Glioma represents the most prevalent malignant tumor of the central nervous system, with chemotherapy serving as an essential adjunctive treatment. However, most chemotherapeutic agents exhibit limited ability to penetrate the blood-brain barrier (BBB). This study introduced a novel dual-targeting strategy for glioma therapy by modulating the formation of nanobody-driven protein coronas to enhance the brain and tumor-targeting efficiency of hydrophobic cisplatin prodrug-loaded lipid nanoparticles (C8Pt-Ls). Specifically, nanobodies (Nbs) with fibrinogen-binding capabilities were conjugated to the surface of C8Pt-Ls, resulting in the generation of Nb-C8Pt-Ls. Within the bloodstream, Nb-C8Pt-Ls could bound more fibrinogen, forming the protein corona that specifically interacted with LRP-1, a receptor highly expressed on the BBB. This interaction enabled a "Hitchhiking Effect" mechanism, facilitating efficient trans-BBB transport and promoting effective brain targeting. Additionally, the protein corona interacted with LRP-1, which is also overexpressed in glioma cells, achieving precise tumor targeting. Computational simulations and SPR detection clarified the molecular interaction mechanism of the Nb-fibrinogen-(LRP-1) complex, confirming its binding specificity and stability. Our results demonstrated that this strategy significantly enhanced C8Pt accumulation in brain tissues and tumors, induced apoptosis in glioma cells, and improved therapeutic efficacy. This study provides a novel framework for glioma therapy and underscores the potential of protein corona modulation-based dual-targeting strategies in advancing treatments for brain tumors.

Objective:To construct a smart elderly education system that in line with the current situation under the Healthy China strategy and explore the constraints on its institutional implementation,in order to provide a basis for scientifically evaluating the implementation effect of this system.Methods:A questionnaire survey was conducted on 34 experts in related fields.The analytic hierarchy process(AHP)was used to perform quantitative and qualitative analyses on the construction of the smart elderly education system,and the weights of the importance of each scheme were obtained.Results:The constructed model of the smart elderly education system included 5 first-level indicators and 15 second-level indicators.Calculations of the judgment matrix for the 5 first-level indicators showed that the maximum eigenvalue(λmax)=5.071 4,the random consistency index(RI)=1.12,the consistency index(CI)=0.017 8,and the consistency ratio(CR)=0.015 9.With CR＜0.1,the result met the consistency requirement.For the second-level indicators under each first-level indicator,pairwise comparison judgment matrices were constructed.The CR values of all 5 judgment matrices were＜0.1.In summary,all judgment matrices passed the consistency test and were applicable.Among the first-level indicators,the top three by weights were guarantee mechanisms,demand orientation,and implementation effectiveness.Among the second-level indicators,the top three by combined weights were funding support capacity,health literacy improvement rate,and health demand identification mechanism.Conclusions:The indicator evaluation system for the smart elderly education system constructed based on AHP includes core dimensions such as guarantee mechanisms and demand orientation,responding to the key issues of institutional implementation.The selected indicators are both objective and practical,and can serve as reference tools for actual evaluation.

Objective:To construct a smart elderly education system that in line with the current situation under the Healthy China strategy and explore the constraints on its institutional implementation,in order to provide a basis for scientifically evaluating the implementation effect of this system.Methods:A questionnaire survey was conducted on 34 experts in related fields.The analytic hierarchy process(AHP)was used to perform quantitative and qualitative analyses on the construction of the smart elderly education system,and the weights of the importance of each scheme were obtained.Results:The constructed model of the smart elderly education system included 5 first-level indicators and 15 second-level indicators.Calculations of the judgment matrix for the 5 first-level indicators showed that the maximum eigenvalue(λmax)=5.071 4,the random consistency index(RI)=1.12,the consistency index(CI)=0.017 8,and the consistency ratio(CR)=0.015 9.With CR＜0.1,the result met the consistency requirement.For the second-level indicators under each first-level indicator,pairwise comparison judgment matrices were constructed.The CR values of all 5 judgment matrices were＜0.1.In summary,all judgment matrices passed the consistency test and were applicable.Among the first-level indicators,the top three by weights were guarantee mechanisms,demand orientation,and implementation effectiveness.Among the second-level indicators,the top three by combined weights were funding support capacity,health literacy improvement rate,and health demand identification mechanism.Conclusions:The indicator evaluation system for the smart elderly education system constructed based on AHP includes core dimensions such as guarantee mechanisms and demand orientation,responding to the key issues of institutional implementation.The selected indicators are both objective and practical,and can serve as reference tools for actual evaluation.

Objective:To explore whether the degree of skeletal muscle atrophy in obese individuals under the influence of colorectal cancer is more severe than that in non-obese individuals.Methods:The clinical data of patients who underwent radical resection of colorectal cancer in our department from Jul 2020 to Dec 2021 was collected. Sixty-four obese patients were included and 64 non-obese patients were matched according to propensity score. At the same time, 51 obese patients were collected from non-tumor patients and matched with 51 non-obese patients. The psoas muscle index (PMI) of included patients was analyzed and compared.Results:The PMI of patients with colorectal cancer was significantly lower than that of corresponding non-tumor patients, regardless of gender and body weight (both P<0.05). The PMI of obese patients with colorectal cancer was significantly lower than that of non-obese patients ( P<0.05). Conclusions:The impact of colorectal cancer on skeletal muscle atrophy in obese individuals is greater than that in normal weight individuals. Therefore, the skeletal muscle status of obese patients with colorectal cancer should be evaluated more comprehensively.

