OBJECTIVE To identify core genes associated with the treatment of coronary heart disease （CHD） with Tongmai yangxin pills， and predict their potential immunological and metabolic mechanisms. METHODS Mendelian randomization （MR） analysis was conducted using protein quantitative trait loci （pQTL） data from the UK Biobank and Icelandic，and data from genome- wide association study to screen core genes related to Tongmai yangxin pills in the treatment of CHD. Gene expression changes were further validated using transcriptomic sequencing data. Mediation analyses of immune cells and plasma metabolites were subsequently performed to explore the downstream regulatory networks of these core genes. RESULTS A total of 62 positive pQTL genes showed significant causal associations with CHD. MR analysis combined with transcriptomic sequencing validation identified three core genes FAM3D，OXT， and ENPP5-associated with Tongmai yangxin pills in the treatment of CHD. The transcriptomic sequencing results showed that after treatment with Tongmai yangxin pills， the expression levels of FAM3D and OXT were significantly reduced （P＜0.01）， while the expression level of ENPP5 was significantly increased （P＜0.05）. Mediation analyses between immune cells and plasma metabolites indicated that these genes may positively or negatively regulate CHD through immune pathways involving regulatory T cells and myeloid dendritic cells expressing CD11c and CD62L， as well as through metabolic pathways related to lipid and fatty acid metabolism， cholesterol metabolism， and bile acid metabolism. CONCLUSIONS This study identified FAM3D，OXT， and ENPP5 as core genes associated with the treatment of CHD by Tongmai yangxin pills， which may exert therapeutic effects via modulation of immune cells and plasma metabolic pathways involving fatty acids and bile acids.

Objective To retrieve,evaluate and summarize the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation,and to provide a reference for clinical practice.Methods UpToDate,BMJ Best Practice,Registered Nurses'Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Yimaitong,Joanna Briggs Institute Library,Cochrane Library,CINAHL,PubMed,SinoMed,CNKI,Wanfang Database,Vip Database and Extracorporeal Life Support Organization Website were researched to collect the literature,including clinical guidelines,expert consensuses,evidence summaries,systematic reviews,and well-designed original studies.The time limit for retrieval was until June 2023.The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of J BI Evidence-Based Health Care Center.Results 14 pieces of the literature were included,including 2 clinical guidelines,4 expert consensuses,5 systematic reviews,2 cohort studies and 1 case series.Totally 33 pieces of evidence were summarized,covering 7 aspects:adaptation conditions for the implementation of awake ECMO,team composition,comprehensive assessment,pre-mobilization preparation,mobilization content,prevention and control of adverse events,and effect evaluation.Conclusion The study summarizes the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation.It is suggested that medical institutions establish a professional team for the early mobilization of awake ECMO patients,apply the best evidence to standardize the early mobilization process,and formulate an individualized mobilization program.

Objective To identify the factors associated with frailty in lung transplant patients by a meta-analysis.Methods Computerized search was performed for studies on the influencing factors of frailty in lung transplant patients in the CNKI,WanFangData,VIP,CBM,PubMed,Web of Science,Embase,Elsevier ScienceDirect and CINAHL databases.The search was conducted from the time of database construction to November 2023.Literature screening,quality assessment,and data extraction were performed independently by 2 investigators,and Meta-analysis was performed using Stata 17.0 software.Results 10 cohort studies,including 1 999 patients,were finally included,and 13 influencing factors were extracted,including advanced age(OR=1.05),female(OR=2.50),BMI(OR=0.38),diagnosis of primary pulmonary disease(OR=2.90),6MWD(OR=0.34),and lung allocation score(OR=0.69),FVC(OR=0.60),pre-transplant frailty(OR=0.81),hypoproteinemia(OR=4.12),hemoglobin(OR=0.50),anemia(OR=4.37),length of ICU stay(OR=1.24),and total length of stay(OR=1.05).Short Physical Performance Battery is an assessment tool for frailty in lung transplant patients,with an incidence of frailty in 24％before transplantation and 50％in post-transplantation.Fried Frailty Phenotype is an assessment tool for frailty in lung transplant patients,with a pre-transplant frailty incidence of 30％.Conclusion There are many factors involved in the incidence of frailty in lung transplant patients,and nursing staff should dynamically evaluate the frailty of lung transplant patients,and give individualized and precise interventions in combination with a multidisciplinary model to improve or delay the progression of frailty.

