“Grafting from”法制备高载量大孔弱阳离子交换层析介质

针对大孔聚合物层析介质孔径大、比表面积低而导致的蛋白结合容量低的问题,采用“graftingfrom”策略,以大孔聚丙烯酸酯微球为基质,通过氧化还原引发甲基丙烯酸在微球表面接枝聚合,制备了高载量弱阳离子交换层析介质.研究了单体浓度、过硫酸钾浓度及反应温度等因素对蛋白结合容量的影响.所得介质的蛋白静态结合容量和动态结合容量分别达到252.21和157.25mg/mL;同时发现具有一定离子交换容量的该类介质能够在0.2 mol/L NaCl缓冲液中保持100 mg/mL的蛋白结合容量.将该层析介质用于鸡卵清中溶菌酶的纯化,获得了较高的纯化效率.

Stage at diagnosis of colorectal cancer through diagnostic route:Who should be screened?

BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.

Efficient Route Planning for Real-Time Demand-Responsive Transit

Demand Responsive Transit (DRT) responds to the dynamic users’ requests without any fixed routes and timetablesand determines the stop and the start according to the demands. This study explores the optimization of dynamicvehicle scheduling and real-time route planning in urban public transportation systems, with a focus on busservices. It addresses the limitations of current shared mobility routing algorithms, which are primarily designedfor simpler, single origin/destination scenarios, and do not meet the complex demands of bus transit systems. Theresearch introduces an route planning algorithm designed to dynamically accommodate passenger travel needsand enable real-time route modifications. Unlike traditional methods, this algorithm leverages a queue-based,multi-objective heuristic A∗ approach, offering a solution to the inflexibility and limited coverage of suburbanbus routes. Also, this study conducts a comparative analysis of the proposed algorithm with solutions based onGenetic Algorithm (GA) and Ant Colony Optimization Algorithm (ACO), focusing on calculation time, routelength, passenger waiting time, boarding time, and detour rate. The findings demonstrate that the proposedalgorithmsignificantly enhances route planning speed, achieving an 80–100-fold increase in efficiency over existingmodels, thereby supporting the real-time demands of Demand-Responsive Transportation (DRT) systems. Thestudy concludes that this algorithm not only optimizes route planning in bus transit but also presents a scalablesolution for improving urban mobility.

Outcomes of surgical correction of Peyronie’s disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft

Objective:Peyronie’s disease(PD)is an abnormal wound healing in the penile tunica albuginea.After fibrotic plaque excision,different graft materials have been used to repair the defects,but the optimal graft remains unknown.This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD.Methods:A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021.The patients were divided into two groups depending on the type of graft used.For 15 patients in Group B,testicular tunica vaginalis grafts were used to repair the defect,while for 18 patients in Group A,bovine pericardium grafts were used.Data of the patient’s age,comorbidities,sexual function,penile curvature,postoperative complications,need for further treatment,change in penile length,and satisfaction were gathered and compared between the groups.Sexual function was evaluated using the 5-item version of the International Index of Erectile Function(IIEF-5),and a functional less than 20-degree penile curvature after surgery was considered a successful intervention.Results:There was no difference in age,comorbidities,degree of curvature,perioperative IIEF-5,operative time,plaque size,or complication rates.After surgery,a statistically significant improvement in curvature degree(p<0.05)and satisfactory penile appearance(p<0.05)were seen in both groups without any superiority between the two groups(p=0.423 and p=0.840,respectively).With a 30-month follow-up,the IIEF-5 was consistent in both groups,with no statistical significance between the groups(p=0.492).The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance(p=0.255 and p=0.101,respectively).Conclusion:Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.

Histological, physio-biochemical, and transcriptomic analyses reveal the potential limiting factors for successful grafting of pecan

