Endoscopic dacryocystorhinostomy(En-DCR)alleviates the clinical symptoms caused by lacrimal drainage obstruction by creating a new anatomical pathway between the lacrimal sac and the nasal cavity. Whether mechanical support of the anastomotic cavity is necessary during En-DCR, as well as the optimal mode of support, remains a subject of ongoing clinical debate. Current evidence suggests that routine primary En-DCR does not require mechanical support of theanastomosis. However, in patients with complex conditions—such as high-level or extensive obstruction, a small lacrimal sac, traumatic lacrimal injury, or those undergoing revision surgery—lacrimal stenting is generally recommended to maintain patency of the surgical cavity. In addition, selective nasal cavity support may be considered for patients at high risk of postoperative bleeding, with a large bony ostium, extensive mucosal injury, or those undergoing concomitant intranasal or endoscopic sinus procedures. This review addresses En-DCR from three perspectives: procedures without mechanical support, selective lacrimal pathway support, and selective nasal cavity support. It summarizes recent advances in the individualized selection of mechanical support strategies for En-DCR, analyzes their clinical outcomes and existing controversies, and aims to provide a theoretical reference for clinical practice to help optimize treatment strategies for lacrimal drainage disorders.

Objective:To explore the related influencing factors for prognosis of patients undergoing plastic and reconstructive surgery with transnasal endoscope for blowout orbital fracture(BOF),so as to adopt corresponding intervention measures for patients in clinical practices,thus improve the prognosis of patients.Methods:A total of 107 patients who underwent plastic and reconstructive surgery with transnasal endoscope for BOF in Qingdao Municipal Hospital from September 2015 and September 2024 were enrolled in this study.Preoperative and postoperative clinical data,as well as follow-up records,of patients who underwent plastic and reconstructive surgery for BOF were collected.According to follow-up data of plastic and reconstructive surgery with transnasal endoscope for BOF,the 107 patients were divided into two groups:a poor prognosis group(n=35)and a favorable prognosis group(n=72).Comparative analysis was performed for the two groups.Logistic regression analysis was subsequently employed to identify influencing factors for prognosis of patients who underwent plastic and reconstructive surgery with transnasal endoscope for BOF,and conduct assessment and analysis for risk factors.Results:In poor prognosis group with 35 patients:12 cases occurred diplopia(34.28%),and 11 cases occurred limited ocular motility(31.42%),and 11 cases occurred enophthalmos(31.42%),and 1 case occurred infraorbital nerve hypoesthesia(2.85%).The age(44.66±12.70 years old)and surgical duration(91.43±56.97 minutes)of poor prognosis group were significantly higher than those of favorable prognosis group,with statistical significance(t=-2.547,-2.23,P<0.05).The proportions of patients with hypertension history,with diabetes history,with bone defect area≥2 cm2,and interval between injury and surgery≥14 days of poor prognosis group were significantly higher than those of favorable prognosis group,with statistical differences(x2=8.756,33.142,62.163,13.769,P<0.05),respectively.Multivariate logistic regression analysis identified diabetes history,bone defect area≥2 cm2,and interval between injury and surgery≥14 days were influencing factors for the prognostic of patients who underwent plastic and reconstructive surgery with transnasal endoscope for BOF(OR=0.022,0.012,0.123,P<0.05),respectively.Conclusion:The d iabetes history,bone defect area≥2 cm2,and interval between injury and surgery≥14 days are independent risk factors for poor prognosis in patients who undergo plastic and reconstructive surgery with transnasal endoscope for BOF.It is important measure that effectively improve prognosis of patients who undergo plastic and reconstructive surgery with transnasal endoscope for BOF,which include selecting optimal surgical timing,defining the extent of bone defects and the comorbidities before surgery,and implementing glycemic control at perioperative and postoperative stage.

