AIM:To evaluate the clinical efficacy and safety of the silk thread traction intubation as a rescue technique for intraoperative silicone stent perforation during RS bicanalicular lacrimal intubation, and to clarify the value of technical innovation and promotion in primary care.METHODS: A retrospective analysis was conducted on patients with silicone stent perforation and failed conventional RS intubation treated at the Department of Ophthalmology, the Second People's Hospital of Changzhou from July 2022 to June 2025. All patients underwent reconstruction of the physiological lacrimal-nasal passage using Zhang's memory guidewire lacrimal probing and guiding needle. Repositioning and implantation of the damaged silicone stent were completed via 3-0 silk thread traction. Standard follow-up was performed for at least 6 mo postoperatively. Intraoperative and postoperative conditions of the patients were observed.RESULTS: A total of 21 patients(21 eyes)were enrolled in this study, including 6 males and 15 females, with a mean age of 59.6±10.8 y. The intraoperative salvage intubation success rate was 100% for all 21 eyes. Among them, 3 eyes required immediate removal of the silicone stent after implantation(1 eye developed a nasal corneal ulcer requiring priority treatment of ocular infection; 2 eyes had intolerable epiphora and discomfort and requested stent removal voluntarily). The remaining 18 eyes had no re-displacement or stent prolapse during indwelling, and the stents were successfully extracted after 3 mo of indwelling as scheduled. The complete lacrimal patency rates at 1, 3 and 6 mo after successful silicone stent implantation were 95%(20 eyes), 90%(19 eyes)and 81%(17 eyes), respectively. At 6 mo postoperatively, 17 eyes(81%)presented complete lacrimal passage patency, 3 eyes(14%)showed incomplete lacrimal patency, and 1 eye(5%)had complete obstruction. Postoperative complications included mild lacrimal puncta tearing in 2 eyes, lacrimal puncta granulation hyperplasia in 1 eye, and lacrimal puncta eversion in 1 eye. Among the 3 eyes with immediate silicone stent removal, only 1 eye developed recurrent lacrimal passage obstruction at 3 wk postoperatively, which was effectively treated by re-intubation. The remaining 2 eyes were cured without aggravation of corneal ulcer, lacrimal stenosis, or persistent lacrimal obstruction.CONCLUSION: The silk thread traction intubation represents a safe, efficient and minimally invasive salvage approach for stent perforation during RS lacrimal intubation. With the advantages of precise localization, high operative efficiency and minimal tissue damage, it greatly increases the success rate of silicone stent repositioning and reintubation accompanied by manageable complications.

Objective To construct a Ca2+/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ)long-fragment fusion protein plasmid;investigate the expression,extraction,and purification of CaMK Ⅱ;and identify its binding to the Cav1.2 channel.Methods The extracted pGEX-6p-1/CaMK Ⅱ long-fragment plasmid was transformed into Escherichia coli BL21 receptor cells and cultured in a shaking incubator for 12 h.Isopropyl β-D-thiogalactoside was added to promote GST fusion protein expression.Next,the GST-CaMK Ⅱ long frag-ment was isolated and purified with GS-4B using dithiothreitol(DTT)combined with ultrasonic crushing.After treatment with the PreScis-sion protease,the GST label was removed to obtain the CaMK Ⅱ long-fragment protein.The molecular weight and relative purity of the CaMKⅡ long-fragment protein were determined using 15％sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE).The concentration of the purified protein was determined using the Bradford method.The binding ability of the CaMK Ⅱ long-fragment pro-tein to the Cav1.2 channel protein was evaluated using the pull-down method combined with Western blotting.Results The sequencing results showed that the CaMK Ⅱ long fragment was successfully constructed.A CaMK Ⅱ long-fragment protein with high purity and con-centration was obtained using DTT combined with ultrasonic crushing.This protein can bind to the CT1 protein of cardiac Cav1.2 calcium channel.Conclusion In this study,we successfully constructed a CaMKⅡ long-fragment plasmid.The CaMKⅡ long-fragment protein was extracted and purified,and was determined to bind to Cav1.2 channel proteins and exhibit biological activity.Collectively,this study provides a basis for further study of the function of CaMK Ⅱ.

