions in the group A, group B and group C was 20.00%(10/50), 16.00%(8/50), 4.00%(2/50), there was statistical difference ( χ2 = 6.31, P = 0.043). Conclusions:Compared with high-throughput hemodialysis and sequential hemodialysis, hemodialysis combined with hemoperfusion can effectively improve the nutritional status of patients, reduce their blood sugar level and insulin resistance, reduce their micro inflammatory state, and reduce adverse reactions.