Objective:To explore the related influencing factors for prognosis of patients undergoing plastic and reconstructive surgery with transnasal endoscope for blowout orbital fracture(BOF),so as to adopt corresponding intervention measures for patients in clinical practices,thus improve the prognosis of patients.Methods:A total of 107 patients who underwent plastic and reconstructive surgery with transnasal endoscope for BOF in Qingdao Municipal Hospital from September 2015 and September 2024 were enrolled in this study.Preoperative and postoperative clinical data,as well as follow-up records,of patients who underwent plastic and reconstructive surgery for BOF were collected.According to follow-up data of plastic and reconstructive surgery with transnasal endoscope for BOF,the 107 patients were divided into two groups:a poor prognosis group(n=35)and a favorable prognosis group(n=72).Comparative analysis was performed for the two groups.Logistic regression analysis was subsequently employed to identify influencing factors for prognosis of patients who underwent plastic and reconstructive surgery with transnasal endoscope for BOF,and conduct assessment and analysis for risk factors.Results:In poor prognosis group with 35 patients:12 cases occurred diplopia(34.28%),and 11 cases occurred limited ocular motility(31.42%),and 11 cases occurred enophthalmos(31.42%),and 1 case occurred infraorbital nerve hypoesthesia(2.85%).The age(44.66±12.70 years old)and surgical duration(91.43±56.97 minutes)of poor prognosis group were significantly higher than those of favorable prognosis group,with statistical significance(t=-2.547,-2.23,P<0.05).The proportions of patients with hypertension history,with diabetes history,with bone defect area≥2 cm2,and interval between injury and surgery≥14 days of poor prognosis group were significantly higher than those of favorable prognosis group,with statistical differences(x2=8.756,33.142,62.163,13.769,P<0.05),respectively.Multivariate logistic regression analysis identified diabetes history,bone defect area≥2 cm2,and interval between injury and surgery≥14 days were influencing factors for the prognostic of patients who underwent plastic and reconstructive surgery with transnasal endoscope for BOF(OR=0.022,0.012,0.123,P<0.05),respectively.Conclusion:The d iabetes history,bone defect area≥2 cm2,and interval between injury and surgery≥14 days are independent risk factors for poor prognosis in patients who undergo plastic and reconstructive surgery with transnasal endoscope for BOF.It is important measure that effectively improve prognosis of patients who undergo plastic and reconstructive surgery with transnasal endoscope for BOF,which include selecting optimal surgical timing,defining the extent of bone defects and the comorbidities before surgery,and implementing glycemic control at perioperative and postoperative stage.

Objective To investigate the expression of serum Maresin 1 and pro-platelet basic protein(PPBP)in patients with diabetes nephropathy(DN)and their correlation with long-term prognosis.Methods A total of 83 patients with diabetes nephropathy admitted to Tangshan Central Hospital from May 2018 to May 2020 were selected as the diabetes nephropathy group.In the same period,60 patients with simple type 2 diabetes were selected as the diabetes group and 60 healthy people as the control group.Enzyme linked immunosorbent assay(ELISA)was used to detect the levels of serum Maresin1 and PPBP.Spearman correlation analysis was used to analyze the correlation between the levels of serum Maresin1 and PPBP and renal pathological damage.COX proportional hazard regression analysis was used to analyze the factors influencing the long-term poor prognosis of patients with diabetes nephropathy.ROC curve was used to evaluate the predictive value of serum Maresin1 and PPBP for the long-term poor prognosis.Results The levels of serum Maresin1(15.90±4.53 ng/ml,12.34±4.29 ng/ml,9.65±4.38 ng/ml)in the control group,diabetes group and diabetes nephropathy group were decreased in turn while the levels of serum PPBP(263.45±85.22 pg/ml,349.28±80.49 pg/ml,435.76±87.21 pg/ml)were increased in turn,and the differences were statistically significant(F=35.159,72.678,all P＜0.05).With the increase of IFTA score,interstitial inflammation score,and glomerular grading,serum Maresin1 level was decreased(F=25.838,25.187,9.751,all P＜0.05),while serum PPBP level was increased(F=56.513,92.702,58.137,all P＜0.05),and the differences were statistically significant,respectively.Serum Maresin1 was negatively correlated with IFTA score,interstitial inflammation score,and glomerular grading(r=-0.637,-0.581,-0.594,all P＜0.05),while serum PPBP was positively correlated with IFTA score,interstitial inflammation score,and glomerular grading(r=0.659,0.664,0.608,all P＜0.05),with significant differences.The course of diabetes nephropathy(HR=1.135,95％CI:1.012～1.370),24-hour urinary protein(HR=1.087,95％CI:1.016～1.164),PPBP(HR=1.208,95％CI:1.119～1.365),and IFTA score(HR=1.139,95％CI:1.024～1.219),interstitial inflammation score(HR=1.122,95％CI:1.006～1.249)and glomerular grading(HR=1.139,95％CI:1.052～1.273)were independent risk factors for long-term prognosis of diabetes nephropathy patients,while eGFR(HR=0.934,95％CI:0.892～0.993)and Maresin1(HR=0.903,95％CI:0.816～0.982)were protective factors for long-term prognosis(all P＜0.05).The areas under the curve(AUC)of serum Maresin1,PPBP and two indicators combined to predict the long-term poor prognosis of patients with diabetes nephropathy were 0.781,0.777 and 0.901,respectively.The AUC of two indicators combined was higher than that,and the differences were significant(Z=3.049,3.258,all P＜0.05).Conclusion In patients with diabetes nephropathy,serum Maresin1 was decreased and PPBP was increased,and the two indexes were closely related to the degree of renal injury.The combined test could effectively predict the long-term poor prognosis of patients.