Objective:To evaluate the performance of deep learning reconstruction (DLR) in visualizing lenticulostriate arteries (LSAs) on cerebral CT angiography (CTA).Methods:This cross-sectional study retrospectively analyzed cerebral CTA from 38 patients who underwent cerebral CTA at the Fourth Affiliated Hospital of Harbin Medical University between January and December 2023. Images were reconstructed using filtered back projection (FBP), three-dimensional adaptive iterative dose reduction (AIDR), and DLR-advanced inteuigent clear-IQ engine(AiCE) algorithms (FBP group, AIDR group, DLR-AiCE group). On axial images, the mean CT values, standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus. Subjective evaluations were performed for overall vascular visualization and LSAs delineation. Comparisons of subjective and objective evaluation indexes among the 3 groups were performed using the complex measurement ANOVA, Friedman test, or χ2 test. Results:The CT, SD, SNR and CNR values at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus demonstrated statistically significance among DLR-AiCE group, AIDR group and FBP group ( P<0.001), in which, except for the difference between the FBP group and the AIDR group in the CT value of the head of the caudate nucleus and the CT value of the cerebrospinal fluid of the lateral ventricle which was not statistically significant ( P>0.05), the remaining pairwise comparisons between the groups for each site measurements were statistically significant ( P<0.001). The difference in the overall comparison of the subjective scores of the overall vessels and LSAs in the images of the DLR-AiCE group, the AIDR group, and the FBP group was statistically significant ( P<0.001), and the two-by-two comparisons showed a statistically significant difference ( P<0.001) except for the difference in the subjective scores of LSAs between the FBP group and the AIDR group. Conclusion:The DLR-AiCE algorithm significantly reduces image noise and improves image quality, enabling superior visualization of LSAs, thereby enhancing diagnostic confidence.

Objective:To evaluate the performance of deep learning reconstruction (DLR) in visualizing lenticulostriate arteries (LSAs) on cerebral CT angiography (CTA).Methods:This cross-sectional study retrospectively analyzed cerebral CTA from 38 patients who underwent cerebral CTA at the Fourth Affiliated Hospital of Harbin Medical University between January and December 2023. Images were reconstructed using filtered back projection (FBP), three-dimensional adaptive iterative dose reduction (AIDR), and DLR-advanced inteuigent clear-IQ engine(AiCE) algorithms (FBP group, AIDR group, DLR-AiCE group). On axial images, the mean CT values, standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus. Subjective evaluations were performed for overall vascular visualization and LSAs delineation. Comparisons of subjective and objective evaluation indexes among the 3 groups were performed using the complex measurement ANOVA, Friedman test, or χ2 test. Results:The CT, SD, SNR and CNR values at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus demonstrated statistically significance among DLR-AiCE group, AIDR group and FBP group ( P<0.001), in which, except for the difference between the FBP group and the AIDR group in the CT value of the head of the caudate nucleus and the CT value of the cerebrospinal fluid of the lateral ventricle which was not statistically significant ( P>0.05), the remaining pairwise comparisons between the groups for each site measurements were statistically significant ( P<0.001). The difference in the overall comparison of the subjective scores of the overall vessels and LSAs in the images of the DLR-AiCE group, the AIDR group, and the FBP group was statistically significant ( P<0.001), and the two-by-two comparisons showed a statistically significant difference ( P<0.001) except for the difference in the subjective scores of LSAs between the FBP group and the AIDR group. Conclusion:The DLR-AiCE algorithm significantly reduces image noise and improves image quality, enabling superior visualization of LSAs, thereby enhancing diagnostic confidence.