Budding is an important grafting technique to asexually propagate pecan(Carya illinoinensis(Wangenh.)K.Koch).To determine factors that might hamper success-ful budding of the species,a representative easy-to-survive cultivar‘Pawnee’and a typical difficult-to-survive culti-var‘Jinhua’were used for comprehensive analysis.Mor-phological observation showed that cells surrounding the secretory cells or sieve tube had collapsed in‘Jinhua’but not in‘Pawnee’during grafting.‘Jinhua’might suffer more hypoxia stress than‘Pawnee’as‘Jinhua’had higher catalase,superoxide dismutase,polyphenol oxidase,pyruvate decar-boxylase(PDC),alcohol dehydrogenase(ADH)activities during grafting and contained greater levels of hydrogen per-oxide 12 days after grafting(DAG).Transcriptions of PDC and ADH were also up-regulated significantly in‘Jinhua’whereas they were not significantly affected in‘Pawnee’.Phenylalanine ammonia-lyase activities of‘Jinhua’were consistently lower than that of‘Pawnee’.Initial phenol con-tents were similar between the two cultivars.Graft-promot-ing substances,including soluble sugar,soluble protein,and gibberellin(GA)were incompletely recovered in‘Jinhua’12 DAG while fully restored in‘Pawnee’.Increased levels of trans-zeatin riboside in‘Jinhua’were much smaller than in‘Pawnee’3 DAG.The contents of indole-3-acetic acid were similar,and the dynamics of abscisic acid were the same between the two genotypes.Results suggest that hypoxia stress and shortages of sugar,protein,GA,and cytokinin during the healing process might be key factors limiting successful budding of pecan.The degree of scion-rootstock compatibility and the content of phenols might be excluded as constraints for successful budding.

CoopAI-Route: DRL Empowered Multi-Agent Cooperative System for Efficient QoS-Aware Routing for Network Slicing in Multi-Domain SDN

The emergence of beyond 5G networks has the potential for seamless and intelligent connectivity on a global scale.Network slicing is crucial in delivering services for different,demanding vertical applications in this context.Next-generation applications have time-sensitive requirements and depend on the most efficient routing path to ensure packets reach their intended destinations.However,the existing IP(Internet Protocol)over a multi-domain network faces challenges in enforcing network slicing due to minimal collaboration and information sharing among network operators.Conventional inter-domain routing methods,like Border Gateway Protocol(BGP),cannot make routing decisions based on performance,which frequently results in traffic flowing across congested paths that are never optimal.To address these issues,we propose CoopAI-Route,a multi-agent cooperative deep reinforcement learning(DRL)system utilizing hierarchical software-defined networks(SDN).This framework enforces network slicing in multi-domain networks and cooperative communication with various administrators to find performance-based routes in intra-and inter-domain.CoopAI-Route employs the Distributed Global Topology(DGT)algorithm to define inter-domain Quality of Service(QoS)paths.CoopAI-Route uses a DRL agent with a message-passing multi-agent Twin-Delayed Deep Deterministic Policy Gradient method to ensure optimal end-to-end routes adapted to the specific requirements of network slicing applications.Our evaluation demonstrates CoopAI-Route’s commendable performance in scalability,link failure handling,and adaptability to evolving topologies compared to state-of-the-art methods.

Frequency-tunable single-photon router based on a microresonator containing a driven three-level emitter

We propose a frequency-tunable router of single photons with high routing efficiency, which is constructed by two waveguides mediately linked by a single-mode whispering gallery resonator with a driven three-level emitter. Quantum routing probability in the output port is obtained via the real-space Hamiltonian. By adjusting the resonator–emitter coupling and the drive, the desired continuous central frequencies for the resonance peaks of routing photons can be manipulated nearly linearly, with the assistance of Rabi splitting effect and optical Stark shift. The proposed routing system may provide potential applications in designing other frequency-modulation quantum optical devices, such as multiplexers,filters, and so on.

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.

Superhydrophobic melamine sponge prepared by radiation-induced grafting technology for efficient oil-water separation

This paper presents a superhydrophobic melamine(ME)sponge(ME-g-PLMA)prepared via high-energy radiation-induced in situ covalent grafting of long-alkyl-chain dodecyl methacrylate(LMA)onto an ME sponge for efficient oil–water separation.The obtained ME-g-PLMA sponge had an excellent pore structure with superhydrophobic(water contact angle of 154°)and superoleophilic properties.It can absorb various types of oils up to 66–168 times its mass.The ME-g-PLMA sponge can continuously separate oil slicks in water by connecting a pump or separating oil underwater with a gravity-driven device.In addition,it maintained its highly hydrophobic properties even after long-term immersion in different corrosive solutions and repeated oil adsorption.The modified ME-g-PLMA sponge exhibited excellent separation properties and potential for oil spill cleanup.

