Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective:To explore facilitators and impediments to home glucose management for patients undergoing bariatric surgery based on the consolidated framework for implementation research (CFIR), so as to inform the development of a glucose management pathway after bariatric surgery.Methods:This study was a descriptive phenomenological study. Using purposive sampling method, seven healthcare professionals and 11 patients undergoing bariatric surgery from the General Surgery·Metabolic and Bariatric Center of China-Japan Friendship Hospital were selected from November 2023 to January 2024 for semi-structured interviews. Targeted content analysis was used for the data analysis.Results:A total of six facilitators and six impediments related to the five dimensions of CFIR were distilled. Facilitators included the personalized glucose management program, regular long-term follow-up, multidisciplinary management team, support from family and friends, complication distress, and information technology platform. Impediments involved patterned follow-up, poor accessibility and convenience of resources, role conflict, herd mentality, poor behavioral compliance, and low utilization of digital equipment.Conclusions:Glucose management needs vary in patients after bariatric surgery, with a gradual decline in management compliance. Healthcare professionals should build an "Internet +"home glucose management service model, carry out targeted multidisciplinary team follow-up, and promote the formation of a standardized pathway for patients' home glucose management.

A systematic review of the traditional Chinese medicine （TCM） literatures published over the past decade on blood glucose fluctuations in diabetes mellitus was conducted to summarize related TCM research progress of theories and prescriptions， so as to provide references for future TCM theoretical exploration， basic research， and clinical prevention and treatment. Blood glucose fluctuation is an independent risk factor for chronic complications of diabetes mellitus， with significant progress made in TCM theories and prescription studies targeting this condition. The TCM theories include "spleen-pancreas homology"， "liver controlling dispersion"， "small intestine transforming qi and separating purity from turbidity"， "Yi Qi Zhou Liu theory"， "Xuan Fu Qi Ye theory"， "Yin-fire theory" and so on， all of which emphasize "Qi". Prescription studies primarily utilize clinical trials， which evaluate plentiful indexes of blood glucose fluctuation such as the mean amplitude of glycemic excursion. Classical and self-formulated prescriptions are widely used， with various dosage forms such as decoctions， granules and capsules. "Qi-Yin deficiency" is the main syndrome of blood glucose fluctuation. Basic research focuses on mechanisms that improve blood glucose fluctuation and reduce chronic complications， such as the renin-angiotensin system regulating islet β cell's function， and the transforming growth factor-β₁ inhibiting organ fibrosis. However， there are still some deficiencies in the evidential support and syndrome study of TCM theories， in the high-level evidence-based evaluation， efficacy comparison among multiple dosage forms， and the integration of TCM theories with prescription's clinical research， in the quantities， multi-level verifications， blood glucose fluctuation model establishment and intervention criteria as well as prescription-syndrome correspondence of prescription's basic research， and in the collaboration between clinical and basic research. Despite these challenges， TCM offers a promising approach to improving blood glucose fluctuation and reducing chronic complications in diabetes mellitus， with its rich theories， diverse methods， and proven efficacy.

Objective To discuss the application of bidirectional dual loop technique in retrieving Aegisy inferior vena cava filters.Methods The clinical data of 12 patients with deep vein thrombosis in the lower limbs complicated by pulmonary embolism,who received mechanical thrombectomy and Aegisy inferior vena cava(IVC)filter implantation at the Zhoukou Municipal Central Hospital of China from January 2016 to November 2023,were retrospectively analyzed.The retrieval of Aegisy IVC filters beyond the time window was tried by standard methods,guide wire stripping,balloon dilatation,unidirectional single loop technique,unidirectional dual loop technique,etc.However,because of the difficulty in retrieval of filter,bidirectional dual loop technique had to be used.The indwelling time of the IVC filters was 30-365 days,with an average time of 105 days.Results The IVC filter was completely removed in 11 patients.Angiography showed that IVC was unobstructed,no contrast extravasation was observed,and the average operation time was 126 minutes.The retrieval of filter failed in one patient,and the patient had to receive anticoagulation therapy lifelong.No surgery-related complications occurred.Conclusion For retrieving Aegisy IVC filters beyond the time window,bidirectional dual loop technique is clinically safe and effective,and this technology is worthy of clinical promotion and application.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective:To explore facilitators and impediments to home glucose management for patients undergoing bariatric surgery based on the consolidated framework for implementation research (CFIR), so as to inform the development of a glucose management pathway after bariatric surgery.Methods:This study was a descriptive phenomenological study. Using purposive sampling method, seven healthcare professionals and 11 patients undergoing bariatric surgery from the General Surgery·Metabolic and Bariatric Center of China-Japan Friendship Hospital were selected from November 2023 to January 2024 for semi-structured interviews. Targeted content analysis was used for the data analysis.Results:A total of six facilitators and six impediments related to the five dimensions of CFIR were distilled. Facilitators included the personalized glucose management program, regular long-term follow-up, multidisciplinary management team, support from family and friends, complication distress, and information technology platform. Impediments involved patterned follow-up, poor accessibility and convenience of resources, role conflict, herd mentality, poor behavioral compliance, and low utilization of digital equipment.Conclusions:Glucose management needs vary in patients after bariatric surgery, with a gradual decline in management compliance. Healthcare professionals should build an "Internet +"home glucose management service model, carry out targeted multidisciplinary team follow-up, and promote the formation of a standardized pathway for patients' home glucose management.