Objective To construct a Ca2+/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ)long-fragment fusion protein plasmid;investigate the expression,extraction,and purification of CaMK Ⅱ;and identify its binding to the Cav1.2 channel.Methods The extracted pGEX-6p-1/CaMK Ⅱ long-fragment plasmid was transformed into Escherichia coli BL21 receptor cells and cultured in a shaking incubator for 12 h.Isopropyl β-D-thiogalactoside was added to promote GST fusion protein expression.Next,the GST-CaMK Ⅱ long frag-ment was isolated and purified with GS-4B using dithiothreitol(DTT)combined with ultrasonic crushing.After treatment with the PreScis-sion protease,the GST label was removed to obtain the CaMK Ⅱ long-fragment protein.The molecular weight and relative purity of the CaMKⅡ long-fragment protein were determined using 15％sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE).The concentration of the purified protein was determined using the Bradford method.The binding ability of the CaMK Ⅱ long-fragment pro-tein to the Cav1.2 channel protein was evaluated using the pull-down method combined with Western blotting.Results The sequencing results showed that the CaMK Ⅱ long fragment was successfully constructed.A CaMK Ⅱ long-fragment protein with high purity and con-centration was obtained using DTT combined with ultrasonic crushing.This protein can bind to the CT1 protein of cardiac Cav1.2 calcium channel.Conclusion In this study,we successfully constructed a CaMKⅡ long-fragment plasmid.The CaMKⅡ long-fragment protein was extracted and purified,and was determined to bind to Cav1.2 channel proteins and exhibit biological activity.Collectively,this study provides a basis for further study of the function of CaMK Ⅱ.

Objective To explore the effect of ultra-low dose dexmedetomidine on cough during an-esthesia recovery period in elderly patients undergoing carotid artery stenting(CAS).Methods A total of 111 elderly patients,75 males and 36 females,aged≥65 years,BMI 18-32 kg/m2,ASA physical statusⅡ or Ⅲ,diagnosed with asymptomatic unilateral severe carotid artery stenosis and scheduled for CAS,were randomly assigned to two groups using a random number table:the dexmedetomidine group(group D,n = 55)and the control group(group C,n = 56).Group D was given dexmedetomidine 0.2-0.5 μg/kg before anesthesia induction,and dexmedetomidine was intravenously infused at a ultra-low dose(0.1-0.2 μg·kg-1·h-1)after anesthesia induction to 30 minutes before the end of the operation,while group C did not receive any dexmedetomidine.The anesthesia regimen and intraoperative medication were the same for both groups.The MAP and HR were recorded 15 minutes before anesthesia induction(T0),5 minutes after anesthesia induction(T1),5 minutes before stent implantation(T2),5 minutes after stent implantation(T3),and 5 minutes after tracheal extubation(T4).The dosage of intraoperative propofol and remifentanil,cough and agitation during anesthesia recovery period,respiratory depression(SpO2＜90%),extubation time,postoperative puncture infection,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting were recorded.Results Compared with group C,MAP was significantly decreased at T1 and T2,increased at T3 and T4,and HR was significantly decreased at T1,T3,and T4 in group D(P＜0.05).Compared with group C,the intraoperative use of propofol and remifentanil was significantly decreased,and the incidence of cough and agitation during anesthesia recovery period was significantly decreased in group D(P＜0.05).There was no statistically significant difference in the incidence of respiratory depression,ex-tubation time,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting between the two groups.None of the recruited patients experienced infection at the puncture site.Conclusion Ultra-low dose dexmedetomidine can effectively maintain intraoperative hemodynamic stability,reduce the incidence of cough and agitation during anesthesia recovery period,and does not increase other postoperative adverse re-actions,enhancing anesthesia recovery quality in elderly patients undergoing CAS.