Objective: To investigate the status of insomnia, Internet addiction, and depressive symptoms among medical students and to analyze the effect of Internet addiction on insomnia and the mediating role of depressive symptoms, in order to provide a basis for the development of targeted interventions and measurements for medical students. Methods: A stratified whole group sampling method was used to select full-time college students from three medical universities in Anhui Province. The Chinese version of Insomnia Severity Index (ISI), Internet Addiction Test (IAT) scale and 9-item Patient Health Questionnaire (PHQ-9) were used to evaluate the symptoms of insomnia, Internet addiction and depressive in students. A multivariate Logistic regression analysis was used to explore the factors influencing insomnia among medical students and to analyze the relationship between insomnia with Internet addiction and depressive symptoms, respectively. Results: The overall rate of Internet addiction was 49.5%, depressive symptoms was 39.5%, insomnia was 18.6%. High academic stress, and the presence of surrounding people diagnosed with COVID-19 were associated with a higher risk of insomnia ( P <0.05). The higher the level of Internet addiction (mild, OR =2.60; moderate/severe, OR =4.21) and depression. (mild, OR =6.35; moderate/severe, OR =19.32), the higher the risk of insomnia. Mediated effect analysis showed that Internet addiction had a direct predictive effect ( β =0.02, P <0.05) on insomnia and also indirectly affected insomnia through depression (indirect effect=0.07，95% CI =0.06-0.08). Conclusion The detected rates of insomnia, Internet addiction and depressive symptoms are high among medical students in Anhui Province, and Internet addiction and depressive symptoms are risk factors for insomnia, which should be given more attention and appropriate interventions when necessary to improve their physical and mental health.

Objective:To investigate the application value of ambulatory surgery mode in inguinal hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 416 patients with inguinal hernia who were admitted to the Meishan People′s Hospital, West China Hospital of Sichuan University from January 2020 to January 2022 were collected. There were 374 males and 42 females, aged 52(range, 25-70)years. All patients underwent inguinal hernia repair with the ambulatory surgery mode. Observation indicators: (1) surgical situations; (2) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. Of the 416 patients, 258 patients underwent laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) under general anesthesia and 158 patients underwent open inguinal hernia repair under local anesthesia (98 cases of Lichtenstein repair and 60 cases of preperitoneal repair). The intraoperative measured diameter of hernia ring defect and operation time of the 416 patients were 1.9 (range, 0.9-3.2)cm and 52 (range, 35-80)minutes. The duration of hospital stay of the 416 patients <48 hours, including 395 cases with the duration of hospital stay <24 hours. There were 21 patients with delayed discharge including 12 cases as post-operative pain, 8 cases as adverse reactions to general anesthesia, and 1 case as postoperative seroma. (2) Follow-up. All 416 patients were followed up for 12 months after surgery. During the follow-up period, there was no serious complication such as recurrent inguinal hernia, wound infection, intestinal fistula or obstruction. At 1 month after surgery, ultrasound examination of the inguinal area did not reveal any serum swelling or seroma. The postoperative visual analogue scale of pain in patients undergoing laparoscopic TAPP was 2.70±0.10 at postoperative 3 days and 0 at postoperative 12 months. The above indicator in patients undergoing Lichtenstein repair and pre-peritoneal repair was from 3.20±0.20 and 3.00±0.10 at postoperative 3 days to 0 and 0 at post-operative 12 months, respectively. All patients did not experience chronic pain for more than 3 months. All 416 patients conducted satisfaction surveys over the phone, and all of them were very satisfied or satisfied, with a satisfaction rate as 100.00%(416/416).Conclusion:Ambulatory surgery mode in inguinal hernia repair is safe and feasible.

As a new type of medical service mode, day surgery significantly alleviates the contradiction between supply and demand of medical resources. Since 2009, day surgery center in West China Hospital of Sichuan University has gradually carried out endoscopic gastrointestinal(GI) polypectomy, continuously explored and practiced the centralized management mode of GI polyps. The integrated management process included pre-hospital management, clinical pathway during hospitalization, and extended service after discharge. The overall-management database for day surgery patients was established, guiding the clinical practice and standardizing clinical behavior based on various clinical studies, which help day surgery managers make clinical decisions, and achieve the management objectives of fine management, quality and safety normalization for day surgery.

Consultation system is one of the eighteen core systems. Excellent consultation supervision can assist clinical departments to maximize cooperation efficiency. This article, concentrating on timeliness, built an individual-group-organization model based on the organizational behavior theory and actual conditions, and took management actions from three aspects, including changing personal behavior attitude, adjusting organizational performance plan and establishing task-based groups. Timeliness data in October and November 2018 were selected retrospectively one month before and one month after the new actions. The timely rate of consultation increased from 76.69% to 82.62% with a significant difference(P=0.000 2).

