Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol

BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after surgery(ERAS)protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications.AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022.Among them,99 patients were managed using the traditional perioperative care approach(non-ERAS protocol),while the remaining 99 patients were managed using the ERAS protocol.Relevant indicator data were collected for patients preoperatively,intraoperatively,and postoperatively,and surgical outcomes were compared between the two groups.RESULTS The comparison results between the two groups of patients in terms of age,sex,BMI,underlying diseases,surgical type,and preoperative hospital stay showed no statistically significant differences.However,the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group(4.0±0.9 h vs 7.6±0.9 h).Regarding intraoperative indicators,there were no significant differences between the two groups of patients.However,in terms of postoperative recovery,the ERAS protocol group exhibited significant advantages over the non-ERAS group,including a shorter hospital stay,lower postoperative pain scores and postoperative hunger scores,and higher satisfaction levels.The readmission rate was lower in the ERAS protocol group than in the non-ERAS group(3.0%vs 8.1%),although the difference was not significant.Furthermore,there were significant differences between the two groups in terms of postoperative nausea and vomiting severity,postoperative abdominal distention at 24 h,and daily life ability scores.CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy,including reduced readmission rates,decreased postoperative nausea and vomiting,alleviated abdominal distension,and enhanced functional capacity.While the protocol may not exhibit significant improvement in early postoperative symptoms,it does exhibit advantages in long-term postoperative symptoms and recovery.These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients,as it contributes to improving patients'recovery and quality of life while reducing health care resource utilization.

Whole-process case management effects on mental state and selfcare ability in patients with liver cancer

BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical cancer.In a previous study,the whole-process management model was applied to patients with breast cancer,which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction.METHODS In this single-center,randomized,controlled study,60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group(n=30),who received whole-process case management on the basis of routine nursing mea-sures,and a control group(n=30),who were given routine nursing measures.We compared differences between the two groups in terms of anxiety,depression,the level of hope,self-care ability,symptom distress,sleep quality,and quality of life.RESULTS Post-intervention,Hamilton anxiety scale,Hamilton depression scale,memory symptom assessment scale,and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention,and the observation group had lower scores than the control group(P<0.05).Herth hope index,self-care ability assessment scale-revision in Chinese,and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention,with higher scores in the observation group compared with the control group(P<0.05).CONCLUSION Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer,alleviate symptoms and problems,and improve the level of hope,self-care ability,sleep quality,and quality of life,as well as provide feasible nursing alternatives for patients with liver cancer.

Broader Horizons for People with Disabilities

Providing better-quality,more comprehensive education,and employment opportunities for people with disabilities serves their interests and also those of communities,the nation,and humanity as a whole.

Mussel-inspired Methacrylic Gelatin-dopamine/Ag Nanoparticles/Graphene Oxide Hydrogels with Improved Adhesive and Antibacterial Properties for Applications as Wound Dressings

A novel strategy was developed to prepare the methacrylic gelatin-dopamine(GelMA-DA)/Ag nanoparticles(NPs)/graphene oxide(GO) composite hydrogels with good biocompatibility,mechanical properties,and antibacterial activity.Mussel-inspired DA was utilized to modify the GelMA molecules,which imparts good adhesive performance to the hydrogels.GO,interfacial enhancer,not only improves mechanical properties of the hydrogels,but also provides anchor sites for loading Ag NPs through numerous oxygencontaining functional groups on the surface.The experimental results show that the GelMA/Ag NPs/GO hydrogels have good biocompatibility,and exhibit a swelling rate of 202±16%,the lap shear strength of 147±17 kPa,and compressive modulus of 136±53 kPa,in the case of the Ag NPs/GO content of 2 mg/mL.Antibacterial activity of the hydrogels against both gram-negative and gram-positive bacteria is dependent on the Ag NPs/GO content derived from the release of Ag^(+).Furthermore,the GelMA/Ag NPs/GO hydrogels possess good adhesive ability,which is resistant to highly twisted state when stuck on the surface of pigskin.These results demonstrate promising potential of the GelMA-DA/Ag NPs/GO hydrogels as wound dressings for biomedical applications in clinical and emergent treatment.