The Impact of Sea Level Rise on Roadway Design and Evacuation Routes in Delaware

As the global temperature continues to increase, the sea level continues to rise at a rapid rate that has never been seen before. This becomes an issue for many facets of life but one of the most impacted is the transportation infrastructure. Many people living in low elevation coastal areas can become trapped by flooding with no way in or out. With Delaware being a coastal state, this would affect a large portion of the population and will have detrimental effects over time if nothing is done to combat sea level rise. The issue with sea level rise in transportation is that once the roads become flooded, they become virtually unusable and detour routes would be needed. If all the roads in a coastal area were to be affected by sea level rise, the options for detours would become limited. This article looks at direct solutions to combat sea level rise and indirect solutions that would specifically help transportation infrastructure and evacuation routes in Delaware. There is not one solution that can fix every problem, so many solutions are laid out to see what is applicable to each affected area. Some solutions include defense structures that would be put close to the coast, raising the elevation of vulnerable roads throughout the state and including pumping stations to drain the water on the surface of the road. With an understanding of all these solutions around the world, the ultimate conclusion came in the form of a six-step plan that Delaware should take in order to best design against sea level rise in these coastal areas.

Surgical Treatment of Osteonecrosis of the Femoral Head Using Minimally Invasive Surgical Drilling and Cancellous Grafting at Brazzaville University Hospital

Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.

Clinical effect of botulinum toxin type A combined with autologous fat grafting in patients with nasolabial fold depression

BACKGROUND Nasolabial fold(NLF)depression can affect the facial appearance of patients to some extent and increase their psychological burdens.In recent years,autologous fat grafting(AFG)combined with botulinum toxin A(BTX-A)injection(AFG+BTX-A injection)has been gradually applied in the treatment of patients with NLF depression.Although studies have been conducted on the efficacy and safety of AFG+BTX-A injection in treating NLF depression,the experimental design,observational indicators,and sample enrollment criteria vary remarkably,making it difficult to draw convincing and consistent conclusions.Thus,further relevant research is warranted.AIM To assess the esthetic improvement,efficacy,and safety of AFG+BTX-A injections in patients with NLF depression.METHODS This study included 60 patients with NLF depression who were treated in our hospital from February 2019 to April 2021.These patients were categorized into control(n=30)and observation(n=30)groups.The observation group received AFG+BTX-A injection,whereas the control group underwent AFG only.All patients were evaluated using the wrinkle severity rating scale(WSRS)and global aesthetic improvement scale.The compactness of facial contours,skin evaluation indexes,adverse reactions,and satisfaction of the two groups were evaluated 3 months postoperatively.RESULTS The WSRS scores of the observation group at 1,3,and 6 months postoperatively were lower than those of the control group(P<0.05).Three months postoperatively,facial fine lines and pores showed obvious improvement and the skin index score was higher in the observation group than in the control group(P<0.05).The compactness of facial contours was better in the observation group than in the control group(P<0.05).In addition,no remarkable differences were noted in the incidence of postoperative adverse reactions such as facial stiffness,facial asymmetry,facial bruising,and facial concavity inequality(P>0.05).CONCLUSION AFG+BTX-A injection is a highly safe,cost-effective,effective,and long-lasting treatment for NLF depression with high esthetic value,which should be promoted in the future.

Negative pressure device-assisted autologous fat grafting: A case report

This report describes a novel technique for improving depressed scars using negative pressure suction-assisted autologous fat grafting.A 35-year-old woman presented with a 20-year history of bilateral central buttock con-cavities,causing aesthetic concerns.To maximize fat graft survival and enhance tissue volume,we implemented intermittent negative pressure suction on the recipient area for one month preoperatively.The patient expressed satisfaction with the cosmetic outcome,and a three-month follow-up confirmed a significantly improved fat graft survival rate.This minimally invasive,cost-effective,and easily reproducible technique offers a promising clinical strategy for treating depressed scars.

