Modified Fusicoccane-Type Diterpenoids from Alternaria brassicicola.

Seven new modified fusicoccane-type diterpenoids (1-7), together with two known congeners (8 and 9), were obtained from Alternaria brassicicola. Their structures were elucidated from a combination of NMR and HRESIMS data and 13C NMR calculation as well as DP4+ probability analyses, and the absolute configurations of 1-5 were determined by ECD calculation and single-crystal X-ray diffraction (Cu Kα). Compounds 1-3 belong to a rare class of 16-nor-dicyclopenta[a,d]cyclooctane diterpenoids, and compounds 2 and 4 represent the first examples of fusicoccane-type diterpenoids featuring two previously undescribed tetracyclic 5/6/6/5 ring systems, while compound 5 features a previously undescribed tetracyclic 5/8/5/3 ring system. Compound 7 was moderately anti-inflammatory, and compounds 2, 3, 5, and 7 were weakly cytotoxic.

Fusicoccane-derived diterpenoids with bridgehead double-bond-containing tricyclo[9.2.1.03,7]tetradecane ring systems from Alternaria brassicicola.

Fusicoccane-derived diterpenoids bearing a unique bridgehead double-bond-containing tricyclo[9.2.1.03,7]tetradecane (5-9-5 ring system) core skeleton represent a rarely reported class of rearranged terpenoids, which traced back to fusicoccanes with a classical dicyclopenta[a,d]cyclooctane (5-8-5 ring system) core skeleton via a crucial Wagner-Meerwein rearrangement reaction. In this research, alterbrassicenes B-D (1-3), three new rearranged fusicoccane diterpenoids bearing a rare bridgehead double-bond-containing tricyclo[9.2.1.03,7]tetradecane core skeleton, together with two known congeners, brassicicenes O and K (4 and 5), were isolated from the modified cultures of fungus Alternaria brassicicola. Their structures were elucidated by comprehensive analyses of the NMR and HRESIMS data, and the absolute configurations of 1 and 4 were further confirmed via a combination of 13C NMR and ECD calculations and single-crystal X-ray diffraction analysis (Cu Kα). Interestingly, alterbrassicene B (1) represented the second case of bridgehead C-10-C-11 double-bond-containing natural products with a bicyclo[6.2.1]undecane core skeleton, and also featured an undescribed oxygen bridge between C-6 and C-14 to construct an unprecedentedly caged tetracyclic system. Alterbrassicenes B-D showed moderate cytotoxic activity against certain human tumor cell lines with IC50 values in the range of 15.87-36.85 µM.

Risk factor analysis and management strategies of operating room-related infections after coronary artery bypass grafting.

BACKGROUND: To investigate and analyze the risk factors of operating room-related infections after coronary artery bypass grafting (CABG), to propose corresponding infection control management strategies, and to verify and evaluate the effectiveness of the strategy implementation. METHODS: Patients with coronary heart disease who underwent CABG in a hospital from January 2015 to December 2016 were selected for inclusion in this study. The following patient variables were documented: demographics, history of underlying diseases (hypertension and diabetes), preoperative American Society of Anesthesiologists (ASA) score, skin preparation method, perioperative use of antibiotics, operation duration, intraoperative hypothermia, intraoperative blood loss, intraoperative blood transfusion, presence of visitors in the operating room, consecutive use of the same operating room, qualification of the surgeon, and surgical site infection. The infection diagnosis was confirmed using the Diagnostic Criteria for Nosocomial Infections (Trial) issued by the Ministry of Health in 2001. Univariate chi-square tests and multivariate logistic regression analysis were used to analyze the risk factors for infection in patients undergoing CABG, and infection control management strategies were proposed. The proposed infection control strategies were applied to patients who underwent CABG in the hospital in 2017. The effectiveness of the strategy implementation was evaluated. RESULTS: We analyzed in 139 patients (417 coronary artery bypass grafts from January 2015 to December 2016) and identified 4 surgical site infections. The incidence of infection was 2.88%. According to the univariate analysis, the following factors were related to the high incidence of surgical site infections: advanced age, history of underlying diseases (hypertension and diabetes), obesity, ASA score (class II or above), conventional skin preparation method, irrational perioperative antibiotic use, operation duration >4 hours, presence of visitors in the operating room, and consecutive use of the same operating room (P<0.05 for all variables). Multivariate logistic regression analysis showed that advanced age, history of underlying diseases (hypertension and diabetes), irrational perioperative antibiotic use, operation duration >4 hours, and presence of visitors in the operating room were high risk factors for surgical site infection after CABG. From January 2017 to December 2017, after applying the proposed infection control measures to patients undergoing CABG, the surgical site infection rate was 1.13% (3/266), which was significantly different from that of the previous period (P<0.05). CONCLUSIONS: The following are high risk factors for surgical site infection after CABG: advanced age, history of underlying diseases (hypertension and diabetes), irrational antibiotic use during the perioperative period, operation duration >4 hours, and presence of visitors in the operating room. Medical providers should fully understand these risk factors and optimize the adjustable factors during the perioperative period to minimize the incidence of infections after CABG.

Perioperative nursing for immediate breast reconstruction with deep inferior epigastric perforator flap after breast cancer resection.

BACKGROUND: To investigate the value of the nursing cooperation workflow for immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap after breast cancer resection. METHODS: The clinical data of 29 patients who had undergone immediate breast reconstruction with DIEP flap after breast cancer resection in our center from January 2016 to December 2017 were retrospectively analyzed. In particular, the nursing cooperation workflow was reviewed. RESULTS: All the 29 patients were emotionally stable before surgery and were able to cooperate well with the surgery. The surgery was smooth. In 27 patients, the flaps survived after surgery and primary healing was achieved at the wounds. The remaining two cases presented with venous vascular crisis within 24 h after the surgery, and the flaps survived after active rescue. The patients were followed up for 4 months to 3 years. Neither complication such as local tumor recurrence, incision infection, flap necrosis, or upper limb lymphedema in the surgical area nor complication such as abdominal wall bulging, abdominal wall hernia, or fat liquefaction of incision in the donor area was reported. The shape of the reconstructed breasts was natural and satisfactory. CONCLUSIONS: Immediate breast reconstruction with DIEP flap after breast cancer resection involves two disciplines: tumor resection and plastic repair. It is time-consuming and difficult to perform. Before the surgery, nurses in the operating room should carefully assess the patient's disease condition, communicate well with the operator, fully understand and be familiar with the surgical procedure and its special requirements, and formulate the surgical cooperation plan. During the surgery, the nurses should strictly implement cancer-free technique and be ready to assist for every next step, so as to effectively shorten the operative time, prevent local tumor recurrence, and thus pave the way for a successful surgery.