Improvement of learning and memory abilities and motor function in rats with cerebral infarction by intracerebral transplantation of neuron-like cells derived from bone marrow stromal cells

BACKGROUND： Transplantation of fetal cell suspension or blocks of fetal tissue can ameliorate the nerve function after the injury or disease in the central nervous system, and it has been used to treat neurodegenerative disorders induced by Parkinson disease. OBJECTIVE： To observe the effects of the transplantation of neuron-like cells derived from bone marrow stromal cells （rMSCs） into the brain in restoring the dysfunctions of muscle strength and balance as well as learning and memory in rat models of cerebral infarction. DESIGN ： A randomized controlled experiment.SETTING ： Department of Pathophysiology, Zhongshan Medical College of Sun Yat-sen University.MATERIALS ： Twenty-four male SD rats （3-4 weeks of age, weighing 200-220 g） were used in this study （Certification number：2001A027）. METHODS： The experiments were carried out in Zhongshan Medical College of Sun Yat-sen University between December 2003 and December 2004. ① Twenty-four male SD rats randomized into three groups with 8 rats in each： experimental group, control group and sham-operated group. Rats in the experiment al group and control group were induced into models of middle cerebral artery occlusion （MCAO）. After in vitro cultured, purified and identified with digestion, the Fischer344 rMSCs were induced to differentiate by tanshinone IIA, which was locally injected into the striate cortex （18 area） of rats in the experimental group, and the rats in the control group were injected by L-DMEM basic culture media （without serum） of the same volume to the corresponding brain area. In the sham-operated group, only muscle and vessel of neck were separated. ② At 2 and 8 weeks after the transplantation, the rats were given the screen test, prehensile-traction test, balance beam test and Morris water-maze test. ③ The survival and distribution of the induced cells in corresponding brain area were observed with Nissl stained with toluidine blue and hematoxylin and eosin （HE） staining in the groups.MAIN OUTCOME MEASURES ： ① Results of the behavioral tests （time of the Morris water-maze test screen test, prehensile-traction test, balance beam test）; ② Survival and distribution of the induced cells.RESULTS： All the 24 rats were involved in the analysis of results. ① Two weeks after transplantation, rats with neuron-like cells grafts in the experimental group had significant improvement on their general muscle strength than those in the control group [screen test： （9.4±1.7）, （4.7±1.0） s, P 〈 0.01]; forelimb muscle strength [prehensile-traction test： （7.6±1.4）, （5.2±1.2） s, P 〈 0.01], ability to keep balance [balance beam test： （7.9±0.74）, （6.1±0.91） s, P 〈 0.01] and abilities of learning and memory [latency to find the platform： （35.8±5.9）, （117.5±11.6） s, P 〈 0.01; distance： （623.1±43.4）, （1 902.3±98.6） cm, P 〈 0.01] as compared with those in the control group. The functional performances in the experimental group at 8 weeks were better than those at two weeks, which were still obviously different from those in the sham-operated group （P 〈 0.05）. ② The HE and Nissl stained brain tissue section showed that there was nerve cell proliferation at the infarcted cortex in the experiment group, the density was higher than that in the control group, plenty of aggregative or scattered cells could be observed at the site where needle was inserted for transplantation, the cells migrated directively towards the area around them, the cerebral vascular walls were wrapped by plenty of cells; In the control group, most of the cortices were destroyed, karyopyknosis and necrosis of neurons were observed, normal nervous tissue structure disappeared induced by edema, only some nerve fibers and glial cells remained.CONCLUSION： The rMSCs transplantation can obviously enhance the motor function and the abilities of learning and memory in rat models of cerebral infarction.