Objective To observe the value of relative adverse reactions for predicting prognosis of ≥5 cm unresectable hepatocellular carcinoma(HCC)after treated with drug-eluting beads TACE(DEB-TACE)combined with low-dose apatinib.Methods Totally 172 patients with unresectable HCC≥5 cm who underwent DEB-TACE combined with low-dose apatinib.Apatinib-related adverse reactions were recorded and graded according to common terminology criteria for adverse events(CTCAE).Multivariate Cox regression model was performed to screen independent impact factors of apatinib-related adverse reactions for predicting survival time of patients after DEB-TACE combined with low-dose apatinib.Results Among 172 cases,apatinib-related adverse reactions included hand-foot syndrome and hypertension in each 147 cases(147/172,85.47％),loss of appetite in 91 cases(91/172,52.91％),diarrhea in 81 cases(81/172,47.09％),fatigue in 75 cases(75/172,43.60％),rashes in 38 cases(38/172,22.09％),oral mucositis in 20 cases(20/172,11.63％)and dysphonia in 18 cases(18/172,10.47％).After correction of baseline data,multivariate Cox regression model showed that grade 1-2 hand-foot syndrome and grade 2 oral mucocitis were all independent factors for predicting survival time after DEB-TACE combined with low-dose apatinib of unresectable HCC≥5 cm(all P＜0.05).Conclusion After DEB-TACE combined with low dose apatinib,patients with unresectable HCC≥5 cm who occurred grade CTCAE 1-2 hand-foot syndrome and grade 2 oral mucositis had better prognosis.

Objective:To analyze the efficacy of gasless unilateral axillary endoscopic approach, transoral vestibular endoscopic approach and open thyroidectomy for papillary thyroid carcinoma (PTC).Methods:A retrospective analysis was made on 98 PTC patients who underwent surgical treatment at our hospital from Aug 2020 to Dec 2022,including 29 cases of transaxillary non pneumatic endoscopic surgery (group A), 33 cases of oral vestibular non pneumatic endoscopic surgery (group B), and 36 cases of traditional open neck surgery (group C). The operation related indicators, neck function, immune function, scar condition and postoperative complications of the three groups were compared.Results:The intraoperative blood loss (18.3±2.8),(30.2±4.2)ml in group A and group B was lower than that in group C (37.0±13.6)ml, the operation time (126.4±9.2) min,(191.0±60.1) min was longer than that in group C (73.8±6.3)min, and the drainage volume (91.8±5.4)ml,(85.2±6.1)ml was higher than that in group C (52.7±7.3)ml ( F=37.431, 94.144, 357.922, all P<0.05). The scores of dysphagia index (6.8±2.5,7.0±2.6) in group A and B were lower than those in group C (12.6±3.5) ( P<0.05). After treatment, surface antigen differentiation cluster 4 + (35.5±7.3,35.0±7.3,31.6±5.4), surface antigen differentiation cluster 4 +/surface antigen differentiation cluster 8 +level(1.4±0.4, 1.4±0.4, 1.0±0.3) decreased, and surface antigen differentiation cluster 8 +level (26.4±3.4 ,26.8 ±3.4, 29.5 ±3. 8) increased in the three groups,and the change amplitude in groups A and B was higher than that in group C ( P<0.05). At 3 months after operation, the VSS scores in group A and group B (6.0±1.0, 6.4±1.0) were lower than those in group C (8.5±1.2) ( F=18.925, P<0.05). Conclusions:Compared with open thyroidectomy for PTC, application of endoscopic thyroidectomy via gasless unilateral axillary or transoral vestibular approach has the advantage of a less swallowing impact and better patient satisfaction with cosmetic appearance, making it a safe and effective surgical procedure for clinical treatment of PTC.

Objective To observe the value of relative adverse reactions for predicting prognosis of ≥5 cm unresectable hepatocellular carcinoma(HCC)after treated with drug-eluting beads TACE(DEB-TACE)combined with low-dose apatinib.Methods Totally 172 patients with unresectable HCC≥5 cm who underwent DEB-TACE combined with low-dose apatinib.Apatinib-related adverse reactions were recorded and graded according to common terminology criteria for adverse events(CTCAE).Multivariate Cox regression model was performed to screen independent impact factors of apatinib-related adverse reactions for predicting survival time of patients after DEB-TACE combined with low-dose apatinib.Results Among 172 cases,apatinib-related adverse reactions included hand-foot syndrome and hypertension in each 147 cases(147/172,85.47％),loss of appetite in 91 cases(91/172,52.91％),diarrhea in 81 cases(81/172,47.09％),fatigue in 75 cases(75/172,43.60％),rashes in 38 cases(38/172,22.09％),oral mucositis in 20 cases(20/172,11.63％)and dysphonia in 18 cases(18/172,10.47％).After correction of baseline data,multivariate Cox regression model showed that grade 1-2 hand-foot syndrome and grade 2 oral mucocitis were all independent factors for predicting survival time after DEB-TACE combined with low-dose apatinib of unresectable HCC≥5 cm(all P＜0.05).Conclusion After DEB-TACE combined with low dose apatinib,patients with unresectable HCC≥5 cm who occurred grade CTCAE 1-2 hand-foot syndrome and grade 2 oral mucositis had better prognosis.

With the progress of society,the global development of scientific and technical research activities,and the increasing number of medical Institutional Review Board(IRB)review projects,the construction and management of electronic informatization have become extremely important.In the process of electronic information construction in institutional ethics review,it is necessary to take into account the new policy of ethical governance of science and technology,consider the system and standard operating procedures of IRB,and develop reasonable processes based on practical work,simplify manual operation,improve the accuracy of project management,achieve refined management,and facilitate communication among researchers,ethics committee secretaries,and members.