Objective To explore the effects of intensive self-care intervention on self-care agency, reactive mode, psychology and voice functional recovery in patients undergoing self-retaining laryngoscope CO2 laser vocal polyp resection after leaving hospital. Methods From January 2016 to June 2017, 75 patients with selective self-retaining laryngoscope CO2laser vocal polyp resection were selected. From January to September 2016, a total of 37 patients with conventional nursing were selected as control group. From October 2016 to June 2017, a total of 38 patients accepting intensive self-care intervention were chosen as observation group. The self-care agency, reactive mode and voice functional recovery of patients in two groups were compared at different times. Results The score of self-care agency of two groups all increased one and three months after leaving hospital compared with that on admission (P< 0.05). The score of self-care agency of observation group one and three months after leaving hospital were (125.32±6.75) and (122.46±8.24) significantly higher than those [(117.69±12.47) and (115.38±10.25)]of control group (P< 0.05). The score of positive coping style of observation group one and three months after leaving hospital were (23.87±1.76) and (24.00±1.83) significantly higher than those [(20.13±1.20) and (20.08±1.35)]of control group (P< 0.05). The fine rate of voice functional recovery in observation group one month after leaving hospital was 78.95% higher than that (51.35%) in control group with a significant difference (P<0.05). However, there was no statistically significant difference in the fine rate of voice functional recovery between two groups after 3 months leaving hospital (P>0.05). Conclusions Intensive self-care intervention can improve the self-care agency, positive coping style and promote voice functional recovery in patients undergoing self-retaining laryngoscope CO2laser vocal polyp resection.

Objective To explore the clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients.Methods The retrospective cohort study was adopted.The clinical data of 675 patients undergoing ambulatory surgery for inguinal hernia and 464 patients (age ≥ 70 years) undergoing inpatient surgery for inguinal hernia who were admitted to the West China Hospital of Sichuan University from January 2015 to May 2016 were collected.Of 675 patients undergoing ambulatory surgery,594 patients with age ＜ 70 years and 81 with age≥70 years were respectively allocated into the under 70 years group and 70 years or older group.Four hundred sixty-four patients undergoing inpatient surgery with age ≥ 70 years were allocated into the inpatient surgery group.Observation indicators included:(1) efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time,② cases with delayed discharge and cases with unplanned readmission,③postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection.(2) Efficacies of patients with inpatient surgery:①type of anesthesia,surgical procedures and operation time,② postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection,③ duration of postoperative hospital stay.(3) Follow-up.Patients were regularly followed up using telephone interview at postoperative day 1,2,3,and using outpatient examination and telephone interview at postoperative week 2 and month 3,6,12 up to July 2016.Follow-up included the survival of patients,recurrence of hernia and number of readmission.Measurement data with normal distribution were represented as （x） ± s and comparison between groups was evaluated with the t test.Comparison of count data were analyzed using the chi-square or Fisher exact probability.Results (1) Efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time:patients in the under 70 years group and 70 years or older group underwent tensionfree repair under local anesthesia.The operation time in the under 70 years group and 70 years or older group was respectively (29 ± 11) minutes and (28 ± 10) minutes,with no statistically significant difference between 2 groups (t =0.378,P ＞ 0.05).② The cases with delayed discharge and with unplanned readmission:there were 2 patients with delayed discharge and 1 with unplanned readmission in the under 70 years group and no case in the 70 years older group,with no statistically significant difference between the 2 groups (x2=0.601,0.137,P ＞ 0.05).③ The postoperative complications:wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain were detected in 4,2,1,3 patients in the under 70 years group and 1,0,0,1 patients in the70 years or older group,respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).No patch infection occurred.(2) Efficacies of patients undergoing inpatient surgery:① type of anesthesia,surgical procedures and operation time:patients in the inpatient surgery group underwent tension-free repair under local anesthesia and operation time was (29 ± 10) minutes.There was no statistically significant difference in operation time between the inpatient surgery group and 70 years or older group (t =0.806,P ＞ 0.05).② The wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain in the inpatient surgery group were respectively detected in 3,1,1,2 patients,showing no statistically significant difference between the inpatient surgery group and 70 years or older group (P ＞ 0.05).No patch infection occurred.③ Duration of postoperative hospital stay was less than 1 day in 439 patients and more than 1 day in 25 patients in the inpatient surgery group,respectively.(3) Follow-up:625 of 675 patients undergoing ambulatory surgery were followed up for a median time of 9 months (range,2-18 months).One patient in the under 70 years group was complicated with recurrence of hernia and then was cured by reoperation.There was no recurrence of hernia in the 70 years or older group.Of 464 patients in the inpatient surgery group,432 were followed up for a median time of 9 months (range,2-18 months),and 1 patient with recurrence of hernia was cured by reoperation.Conclusion Ambulatory surgery for inguinal hernia is feasible in 70 years or older patients.