Patterns and drivers of avian taxonomic and phylogenetic beta diversity in China vary across geographical backgrounds and dispersal abilities

Geographical background and dispersal ability may strongly influence assemblage dissimilarity;however,these aspects have generally been overlooked in previous large-scale beta diversity studies.Here,we examined whether the patterns and drivers of taxonomic beta diversity(TBD)and phylogenetic beta diversity(PBD)of breeding birds in China vary across(1)regions on both sides of the Hu Line,which demarcates China’s topographical,climatic,economic,and social patterns,and(2)species with different dispersal ability.TBD and PBD were calculated and partitioned into turnover and nestedness components using a moving window approach.Variables representing climate,habitat heterogeneity,and habitat quality were employed to evaluate the effects of environmental filtering.Spatial distance was considered to assess the impact of dispersal limitation.Variance partitioning analysis was applied to assess the relative roles of these variables.In general,the values of TBD and PBD were high in mountainous areas and were largely determined by environmental filtering.However,different dominant environmental filters on either side of the Hu Line led to divergent beta diversity patterns.Specifically,climate-driven species turnover and habitat heterogeneity-related species nestedness dominated the regions east and west of the line,respectively.Additionally,bird species with stronger dispersal ability were more susceptible to environmental filtering,resulting in more homogeneous assemblages.Our results indicated that regions with distinctive geographical backgrounds may present different ecological factors that lead to divergent assemblage dissimilarity patterns,and dispersal ability determines the response of assemblages to these ecological factors.Identifying a single universal explanation for the observed pattern without considering these aspects may lead to simplistic or incomplete conclusions.Consequently,a comprehensive understanding of large-scale beta diversity patterns and effective planning of conservation strategies necessitate the consideration of both geographical background and species dispersal ability.

Research on the Effect of Dance Therapy on Improving Social Communication Ability of Children with Autism

Research motivation:Through the 12 weeks dance therapy intervention for children with autism,the purpose is to explore the intervention model of dance therapy for children with autism and the changes in motor ability,social ability,and communication ability of children with autism after dance therapy intervention.The results of the research are expected to expand the intervention mode of dance therapy in my country and provide practical reference for rehabilitation intervention of children with autism.Research methods:24 autistic boys aged 6 to 12 with mild to moderate symptoms were recruited and screened through the Internet as the subjects of this study.We randomly divided them into experimental group(N=12)and control group(N=12).All children with autism have an autism diagnosis certificate issued by Children’s Hospital or a tertiary hospital,excluding other mental diseases(such as epilepsy,major physical disability,mental illness,no history of drugs and other interventions,etc.).We used the paired sample t-test to compare the score difference between the dance treatment group and the control group before and after the two groups,and used the observation method to record the basic communication behavior and the number of active communication behaviors in the experimental group during the intervention process.All data analysis is used in SPSS 20.0.Research results:After 12 weeks of dance therapy intervention,there were statistically significant differences in the gross movement,balance,and coordination abilities of the children in the experimental group compared with those before the intervention(p<0.01).There was no significant difference between the children in the control group(p>0.05).After 12 weeks of dance therapy intervention,there were statistically significant differences in the scores of the social response scale for children with autism in the experimental group(p<0.05).There was no significant change in the scores of each item of the SRS scale before and after intervention in the control group and the dance treatment group(p>0.05).

Damage Diagnosis of Bleacher Based on an Enhanced Convolutional Neural Network with Training Interference

Bleachers play a crucial role in practical engineering applications, and any damage incurred during their operationposes a significant threat to the safety of both life and property. Consequently, it becomes imperative to conductdamage diagnosis and health monitoring of bleachers. The intricate structure of bleachers, the varied types ofpotential damage, and the presence of similar vibration data in adjacent locations make it challenging to achievesatisfactory diagnosis accuracy through traditional time-frequency analysis methods. Furthermore, field environmentalnoise can adversely impact the accuracy of bleacher damage diagnosis. To enhance the accuracy and antinoisecapabilities of bleacher damage diagnosis, this paper proposes improvements to the existing ConvolutionalNeural Network with Training Interference (TICNN). The result is an advanced Convolutional Neural Networkmodel with superior accuracy and robust anti-noise capabilities, referred to as Enhanced TICNN (ETICNN).ETICNN autonomously extracts optimal damage-sensitive features from the original vibration data. To validatethe superiority of the proposed ETICNN, experiments are conducted using the bleacher model from Qatar Universityas the subject. Comparative studies under identical experimental conditions involve TICNN, Deep ConvolutionalNeural Networks with wide first-layer kernels (WDCNN), and One-Dimensional ConvolutionalNeural Network (1DCNN). The experimental findings demonstrate that the ETICNN model achieves the highestaccuracy, approximately 99%, and exhibits robust classification abilities in both Phases I and II of the damagediagnosis experiments. Simultaneously, the ETICNN model demonstrates strong anti-noise capabilities, outperformingTICNN by 3% to 4% and surpassing other models in performance.

