Objective To retrieve,analyze and synthesize evidence on post-transplant diabetes mellitus(PTDM)in lung transplant patients,providing reference for clinical healthcare professionals in preventing and managing PTDM in lung transplant patients.Methods Based on the"6S"evidence model,systematic searches were conducted across guideline websites,professional associations,and Chinese/English databases regarding post-transplant diabetes mellitus(PTDM)in lung transplant patients.The search period spanned from data-base inception to January 2025.Two researchers independently completed literature screening,quality assess-ment,and evidence extraction.Results A total of 14 articles were included,comprising 1 clinical decision,2 guidelines,5 expert consensuses,2 specifications,1 evidence summary,and 3 systematic reviews.Twenty-four pieces of best evidence were synthesized from seven aspects:risk factors,diagnosis,screening,prevention,treatment,glycemic control targets,and health education.Conclusion The best evidence for preventing and managing post-transplant diabetes mellitus in lung transplant patients provides an evidence-based foundation for clinical practice among healthcare professionals.Evidence should be selected and applied according to spe-cific clinical situations and patient needs.

Objective To investigate the status of feeding intolerance in patients with enteral nutrition after lung transplantation and analyze its influencing factors,to provide a reference for formulating a reasonable enteral nutrition plan and improving patients'nutritional status.Methods Convenient sampling method was used to retrospectively collect the clinical data of 115 patients who received enteral nutrition support after lung transplantation and were hospitalized in the ICU of a tertiary hospital in Guangdong Province from August 2022 to November 2023.According to the occurrence of feeding intolerance during ICU hospitalization,the patients were divided into a feeding tolerance group and a feeding intolerance group.Univariate and logistic regression analysis were used to analyze the influencing factors of feeding intolerance patients with enteral nutrition after lung transplantation.Results Within 7 days of initiating enteral nutrition,a total of 63 patients developed feeding intolerance,with an incidence of 54.78％.Among them,the incidence of feeding intolerance was relatively high within 1 to 3 days after initiating enteral feeding.The clinical manifestations of feeding intolerance were diarrhea,bloating,gastric retention,vomiting/regurgitation,among which the diarrhea was the highest incidence(87.30％).Logi-stic regression analysis showed that intraoperative net balance volume(OR=0.999),intraoperative blood transfusion(OR=1.001)volume and diabetes history(OR=0.170)were independent influencing factors for feeding intolerance in patients with enteral nutrition after lung transplantation(P＜0.05).Conclusion There was a high incidence of feed-ing intolerance in patients with enteral nutrition after lung transplantation.Patients undergoing lung transplantation who have a high net intraoperative fluid balance,receive a low volume of intraoperative blood transfusions,and have a history of diabetes are at a lower risk of developing feeding intolerance when receiving postoperative enteral nutrition.When starting enteral nutrition,medical staff should dynamically evaluate the risk factors of feeding intolerance,screen high-risk patients as early as possible,and formulate reasonable enteral nutrition programs to improve the nutritional status of patients and promote their rehabilitation.

Objective To investigate the status of feeding intolerance in patients with enteral nutrition after lung transplantation and analyze its influencing factors,to provide a reference for formulating a reasonable enteral nutrition plan and improving patients'nutritional status.Methods Convenient sampling method was used to retrospectively collect the clinical data of 115 patients who received enteral nutrition support after lung transplantation and were hospitalized in the ICU of a tertiary hospital in Guangdong Province from August 2022 to November 2023.According to the occurrence of feeding intolerance during ICU hospitalization,the patients were divided into a feeding tolerance group and a feeding intolerance group.Univariate and logistic regression analysis were used to analyze the influencing factors of feeding intolerance patients with enteral nutrition after lung transplantation.Results Within 7 days of initiating enteral nutrition,a total of 63 patients developed feeding intolerance,with an incidence of 54.78％.Among them,the incidence of feeding intolerance was relatively high within 1 to 3 days after initiating enteral feeding.The clinical manifestations of feeding intolerance were diarrhea,bloating,gastric retention,vomiting/regurgitation,among which the diarrhea was the highest incidence(87.30％).Logi-stic regression analysis showed that intraoperative net balance volume(OR=0.999),intraoperative blood transfusion(OR=1.001)volume and diabetes history(OR=0.170)were independent influencing factors for feeding intolerance in patients with enteral nutrition after lung transplantation(P＜0.05).Conclusion There was a high incidence of feed-ing intolerance in patients with enteral nutrition after lung transplantation.Patients undergoing lung transplantation who have a high net intraoperative fluid balance,receive a low volume of intraoperative blood transfusions,and have a history of diabetes are at a lower risk of developing feeding intolerance when receiving postoperative enteral nutrition.When starting enteral nutrition,medical staff should dynamically evaluate the risk factors of feeding intolerance,screen high-risk patients as early as possible,and formulate reasonable enteral nutrition programs to improve the nutritional status of patients and promote their rehabilitation.