Guaranteeing the rights and safety of subjects is an important responsibility of all participants in the medical devices clinical trial, including medical institutions, sponsors and researchers. The legal disputes caused by serious adverse events in the clinical trial of medical devices are characterized by complex legal relationships, great difficulty in handling, and many points of dispute. Based on a typical case of medical device clinical trials, this paper discussed the litigation subject qualification, the treatment of contract breach and tort in medical device clinical trial, analyzed the responsibility of different subjects, and provided constructive suggestions on the risk management of medical device clinical trial.

Under the background of "Medical Education Synergy", the clinical practice ability of postgraduates has been significantly improved, and the post competency has been enhanced. However, the "cultivation goal orientation" focuses on clinical practice, the education management department has weakened the cultivation of scientific research literacy, and the postgraduate tutors have not paid enough attention. As a result, the cultivation of scientific research literacy of professional degree postgraduates is seriously affected, and their scientific research ability is obviously weak. Taking gastroenterology as an example, by optimizing the course setting and rotation plan arrangement, attaching importance to the management of the graduate management department and the tutor responsibility system, and strengthening the application of interdisciplinary in the innovation and development of disciplines, we have explored an educational plan for cultivating professional degree postgraduates. The clinical practice and clinical research capabilities of postgraduates majoring in gastroenterology have been synergistically developed with remarkable results.

Objective:To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection.Methods:This was a retrospective cohort study. We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023. Patients were divided into a colloidal gold immunochromatographic assay (GICA) group (17 patients) and conventional testing group (56 patients) based on whether a GICA for CRE had been performed on the patients' first blood culture sample during the diagnosis and treatment process. There were no statistically significant differences between the GICA and conventional testing groups in age ([55.9±17.3] vs. [47.6±16.4] years), sex ([16 men vs. one woman ] vs. [41 men vs. 15 women]), median Charlson comorbidity index (3.0[2.0,4.0] vs. 3.0[2.0, 4.8]), septic shock (10 vs. 39), or acute kidney injury (8 vs. 40) (all P>0.05). Both groups routinely underwent traditional bacterial identification and drug susceptibility testing. Additionally, patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit. The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups. We also compared the microbial clearance rate, duration of hospitalization and intensive care unit stay, and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups. Results:The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group (15/17 vs. 34/56 [60.7%], χ 2=4.476, P=0.034), whereas the 28-day mortality tended to be lower in the GICA than conventional testing group [5/17 vs. 44.6% [25/56], χ 2=1.250, P=0.264). The 90-day mortality (8/17 vs. 53.6% [30/56], χ 2=0.222, P=0.638), median duration of hospitalization (37.0 [18.0, 46.5] days vs. 45.5 [32.2, 64.8] days, Z=-1.867, P=0.062), and median duration of intensive care unit stay (18.0 [6.5, 35.0] days vs. 32.0 [5.0, 51.8] days, Z=-1.251, P=0.209). The median time between the onset of bloodstream infection and administration of antibiotics was 49.0 (38.0, 69.0) hours in the GICA group, which is significantly shorter than the 163.0 (111.8, 190.0) hours in the conventional testing group ( Z=-5.731, P<0.001). The median time between the onset of bloodstream infection and administration of appropriate antibiotics was 40.0 (34.0, 80.0) hours in the GICA group, which is shorter than in the conventional testing group (68.0 [38.2, 118.8]) hours; however, this difference is not statistically significant ( Z=-1.686, P=0.093). Conclusions:GICA can provide information on carbapenemase- producing pathogens faster than traditional drug sensitivity testing, enabling early administration of the optimal antibiotics. The strategy of 'carbapenemase detection first' for managing bacterial infection has the potential to improve prognosis of patients and reduce mortality rate.