Study on How to Improve Tourism English Major Students’English Communicative Ability in Higher Vocational College

Tourism English Major students’English communicative ability is very important for students’to promote professional skills.It is necessary for students to improve the commnunicative ability and It is one of the teachers’main tasks to cultivate students’communicative ability.

Integrated Practice of Cultivating Innovative Ability and Ideological Education for Graduate Students of Materials Science Major

Aiming at the problem of weak integration of innovation ability and ideological education of postgraduates in materials major,this paper explores postgraduates’cultivation work under the support of Liaocheng University.It is found that the cultivation of the innovation ability of postgraduates in materials can be the realization path and sublimation carrier of ideological education,ideological education can provide spiritual support and methodological guidance for the former,and the organic integration of the two is feasible.Constructing the fit relationship between innovation ability and ideological education,institutionalizing tutor guidance,establishing tutor+counselor+professional teacher communication mechanism,and taking disciplinary competitions as a handhold can achieve the integration of innovation ability cultivation and ideological education of graduate students in materials major.

Analysis of the Effect of Comfort Care in The Perioperative Care of Patients with Hysteromyomectomy and its Influence on Self-Care Ability

Objective:To analyze the effect of perioperative comfort care for patients with hysteromyomectomy(HYS).Methods:Seventy cases of HYS patients admitted to our hospital from October 2022 to October 2023 were randomly selected and divided into Group A(control group,35 cases,conventional care)and Group B(observation group 35 cases,comfort care).The effects of the two groups before and after nursing care were compared.Results:The self-rating anxiety(SAS)scores,exercise of self-care agency(ESCA)scores,and nursing satisfaction scores at the time of discharge of Group B were better than in Group A after nursing care(P<0.05).Conclusion:Perioperative comfort care for HYS patients improved the patient’s adverse emotions,self-care ability,and nursing satisfaction.

Strategies for Teaching the Reinforced Concrete Structures Course in Engineering Majors

The cultivation of engineering capabilities aims to equip engineering professionals with high-level expertise to meet the demands of society and industry development,thereby enhancing their competitiveness and career potential.This article focuses on engineering capability development,exploring teaching strategies for the Reinforced Concrete Structure course.It aims to provide insights for educators in engineering programs at universities and vocational colleges in China.By doing so,teaching plans that meet the needs of engineering capability development,laying a solid educational foundation for the healthy growth of engineering professionals in the new era,and enhancing their application of knowledge and skills can be developed.

The Effect of O2O Education Combined with Peer Education Management Model in Patients with Chronic Obstructive Pulmonary Disease

Objective:To explore the effect of online-to-offline(O2O)education combined with the peer education management model in patients with chronic obstructive pulmonary disease(COPD).Methods:Using convenience sampling,72 patients with COPD who were hospitalized in the respiratory medicine department of a tertiary-level hospital from March to December 2021 were selected as study subjects.Randomized grouping was carried out using the random number table method,the control group was given routine COPD health education in the department,and the intervention group applied O2O trinity health management combined with peer education on the basis of routine care.After 6 months of follow-up after discharge,the two groups were observed and compared for changes in pulmonary function,depression status,self-care ability,and quality of life.Results:At 3 and 6 months after the intervention,the lung function indexes and depression status of the two groups of patients improved significantly,and the improvement effect was more significant in the intervention group(P<0.05);after the intervention,the self-care ability scores of the patients in the intervention group were significantly higher than those of the control group(P<0.05);the quality-of-life scores of the two groups of patients decreased at 3 months after discharge,in which the quality-of-life scores in the intervention group was significantly lower than that of the control group(P<0.05).Conclusion:O2O education combined with the peer education management model can effectively improve the lung function of patients with COPD,depression,self-care ability,and quality of life.