Objective To investigate the effects of continuous infusion of extremely low-dose dexmedetomidine on the hemodynamic sta-bility and recovery of postoperative cognition of older adult patients undergoing carotid artery stenting(CAS).Methods 106 older adult patients undergoing CAS were randomly divided into the dexmedetomidine(group D,n= 52)and control groups(group C,n= 54).Hemo-dynamic and cerebral perfusion changes were recorded 15 min before anesthesia induction(T0),5 min after anesthesia induction(T1),5 min before stent placement(T2),5 min after stent placement(T3),and 5 min after tracheal extubation(T4).The standard deviations(SD)of mean arterial pressure(MAP),heart rate(HR),and regional cerebral oxygen saturation(rSO2)were calculated as SDMAP,SDHR,and SDrSO2,respectively.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate and compare changes in pre-and post-operative cognitive function and examine the incidence of postoperative cognitive dysfunction(POCD)in the two groups.Results SDMAP,SDHR,and SDrSO2 in group D were significantly lower than those in group C(P＜0.05).The applied dosages of anesthetics and vasoactive drugs were significantly lower in group D than C(P＜0.05).Extubation time in group D was significantly shorter than that in group C(P＜0.05).MoCA scores in group D were significantly higher one day after CAS than that in group C and POCD incidence was significantly lower in group D one month after CAS(P＜0.05).Conclusion Continuous infusion of low-dose dexmedetomidine has the potential to maintain hemodynamic stability and cerebral perfusion,reduce the dosage of anesthetic drugs,and improve postoperative cognitive performance in older adult patients.

Objective To understand the current situation of health education contents as well as the differences in their requirements between clinical medical students and clinicians,and to provide reference for the optimization of health education curricula for medical students.Methods A stratified sampling method was adopted to select 511 medical students (303 females and 208 males) from a medical university,and the survey results of 436 clinicians (144 females and 292 males) were taken as reference.Differences in the degrees of need between clinical medical students and clinicians were compared by chi-square tests.Results There were statistical differences in needs between clinical medical students and clinicians regarding drug compliance,smoking cessation intervention,balanced diet,application of Chinese traditional rehabilitation medicine,mobile health technology education,exercise rehabilitation guidance,and theory of health promotion (P＜0.01).With regard to drug compliance,smoking cessation intervention,and exercise rehabilitation guidance,the proportions of clinical medical students' needs were just 87.1％,82.2％,and 81.2％,respectively,but for clinicians the proportions reached up to 96.3％,93.8％,and 92.8％,respectively.Whereas,there were no statistical differences for mental stress management,chronic infectious disease health education,and acute infectious disease health education (P＞0.05).Conclusion There is still a big gap between medical students and clinical doctors when it comes to the knowledge of chronic disease management and healthy lifestyles;clinical medical students have not yet realized the importance of such knowledge and skills.Therefore,the strengthening of course construction for clinical medical students is suggested.

The recommendations of Guideline for Emergency Management of Anaphylaxis answered 15 clinical questions about diagnosis,preparation for treatment,treatment measures,and post-treatment management of anaphylaxis and a total of 26 recommendations were formed.In the recommendations,the quality of evidence was divided into 4 levels:high,moderate,low,and very low.And the strength of recommendation was divided into 2 levels:strong and weak.The strength of recommendations was mainly determined by weighing the advantages and disadvantages,instead of relying on the quality of evidence.Emergency management of anaphylaxis in clinical practice could be carried out with reference to the recommendations of this guideline.

The recommendations of Guideline for Emergency Management of Anaphylaxis answered 15 clinical questions about diagnosis,preparation for treatment,treatment measures,and post-treatment management of anaphylaxis and a total of 26 recommendations were formed.In the recommendations,the quality of evidence was divided into 4 levels:high,moderate,low,and very low.And the strength of recommendation was divided into 2 levels:strong and weak.The strength of recommendations was mainly determined by weighing the advantages and disadvantages,instead of relying on the quality of evidence.Emergency management of anaphylaxis in clinical practice could be carried out with reference to the recommendations of this guideline.