Objective:To investigate the infection and treatment of helicobacter pylori (HP) in flying personnel, as well as their cognition of HP.Methods:By using cluster sampling method, the flying personnel who recuperated at the Second Sanatorium of Air Force Healthcare Center for Special Services Hangzhou were selected for questionnaire survey. They were divided into positive group and negative group according to whether they were infected with HP. The cognition of HP (such as whether they had known HP, how to detect HP, and the symptoms, infection route, as well as the knowledge on treatment and prevention of HP) were compared between 2 groups. The differences on infection situation at different ages, personal lifestyle, diet and living environment were also compared. The treatment of flying personnel in positive group during their stay in the sanatorium was investigated and analyzed among different age groups.Results:A total of 347 flying personnel were included, with 161 in the positive group and 186 in the negative group. The HP infection rate in the rural population before joining the army was higher than that in the urban population, with a significant difference ( χ2=7.19, P=0.007). But there were no significant differences on whether they had long-term smoking history, preferred strong tea or coffee, spicy and fried food and whether their family members were infected ( χ2=0.05-5.92, all P>0.05). The questionnaire showed that the cognition of the negative group was significantly better than the positive group on whether they understood the infection route, symptoms and preventive measures of HP ( χ2=8.28, 12.00, 48.22, P=0.005, 0.001,<0.001), but there was no difference between 2 groups on whether they had known HP, detection methods and treatment after infection ( P>0.05). The treatment rate in positive group was only 29.19% (47/161), and there was no significant difference in the treatment rate among different age groups ( P>0.05). Conclusions:There is a high HP infection rate in flying personnel on base of the survey. The poor awareness of HP would affect the treatment rate and the basic cognition would be beneficial to active prevention. The survey also shows that the environment factors are seemed more sensitive to HP than dietary habit.

Objective:To provide evidence-based recommendations for the prevention and management of lower limb ischemia in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients during treatment according to search, evaluate, and summarize the best evidence on the prevention and management of lower limb ischemia in patients with VA-ECMO.Methods:Based on the PIPOST framework (population, intervention, professional, outcome, setting, and type of evidence), an evidence-based question was formulated. A systematic search was conducted according to the "6S" evidence pyramid model in both domestic and international databases, as well as professional association websites, for all evidence related to the prevention and management of lower limb ischemia in VA-ECMO patients (aged ≥18 years). The types of evidence included clinical decisions, guidelines, expert consensus, systematic reviews, evidence summaries, and original studies. The search was conducted from the construction of the databases to February 2024. Two researchers independently conducted a literature quality evaluation, extracted and summarized evidence from the studies that met the quality criteria.Results:A total of 13 articles were included, consisting of 3 clinical decisions, 3 guidelines, 3 expert consensus, 3 systematic reviews, and 1 randomized controlled trial. A total of 18 pieces of evidence in 7 dimensions were summarized, including risk factors of VA-ECMO lower limb ischemia, evaluation before catheterization, evaluation and monitoring during treatment, prevention of lower limb ischemia, treatment of lower limb ischemia, management of distal perfusion catheter (DPC), and monitoring after VA-ECMO weaning.Conclusion:This evidence summary provides evidence-based recommendations for the prevention and management of lower limb ischemia in VA-ECMO patients, aiming to assist clinical healthcare professionals in developing tailored strategies for the prevention and management of lower limb ischemia based on during VA-ECMO support.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To investigate the infection and treatment of helicobacter pylori (HP) in flying personnel, as well as their cognition of HP.Methods:By using cluster sampling method, the flying personnel who recuperated at the Second Sanatorium of Air Force Healthcare Center for Special Services Hangzhou were selected for questionnaire survey. They were divided into positive group and negative group according to whether they were infected with HP. The cognition of HP (such as whether they had known HP, how to detect HP, and the symptoms, infection route, as well as the knowledge on treatment and prevention of HP) were compared between 2 groups. The differences on infection situation at different ages, personal lifestyle, diet and living environment were also compared. The treatment of flying personnel in positive group during their stay in the sanatorium was investigated and analyzed among different age groups.Results:A total of 347 flying personnel were included, with 161 in the positive group and 186 in the negative group. The HP infection rate in the rural population before joining the army was higher than that in the urban population, with a significant difference ( χ2=7.19, P=0.007). But there were no significant differences on whether they had long-term smoking history, preferred strong tea or coffee, spicy and fried food and whether their family members were infected ( χ2=0.05-5.92, all P>0.05). The questionnaire showed that the cognition of the negative group was significantly better than the positive group on whether they understood the infection route, symptoms and preventive measures of HP ( χ2=8.28, 12.00, 48.22, P=0.005, 0.001,<0.001), but there was no difference between 2 groups on whether they had known HP, detection methods and treatment after infection ( P>0.05). The treatment rate in positive group was only 29.19% (47/161), and there was no significant difference in the treatment rate among different age groups ( P>0.05). Conclusions:There is a high HP infection rate in flying personnel on base of the survey. The poor awareness of HP would affect the treatment rate and the basic cognition would be beneficial to active prevention. The survey also shows that the environment factors are seemed more sensitive to HP than dietary habit.

Objective In this study，we performed two sampie Mendelian Randomization to infer a causal association between Gastroesophageal reflux(GERD) and Atrial fibrillation(AF)，it can effectively avoid the problems such as reverse causation and confounds in traditional epidemiology. Methods We used the Summary data of GERD and AF from published Genome wide association study(GWAS) of European Individuals. Single Nucleotide Polymorphisms (SNPs) were extracted as Instrumental Variables (IVs).The main MR methods include Inverse Variance [] Weighted(IVW)，Weighted Median(WME)，MR-Egger，Simple Mode，and Weighted Mode.In addition，we used the sensitivity analysis such as MR-PRESSO，Cochran's Q test etc. Results The IVW shows a causal association between GERD and AF(P<0.0001，OR=1.16，95%CI:1.10-1.23).The WME shows P＜0.0001，OR=1.20，95%CI:1.11-1.30；Simple Mode shows P=0.01，OR=1.34，95%CI:1.07-1.69；Weighted Mode shows P=0.02，OR=1.33，95%CI:1.06-1.66. Conclusion This study based on genetic data supports the causal association between GERD and AF. The occurrence of GERD could increase the risk of AF.