Objective:To explore the application of flipped classroom teaching in the standardized residency training of students in department of hepatic surgery from the perspective of production-oriented approach (POA) theory.Methods:Based on the implementation time of flipped classroom teaching (January 2017) from the perspective of POA theory in West China Hospital, 51 nursing students who were routinely trained in department of hepatic surgery before the implementation (January 2015 to January 2017) were included in the control group. After the implementation (January 2017 to January 2019), 51 nursing students under the residency training were included in the observation group. The changes of test scores, independent learning ability and professional awareness of the two groups of nursing students before and 6 months after the training were compared, and the teaching satisfaction after the training was recorded. SPSS 19.0 was performed for t test and chi-square test. Results:The total scores of the theoretical examination scores of the two groups of nursing students, the total scores of the clinical practice assessment scores, and the self-learning ability assessment scale for nursing college students (learning motivation, self-management ability, learning cooperation ability, information literacy) scores and total scores in each dimension were significantly higher than those before training, and the observation group was significantly higher than the control group ( P<0.05); the two groups of professional maturity scales (career goals, professional self-confidence, professional autonomy, professional value, dependence on relatives and friends, occupation reference) scores of all dimensions were significantly improved compared with those before the training, and the scores of the observation group (career goals, professional self-confidence, professional autonomy, professional value) were significantly higher than those of the control group during the same period ( P<0.05). There was no statistical significance in the comparison between the two groups' dependence on relatives and friends and occupational reference scores ( P>0.05); the teaching satisfaction rate of nursing students in the observation group was 96.08%, which was significantly higher than that of the control group (82.35%). Conclusion:The application of flipped classroom teaching from the perspective of POA theory in the standardized residency training of department of hepatic surgery can significantly improve the autonomous learning ability of nursing students, which is conducive to the improvement of test scores and professional awareness, with high teaching satisfaction.

Objective:To explore the popularization and practice ofearly mobility idea in Intensive Care Units (ICUs) in Sichuan Province.Methods:Based on literature review, we designed the Early Mobility Implementation Questionnaires for ICU patients by ourselves. We selected ICUs at 103 ClassⅡ Grade A and above hospitals in 18 cities, Sichuan Province, to carry out the survey.Results:There were statistical differences in different levels hospitals whether it was from an affiliated hospital of a university, with different numbers of beds and bed utilization rates ( P<0.05) . Among 70 ICUs that developed the early mobility, there were statistical differences in early mobility implementation of patients in the ICU whether to form a special team, whether to conduct a written evaluation for patients, whether to sign the early mobility informed consent and whether there was an emergency plan ( P<0.05) . Between ICUs with early mobility of ICU patients and standard plan, and ICUs without early mobility, single factor Logistic regression analysis showed that the influencing factors of early mobility implementation of ICU patients included the numbers of beds, nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists, implementing the daily interruption as well as sedation score with statistical differences ( P<0.05) ; between ICUs with early mobility of ICU patients and without standard plan, and ICUs without early mobility, the influencing factors of early mobility implementation of ICU patients included the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists and implementing the daily interruption with statistical differences ( P<0.05) . Multivariate Logistic regression analysis indicated that the influencing factors of early mobility implementation with standard plan were the nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists with statistical differences ( P<0.05) ; the influencing factors of early mobility implementation without standard plan were the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists with statistical differences ( P<0.05) . Conclusions:The implementation rate of early mobility in ICU is still insufficient in Sichuan Province, and implementation quality is no ideal. We should further explore the relevant issues, such as multidisciplinary cooperation as well as human resource allocation, and improve the early mobility forms, strengthen the evidence-based clinical practice and formulate a scheme suitable for China.

Incorporation of multiple functions into one nanoplatform can improve cancer diagnostic efficacy and enhance anti-cancer outcomes. Here, we constructed doxorubicin (DOX)-loaded silk fibroin-based nanoparticles (NPs) with surface functionalization by photosensitizer (N770). The obtained nanotheranostics (N770-DOX@NPs) had desirable particle size (157 nm) and negative surface charge (-25 mV). These NPs presented excellent oxygen-generating capacity and responded to a quadruple of stimuli (acidic solution, reactive oxygen species, glutathione, and hyperthermia). Surface functionalization of DOX@NPs with N770 could endow them with active internalization by cancerous cell lines, but not by normal cells. Furthermore, the intracellular NPs were found to be preferentially retained in mitochondria, which were also efficient for near-infrared (NIR) fluorescence imaging, photothermal imaging, and photoacoustic imaging. Meanwhile, DOX could spontaneously accumulate in the nucleus. Importantly, a mouse test group treated with N770-DOX@NPs plus NIR irradiation achieved the best tumor retardation effect among all treatment groups based on tumor-bearing mouse models and a patient-derived xenograft model, demonstrating the unprecedented therapeutic effects of trimodal imaging-guided mitochondrial phototherapy (photothermal therapy and photodynamic therapy) and chemotherapy. Therefore, the present study brings new insight into the exploitation of an easy-to-use, versatile, and robust nanoplatform for programmable targeting, imaging, and applying synergistic therapy to tumors.