Objective To evaluate the effect of remote interventions with digital health technologies in lung transplant patients.Methods Databases,including CKNI,Wangfang,VIP,CMB,Cochrane Library,PubMed,Embase,Web of Science,Scopus and BMJ Best Practice were searched from their inception to July 2023.There were 2 researchers who independently screened and extracted the literature,and then evaluated quality of the included studies.Meta-analysis was performed using RevMan 5.2.Results 10 studies with 1 262 patients were included.The results of meta-analysis showed that compared with conventional intervention,remote intervention based on digital health technology could improve self-monitoring compliance of lung transplant patients[0R=0.64,95％CI(0.46,0.88),P=0.006],improve quality of life including mental health status[OR=3.08,95％CI(0.41,5.74),P=0.020]and physical health status[OR=3.81,95％CI(1.19,6.43),P=0.004].In terms of the intervention forms,the application-based remote intervention had better self-monitoring compliance,and the difference was statistically significant(P=0.007).However,in terms of the comparison of readmission rate[OR=1.73,95％CI(0.98,3.04),P=0.060],anxiety[OR=-0.12,95％CI(-1.36,1.11),P=0.850],and depression[OR=0.62,95％CI(-0.80,2.03),P=0.390],the effect of intervention was unclear.Conclusion Remote intervention based on digital health technology can improve self-monitoring compliance and quality of life in lung transplant patients;applications are the optimal form of intervention.Limited by the quality and quantity of included studies and the heterogeneity of study results,more high-quality studies are needed to further verify the effects of digital health technology on readmission rates,anxiety and depression of lung transplant patients.

Objective To investigate the incidence and risk factors of post-transplant diabetes mellitus(PTDM)in adult lung transplant recipients.Methods Conducting a convenience sampling method,we retrospectively analyzed the clinical data of lung transplant recipients from January 2020 to December 2022 at a tertiary A hospital in Hangzhou,Zhejiang Province.According to the PTDM diagnostic criteria,lung transplant recipients are divided into a PTDM group and a non-PTDM group.The incidence rate of PTDM is calculated,and the influencing factors for PTDM occurrence are analyzed using both univariate and multivariate logistic regression methods.Results A total of 140 patients were included in this study,and 54 lung transplant recipients developed PTDM within 6 months,with an incidence of 38.57％.Univariate analysis showed that there were significant differences in age,gender,BMI,smoking history,pre-operative glycated albumin,pre-operative fasting blood glucose,early post-operative blood glucose and pre-operative creatinine between the 2 groups(P＜0.05).Multivariate Logistic analysis showed that gender(OR=5.283),BMI(OR=6.122),pre-operative glycated albumin(OR=1.330),and early post-operative blood glucose(0R=1.444)were the influencing factors.Conclusion Lung transplant recipients who were male,BMI ≥24.0,with high levels of glycated albumin before surgery,and high blood sugar early after surgery had a higher risk of developing PTDM.Clinical nurses can formulate relevant nursing measures according to the influencing factors to prevent the occurrence of PTDM.

Objective To evaluate the effect of exercise-diet behavior intervention based on the transtheoretical model in patients undergoing weight loss surgery.Methods By convenience sampling,72 patients undergoing weight loss surgery in a tertiary general hospital in Xinxiang City,Henan Province from February 2021 to October 2022 were selected as the research subjects.By a random number table method,they were divided into a test group and a control group,with 36 cases in each group.The test group received exercise-diet behavior intervention based on the trans-theoretical model,while the control group received conventional intervention.The intervention began on the first day after admission and ended 6 months after surgery.The body mass index,body fat,lean body mass,diastolic blood pressure,systolic blood pressure,fasting blood glucose,insulin resistance index(HOMA-IR),Health Promoting Lifestyle Profile-Ⅱ(HPLP-Ⅱ)score,and Short-Form-36 Health Survey(SF-36)score were compared between the 2 groups before and after surgery for 3 and 6 months,as well as the complications within 6 weeks after surgery.Results The results of repeated measures analysis of variance showed that there was an interaction between the 2 groups in terms of anthropometric measurements,blood pressure and blood glucose,HPLP-Ⅱ scores,and SF-36 scores,with statistically significant differences(P＜0.001).After 6 months of surgery,the body mass index(23.32±2.32),body fat(24.10±3.46)kg,and lean body mass(41.64±3.24)kg in the test group were lower than(27.32±3.64),(28.46±4.18)kg,and(46.68±4.65)kg in the control group,and the differences were statistically significant(P＜0.001).At 3 and 6 months after operation,the diastolic blood pressure,systolic blood pressure,fasting blood glucose and HOMA-IR of the test group were lower than those of the control group,and the differences were statistically significant(P＜0.05).The HPLP-Ⅱ score of the test group was higher than that of the control group at 3 and 6 months after operation(P＜0.001).The SF-36 score of the test group was significantly higher than that of the control group at 6 months after operation(P＜0.05).The incidence of complications in the test group was 2.56％,which was not significantly different from 19.44％in the control group(P＞0.05).Conclusion The exercise-dietary behavior intervention based on the transtheoretical model can promote the formation of healthy behaviors in patients undergoing weight loss surgery,maintain weight loss effects,improve blood pressure and blood glucose levels,and enhance the quality of life of patients.