Analysis of the Application Value of Virtual Reality Combined with Flipped Classroom Teaching Mode in Cardiopulmonary Resuscitation Teaching

Objective:To analyze the value of using virtual reality combined with the flipped classroom teaching model in teaching cardiopulmonary resuscitation(CPR).Methods:Two classes of our nursing program were randomly selected for the study from September 2022 to September 2023,Class A(52 students,conventional teaching method)and Class B(52 students,virtual reality combined with flipped classroom teaching mode).The assessment scores and independent learning ability scores of the students in the two classes were compared.Results:CPR theory and operation scores,passing rate,and independent learning ability scores of Class B were higher than those of Class A(P<0.05).Conclusion:the use of virtual reality combined with the flipped classroom teaching mode in CPR teaching is conducive to the improvement of students’assessment scores and independent learning ability.

Analysis of the Application Effect of Family Collaborative Care Model on Elderly Patients with Type 2 Diabetes Mellitus and the Situation of Self-Care Ability

Objective: To study the application effect of the family collaborative care model on elderly patients with type 2 diabetes mellitus and its influence on self-care ability. Methods: The elderly type 2 diabetes mellitus patients (400 cases) treated in our hospital between March 2020 and July 2023 were divided into two groups by randomized grouping method;the control group received the conventional nursing program, while the observation group received the family collaborative nursing model. Blood glucose level, self-care ability, and quality of life were compared between the groups. Results: The blood glucose level of the observation group was lower than that of the control group (P < 0.05). The self- care ability and quality of life scores of the observation group were higher than those of the control group (P < 0.05). Conclusion: The family collaborative care model for elderly patients with type 2 diabetes mellitus can promote their self- care ability, improve the effect of glycemic control, and improve their quality of life, and is suitable for further promotion and application.

WaveOneGold和ProTaperNext在预备C形根管成形能力和清理能力中的应用效果比较

目的:比较WaveOneGold和ProTaperNext在预备弯曲根管成形能力和清理能力中的应用效果。方法:选取2022年1月-2022年6月新疆维吾尔自治区中医医院收治的接受根管治疗术的180例下颌第二磨牙C形根管患者为研究对象,采用随机数字表法将患者分为WG组(90例,接受WaveOneGold根管预备)与PN组(90例,接受ProTaperNext根管预备);比较两组根管预备时间、成形能力、疼痛情况、清理能力以及根管充填质量。结果:PN组预备时间显著大于WG组(P<0.05);PN组患者根尖部以及根管中部未预备面积明显小于WG组(P<0.05);PN组在距根尖1.5 mm、5.5 mm处根管偏移值明显小于WG组(P<0.05);PN组在距根尖1.5 mm、4.5 mm处中心定位力优于WG组(P<0.05);两组患者术后7 d内约诊间疼痛发生情况、预备后根管壁碎屑评分、根管壁玷污层评分比较差异无统计学意义(P>0.05);根管充填1年后,两组根管填充情况比较差异无统计学意义(P>0.05)。结论:ProTaperNext在预备弯曲根管时相较于WaveOneGold在疼痛情况、清理能力以及充填质量方面无明显差异,WaveOneGold预备时间更短,但ProTaperNext预备具有更好的成形能力。

A Study on English Majors' Abilities to Transmit Chinese Culture in English at Newly Upgraded Universities

The transmitting of Chinese culture in the intercultural communication is of great importance for English learners in China.English majors at newly upgraded universities are weak in their abilities to express Chinese culture in English and transmit Chinese culture.To find measures for the problems,some necessary changes in the syllabus,textbooks,testing and curriculum are suggested,compiling of a dictionary for the standard of Chinese culture items in English is discussed,and the roles of teachers,students and English Corner in the cultivation of the abilities of English majors' to express Chinese culture in English at newly upgraded universities are analyzed.