Objective:To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection.Methods:This was a retrospective cohort study. We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023. Patients were divided into a colloidal gold immunochromatographic assay (GICA) group (17 patients) and conventional testing group (56 patients) based on whether a GICA for CRE had been performed on the patients' first blood culture sample during the diagnosis and treatment process. There were no statistically significant differences between the GICA and conventional testing groups in age ([55.9±17.3] vs. [47.6±16.4] years), sex ([16 men vs. one woman ] vs. [41 men vs. 15 women]), median Charlson comorbidity index (3.0[2.0,4.0] vs. 3.0[2.0, 4.8]), septic shock (10 vs. 39), or acute kidney injury (8 vs. 40) (all P>0.05). Both groups routinely underwent traditional bacterial identification and drug susceptibility testing. Additionally, patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit. The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups. We also compared the microbial clearance rate, duration of hospitalization and intensive care unit stay, and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups. Results:The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group (15/17 vs. 34/56 [60.7%], χ 2=4.476, P=0.034), whereas the 28-day mortality tended to be lower in the GICA than conventional testing group [5/17 vs. 44.6% [25/56], χ 2=1.250, P=0.264). The 90-day mortality (8/17 vs. 53.6% [30/56], χ 2=0.222, P=0.638), median duration of hospitalization (37.0 [18.0, 46.5] days vs. 45.5 [32.2, 64.8] days, Z=-1.867, P=0.062), and median duration of intensive care unit stay (18.0 [6.5, 35.0] days vs. 32.0 [5.0, 51.8] days, Z=-1.251, P=0.209). The median time between the onset of bloodstream infection and administration of antibiotics was 49.0 (38.0, 69.0) hours in the GICA group, which is significantly shorter than the 163.0 (111.8, 190.0) hours in the conventional testing group ( Z=-5.731, P<0.001). The median time between the onset of bloodstream infection and administration of appropriate antibiotics was 40.0 (34.0, 80.0) hours in the GICA group, which is shorter than in the conventional testing group (68.0 [38.2, 118.8]) hours; however, this difference is not statistically significant ( Z=-1.686, P=0.093). Conclusions:GICA can provide information on carbapenemase- producing pathogens faster than traditional drug sensitivity testing, enabling early administration of the optimal antibiotics. The strategy of 'carbapenemase detection first' for managing bacterial infection has the potential to improve prognosis of patients and reduce mortality rate.

Objective:To establish a comprehensive and effective scoring model based on ultrasonic characteristics for predicting the restenosis risk after superficial femoral artery stenting, in order to assess the possibility of in-stent restenosis and to provide guidance for the selection of therapeutic strategies.Methods:A retrospective review of a database of 328 patients (381 limbs) undergoing superficial femoral artery stents in Xuanwu Hospital, Capital Medical University from January 2016 to January 2018 was made as a modeling group.In the modeling cohort, the multivariate logistic regression analysis was performed to screen independent risk factors for in-stent restenosis. A predictive scoring model of restenosis risk was established with weighted score of independent risk factors according to the odd ratio values. Based on the best cut-off value of the receiver operating characteristic (ROC) curves, the scoring table was divided into low-risk and high-risk groups of restenosis.Results:Multivariate logistic regression analysis showed that 8 factors were included in the score system to establish the scoring model of in-stent restenosis risk prediction including calcified plaque, peak systolic velocity of popliteal artery<40 cm/s, runoff scores≥4, ankle-brachial index<0.5, female (1 point each); complicated stroke, complicated chronic renal disease, total lesion length 15.0-24.9 cm (2 points each); total lesion length≥25.0 cm (3 points), a total of 12 points in the model. The validation indicated that the scoring system had good predictive value(AUC=0.775, 95% CI=0.727-0.824, P<0.001) and goodness of fit (Hosmer-Lemeshow χ 2=4.921, P=0.766). The agreement with digital subtraction angiography(DSA) was good (Kappa value=0.609). The scoring system was further divided into the low-risk restenosis (0-5 points) and high-risk restenosis (6-12 points) according to the best cut-off value of 5.5, with a sensitivity of 68.1%, a specificity of 74.6%, and the accuracy of 72.7%. Conclusions:The superficial femoral artery in-stent restenosis risk predicting score model based on ultrasonic characteristics may accurately predict the restenosis preoperatively. It provides a theoretical basis for the precise surgical plans.

Objective To investigate effect of emodin on mice immune function and its hemolysis toxicity.Methods The mouse specific immune cells of T, B lymphocytes and nonspecific immune cell of macrophages and NK cells were prepared and incubated in vitro.The different immune cells were treated by emodin with different concentrations of 5,10,15 and 20μM, and DMSO as control group.The effect of emodin on immune cells function was detected by neutral red assay and MTT assay.The hemolysis test in vitro was conducted by emodin with different concentrations of 20, 40, 60 and 80μM, physiological saline as blank control group and sterile distilled water as positive control group, then the hemolysis toxicity of emodin was observed. Results There were no significant difference of T and B lymphocyte proliferation among control group, 5, 10, 15 and 20 μM group(F=0.009,P=1.000;F=0.003,P=1.000), the phagocytic ability of macrophages enhanced in each dose group and was concentration dependent(F=665.525,P=0.000), the proliferation rate of macrophages enhanced and was concentration dependent(F=134.812,P=0.000), the activity of NK cells enhanced and was concentration dependent(F=200.190,P=0.000).Hemolysis test results showed the hemolysis rate was less than 5% in the range of 20 to 80μM emodin.Conclusion Emodin could significantly promote the nonspecific immune cells activity.Within the concentration of experiment, emodin has no hemolysis toxicity.