Objective:To explore the effects of body mass index (BMI) on the incidence of nocturnal hypertension in patients with hypertension.Methods:Totally 341 hospitalized hypertensive patients treated at the Affiliated Hospital of Jining Medical University from February to May 2023 were selected by convenience sampling. Patients' general information, clinical data, and 24-hour ambulatory blood pressure results were collected. A binomial Logistic regression analysis was conducted to investigate the factors affecting the occurrence of nocturnal hypertension in these patients. The relationship between BMI and the incidence of nocturnal hypertension was examined using threshold effect tests and smooth curve fitting.Results:The binomial Logistic regression analysis indicated that blood phosphate level was a factor influencing the occurrence of nocturnal hypertension in hypertensive patients ( P<0.05). Smooth curve fitting and threshold effect test results showed that the relationship between BMI and the incidence of nocturnal hypertension was curve-correlated, with a turning point at 24.61 kg/m 2. To the left of the turning point, there was no correlation ( P=0.130) ; to the right, there was a correlation ( P=0.016) . Conclusions:When the BMI of hypertensive patients exceeds 24.61 kg/m 2, the likelihood of nocturnal hypertension increases with rising BMI, providing a precise intervention target for weight management-based patient care in hypertension.

Objective To evaluate the effect of LEARNS[listen(L),establish(E),adopt(A),reinforce(R),name(N),strengthen(S)]model health education for patients with peripherally inserted central catheter(PICC)after discharge.Methods From June 2020 to June 2021,193 discharged patients with PICC were selected as the study objects.They were divided into observation group(95 cases)and control group(98 cases)according to random number table method.The control group received routine health education and continued follow-up for 3 months.In the observation group,health education was constructed and implemented at 2,4,8 and 12 weeks after discharge based on the control group and the basis of LEARNS model.The incidence of PICC-related complications and PICC-related adverse events were compared between the two groups,and self-management ability was evaluated using cancer patients PICC self-management scale(CPPSMS)score,strategies used by people to promote health(SUPPH)were used to evaluate self-efficacy.Results The incidence of PICC-related complications and adverse events in the observation group were significantly lower than those in the control group[11.58%(11/95)vs.40.82%(40/98)and 6.32%(6/95)vs.22.45%(22/98),both P＜0.05].There were no statistically significant differences in CPPSMS scores(daily catheter observation,maintenance compliance,management confidence,anomaly handling,information acquisition,tubeed exercise,and tubeed daily life)and SUPPH scores(positive attitude,self-stress reduction,and self-decision-making)in the two groups before intervention,and the above scores were higher than those before intervention.After intervention,the above scores in the observation group were significantly higher than those in the control group(CPPSMS total score was 131.37±27.20 vs.92.41±23.89,daily catheter observation score was 26.02±6.04 vs.18.27±5.43,maintenance compliance score was 18.45±4.36 vs.13.28±3.12,and management confidence score was 17.69±3.37 vs.13.81±3.65,anomaly processing score was 15.01±3.46 vs.10.25±2.74,information acquisition score was 11.98±2.56 vs.7.84±2.07,tube motion score was 15.94±3.46 vs.10.28±2.78,daily life with tubes score was 26.28±5.19 vs.18.68±4.46,all P＜0.05;SUPPH total score was 106.54±20.84 vs.93.93±18.50,positive attitude score was 56.89±11.45 vs.49.34±10.56,self-stress reduction score was 38.25±8.73 vs.34.76±6.28,the self-decision-making score was 11.40±2.57 vs.9.83±2.96,all P＜0.05).Conclusion The implementation of health education based on LEARNS model in discharged patients with PICC tube can improve their self-management ability and self-efficacy,and improve clinical prognosis.

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【Objective】 To investigate the airway parameters of adult-onset eosinophilic asthma （EA） and analyze the correlation between airway remodeling and lung function by quantitative CT. 【Methods】 From March 2015 to November 2016， totally 94 subjects from the “FACT-Digital Lung” Multi-research Center were divided into three groups： 30 normal subjects， 33 EA patients and 31 non-eosinophilic asthma （NEA） patients. We measured and recorded the bronchial parameters of RB1， LB1+2， RB10， and LB10， and small airway disease parameters. The indicators for quantitative evaluation of bronchial parameters include lumen area （LA）， wall thickness （WT）， wall area （WA）， and wall area percentage （WA%）. The parameters for the quantitative assessment of small airway disease included the percentage of inspiratory voxels below -950HU （IN-950）， the mean lung density （MLDin）， and the whole volume of the lung in inspiration （Vin）. Pearson or Spearman rank correlation analysis was used to evaluate the correlation between these parameters and lung function. 【Results】 The differences in LA/BSA， WT/√BSA， and WA/BSA between the three groups were statistically significant （P<0.05）. FEV1% had a significant correlation with IN-950 and MLDin （P<0.01）. FEV1/FVC had a significant correlation with Vin， IN-950， and MLDin （P<0.01）. EOS counts were positively related to IN-950 （r=0.343， P=0.011）， while EOS had a negative correlation with FEV1% （r=－0.343， P=0.015）. 【Conclusion】 With the increase of eosinophils counts in peripheral blood， the airway's stenosis in asthma patients gradually increased， and the extent of airflow limitation steadily increased. The IN-950 may be a sensitive imaging biomarker for evaluating the small airway disease in adult-onset eosinophilic asthma patients.