Efficient and selective removal of Pb(Ⅱ) from landfill leachate using L-serine-modified polyethylene/polypropylene nonwoven fabric synthesized via radiation grafting technique

In this study,to efficiently remove Pb(Ⅱ) from aqueous environments,a novel L-serine-modified polyethylene/polypropylene nonwoven fabric sorbent(NWF-serine)was fabricated through the radiation grafting of glycidyl methacrylate and subsequent L-serine modification.The effect of the absorbed dose was investigated in the range of 5–50 kGy.NWF-serine was characterized by Fourier transform infrared spectroscopy,thermogravimetric analysis,and scanning electron microscopy.Batch adsorption tests were conducted to investigate the influences of pH,adsorption time,temperature,initial concentration,and sorbent dosage on the Pb(Ⅱ) adsorption performance of NWF-serine.The results indicated that Pb(Ⅱ) adsorption onto NWF-serine was an endothermic process,following the pseudo-second-order kinetic model and Langmuir isotherm model.The saturated adsorption capacity was 198.1 mg/g.NWF-serine exhibited Pb(Ⅱ) removal rates of 99.8% for aqueous solutions with initial concentrations of 100 mg/L and 82.1% for landfill leachate containing competitive metal ions such as Cd,Cu,Ni,Mn,and Zn.Furthermore,NWF-serine maintained 86% of its Pb(Ⅱ) uptake after five use cycles.The coordination of the carboxyl and amino groups with Pb(Ⅱ) was confirmed using X-ray photoelectron spectroscopy and extended X-ray absorption fine structure analysis.

Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh

Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk.

Improvement of ionic conductivity of solid polymer electrolyte based on Cu-Al bimetallic metal-organic framework fabricated through molecular grafting

A composite solid electrolyte comprising a Cu-Al bimetallic metal-organic framework(CAB),lithium salt(LiTFSI)and polyethylene oxide(PEO)was fabricated through molecular grafting to enhance the ionic conductivity of the PEO-based electrolytes.Experimental and molecular dynamics simulation results indicated that the electrolyte with 10 wt.%CAB(PL-CAB-10%)exhibits high ionic conductivity(8.42×10~(-4)S/cm at 60℃),high Li+transference number(0.46),wide electrochemical window(4.91 V),good thermal stability,and outstanding mechanical properties.Furthermore,PL-CAB-10%exhibits excellent cycle stability in both Li-Li symmetric battery and Li/PL-CAB-10%/LiFePO4 asymmetric battery setups.These enhanced performances are primarily attributable to the introduction of the versatile CAB.The abundant metal sites in CAB can react with TFSI~-and PEO through Lewis acid-base interactions,promoting LiTFSI dissociation and improving ionic conductivity.Additionally,regular pores in CAB provide uniformly distributed sites for cation plating during cycling.

Red Study Greenway Route Selection at County Scale: A Case Study of Ji’an County, Jiangxi Province, China

Using multi-source data like remote sensing images,resource point coordinates,road networks and land type,a suitability assessment system for red study greenway route selection is constructed with red study resource layer,traffic condition layer,ecological condition layer,and service radius layer as the selection elements.Analytic Hierarchy Process(AHP)and Delphi method aree used to determine the selection factors and weight allocation of each element,and the single factor evaluation and multi factor overlaying analysis are used to accurately identify suitable selection corridors.The potential position is determined based on the lowest cost path.Finally,the final red study greenway is obtained through manual optimization based on the current situation of the road network.The analysis results show that the areas with the highest suitability were those with the richest distribution of first,second,and third level red study resources.An effective connection of red resource points and various elements helps to enhance the competitiveness of red study tours in Ji’an County,providing a realistic path for selecting study greenways for cities rich in red resources.

The Influence of Price Discrimination from Airports on the Route Development Behavior of Airlines

Given the prominence and magnitude of airport incentive schemes,it is surprising that literature hitherto remains silent as to their effectiveness.In this paper,the relationship between airport incentive schemes and the route development behavior of airlines is analyzed.Because of rare and often controversial findings in the extant literature regarding relevant influencing variables for attracting airlines at an airport,expert interviews are used as a complement to formulate testable hypotheses in this regard.A fixed effects regression model is used to test the hypotheses with a dataset that covers all seat capacity offered at the 22 largest German commercial airports in the week 46 from 2004 to 2011.It is found that incentives from primary choice,as well as secondary choice airports,have a significant influence on Low Cost Carriers.Furthermore,Low Cost Carriers,in general,do not leave any of both types of airports when the incentives cease.In the case of Network Carriers,no case is found where one joins a primary choice airport and receives an incentive.Insufficient data between Network Carriers and secondary choice airports in the time when incentives have ceased means that no statement can be given.

Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients

BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.