Selection of female parents with high fertility and high combining abilities for cross-breeding Populus tomentosa

To select maternal parents with high fertility and high combining ability during cross breeding of Populus tomentosa Carr., the ploidy level of 75 female clones was determined using flow cytometry. In addition, genetic variations and phenotypic correlations of seed traits and early growth traits, as well as the general combining ability(GCA) for seedling height(SH) and basal diameter(BD) of all diploid half-sib families were examined. A total of 26 natural triploid clones were identified. For all diploid families, family effects were significant for inflorescence length(IL), thousand kernel weight(TKW), seedling emergence rate(SER), and for SH and BD. There was a positive correlation between TKW and other traits,excluding IL. The seed-bearing coefficient(NS 9 SER)ranged from zero to 32.4%. Clones 3-10-2, 2-8, 3119,3206, and 3-10-1 had the best performance of the GCA for SH and BD. Based on the fertility and GCA for SH and BD, clone 3-10-2 and clone 3119 could be used as female parents for controlled cross-breeding of P. tomentosa.

Ginkgo biloba leaf extract improves the cognitive abilities of rats with D-galactose induced dementia

Standardized Ginkgo biloba leaf extract has been used in clinical trials for its beneficial effects on brain func- tions, particularly in dementia. Substantial experimental evidences indicated that Ginkgo biloba leaf extract （EGB） protected neuronal cells from a variety of insults. We investigated the effect of EGB on cognitive ability and protein kinase B （PKB） activity in hippocampal neuronal cells of dementia model rats. Rats received an intra- peritoneal injection of D-galactose to induce dementia. Forty-eight Spraque-Dawley rats were randomly divided into six groups, including the control group, D-galactose group （Gal）, low-dose EGB group （EGB-L）, mid-dose EGB group （EGB-M）, high-dose EGB group （EGB-H） and treatment group. The EGB-L, EGB-M and EGB-H groups were administered with EGB and D-galactose simultaneously. Y-maze, cresyl violet staining, TUNEL assays and immunohistochemistry staining were performed to detect learning and memory abilities, morpho- logical changes in the hippocampus, neuronal apoptosis and the expressing level of phospho-PKB, respectively. Rats in the Gal group showed decreased abilities of learning and memory, and hippocampal pyramidal cell layer was damaged, while EGB administration improved learning and memory abilities. The Gal group exhibited many stained, condensed nuclei and micronuclei, either isolated or within the cytoplasm of cells （39.5 ± 1.4）. Apoptotic cells decreased in the groups of EGB-L （35.9±0.9）, EGB-M （16.8± 1.0） and EGB-H （10.1±0.8）, and there were statistical significances compared with the Gal group. Immunoreactivity of phospho-PKB was localized diffusely throughout the cytosol of cells in all groups, while the immunoreactivity of the Gal group was weak. EGB signifi- cantly attenuated learning and memory impairment in a dose-dependent manner, while it could decrease the nmber of TUNEL-positive cells, and increase the activity of PKB. Our results demonstrated that EGB attenuated memory impairment and cell apoptosis in galactose-induced dementia model rats by activating PKB.

Microwave-assisted ionothermal synthesis of hierarchical microcube-like BiOBr with enhanced photocatalytic activity

Bismuth oxybromide（BiOBr） with a hierarchical microcube morphology was successfully synthesized via microwave-assisted ionothermal self-assembly method. The as-obtained BiOBr was composed of regular multi-layered nanosheets, which were formed by selective adsorption of ionic liquids on the Br-terminated surface, followed by the formation of hydrogen bond-co-π-π stacking.The synthesized BiOBr exhibited high activity, excellent stability, and superior mineralization ability in the photocatalytic degradation of organic dyes under visible light owing to its enhanced light absorbance and narrow bandgap. Furthermore, photo-generated electrons were determined to be the main active species by comparison with different trapping agents used in the photocatalytic reactions.