Infective endocarditis (IE) is a life-threatening infectious disease. Although histopathological examination remains the gold standard for definitive diagnosis, it is performed in only a minority of patients; thus, the diagnosis of IE continues to rely predominantly on clinical manifestations. However, IE presents with highly variable systemic symptoms that often lack cardiac-specific features, posing significant diagnostic challenges. To address this complexity, multiple diagnostic criteria have been developed, integrating clinical presentation, imaging findings, and microbiological evidence. Over the past three decades, substantial shifts in the microbiological and epidemiological profiles of IE, coupled with advances in imaging modalities and laboratory diagnostics, have profoundly influenced diagnostic approaches, driving continuous refinement of diagnostic criteria. This review provides a comprehensive overview of the major diagnostic criteria for IE, traces their historical evolution, evaluates recent updates and diagnostic performance, and offers theoretical insights and practical implications to guide future research.

ObjectiveTo observe the clinical efficacy of acupuncture combined with bloodletting and cupping in the treatment of chronic spontaneous urticaria（CSU） and to explore its potential mechanisms of action. MethodsSeventy CSU patients were randomly divided into loratadine group and acupuncture + bloodletting group， with 35 patients in each group. The loratadine group received oral loratadine tablets， 10 mg once daily in the evening. The acupuncture + bloodletting group received acupuncture at Zhongwan （CV 12）， Guanyuan （CV 4）， Tianshu （ST 25）， Zusanli （ST 36）， Sanyinjiao （SP 6）， Xuehai （SP 10）， Quchi （LI 11）， Hegu （LI 4）， Taichong （LR 3）， Baihui （GV 20）， and Shenting （GV 24）， once daily，along with bloodletting and cupping at Dazhui （GV 14） and Geshu （BL 17）， every other day. Both groups were treated for 4 weeks. The 7-day urticaria activity score（UAS7） was assessed before and after the treatment， and levels of serum immunoglobulin E （IgE）， interleukin-4 （IL-4）， interleukin-5 （IL-5）， eosinophil cationic protein （ECP）， plasma tissue factor （TF）， activated factor Ⅶ （FⅦa）， prothrombin fragment 1+2 （F1+2）， D-dimer （D-D） and complement component 5a （C5a） were detected. ResultsA total of 65 patients were included in the final analysis， 32 in the loratadine group and 33 in the acupuncture + bloodletting group. Before treatment， there was no significant difference in UAS7 score， serum IgE， IL-4， IL-5， ECP levels， or plasma TF， FⅦa， F1+2， D-D， C5a levels between groups （P＞ 0.05）. After treatment， both groups showed significant reductions in UAS7 score， serum IgE， IL-4， IL-5， and plasma TF， FⅦa， F1+2， D-D， and C5a levels compared to those before treatment （P＜0.01）. However， after treatment， there was no significant difference in UAS7 score and serum ECP， IgE， IL-4， IL-5 levels between groups （P＞0.05）. The acupuncture + bloodletting group showed lower plasma TF， FⅦa， F1+2， D-D and C5a levels compared to the loratadine group （P＜0.05 or P＜0.01）. ConclusionAcupuncture combined with bloodletting and cupping can effectively improve the skin symptoms of CSU patients and reduce the levels of inflammatory factors. The potential mechanism of action may involve the regulation of the coagulation-complement-mast cell activation axis， thereby inhibiting mast cell degranulation.

Objective To summarize the clinical features of infectious intracranial aneurysm (IIA) related to infective endocarditis (IE) and share our experiences in the diagnosis and treatment of IIA. Methods A retrospective analysis was conducted on the clinical data of 554 patients who underwent cardiac surgery for IE at the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from September 2018 to August 2023. Patients with secondary IIA were included and reviewed. Based on the treatment strategies, patients were stratified into two groups: an antibiotic-only group and an endovascular treatment group. Results The cohort comprised 21 males and 10 females, with a median age of 33 years (IQR 26-53). Fifteen (48.4%) patients showed no significant neurological symptoms before IIA diagnosis. Seven patients received antibiotic therapy alone, while 24 underwent additional endovascular embolization, achieving technical success in 23 (95.8%) patients. The median interval between endovascular embolization and cardiac surgery was 2 days (IQR 0-6), with 9 patients undergoing concurrent procedures. In the antibiotic-only group, 3 (42.9%) patients suffered fatal IIA rupture. In contrast, only 1 (4.2%) death due to aneurysm rupture occurred in the endovascular treatment group. All surviving patients recovered well without new neurological deficits. Conclusion Routine neuroimaging screening for IIA is critical in IE patients. For those requiring cardiac surgery, endovascular embolization combined with antimicrobial therapy represents a reasonable strategy to mitigate rupture risks and improve outcomes.

Geriatric oral health care encounters significant challenges with the increase in the proportion of older individuals. Age-related changes in the dentition, muscles, and joints result in a decline in objective masticatory function, subjective restoration requirements, and acceptability among the elderly population, with individual variations influenced by systemic health. Considering functional requirements, the adaptability of stomatognathic and systemic health conditions, health economics and other factors, the authors believe that it should not be limited to the conventional "one-to-one" strategy for replacing missing teeth in geriatric prosthodontics. There is an urgent need for a precise and adaptable restoration strategy that is more suitable for older individuals. The proposal of a new concept of functional tooth loss updates the minimal restoration standards for elderly patients and establishes the theory of age-friendly functional restoration. Based on the restoration strategy of functional tooth loss, this paper proposes a new concept termed "age-friendly functional restoration of the stomatognathic system", which integrates treatment considerations including endodontics, periodontology, mucosa, muscles, temporomandibular joint, and systemic health. Efforts should be made in four areas as follows. Firstly, the "assessment of accessible function" should be enhanced by considering the interrelationship between stomatognathic and systemic health. Secondly, the "evaluation of appropriate function" is supposed to be optimised in view of subjective needs and objective evaluation of the stomatognathic system. Moreover, the "formulation of treatment plans" needs to be accomplished with the aid of assistive technologies, such as artificial intelligence, to accurately exert appropriate functional restoration. Lastly, the "management and maintenance of health" is likely to be strengthened through follow-ups, propaganda and education, and preventive healthcare, so as to improve quality of life and ultimately achieve healthy ageing among older individuals.
Humans ; Tooth Loss/therapy* ; Aged ; Stomatognathic System ; Oral Health ; Dental Care for Aged ; Dental Restoration, Permanent/methods*

Objective:To investigate the effects of electroacupuncture on neuroinflammation in rats with postherpetic neuralgia (PHN) by regulating advanced glycation end products (AGE) and its receptor (RAGE) signaling pathway.Methods:Ten healthy male SD rats were randomly selected as the control group, and the remaining 30 SD rats were used to induce PHN model by resin toxin (RTX). Thirty SD rats were randomly divided into model group, positive drug group and electroacupuncture group, with 10 rats in each group. Intervention was conducted on the 7th day of modeling. The electroacupuncture group intervened with "Yanglingquan"(GB34) and "Huantiao"(GB30); the positive drug group was intragastrically administered with pregabalin suspension 27 mg/kg, once a day for 1 week; the control group and model group were not treated. The paw retraction threshold (PWMT) and paw retraction latency (PWTL) were measured before modeling and on the 7th, 14th, 21st and 28th days after modeling; histopathological changes of spinal cord were observed by HE staining; the levels of TNF-α, IL-1β and IL-6 in spinal cord tissue were detected by ELISA; the expressions of AGE-RAGE signaling pathway related proteins in spinal cord was detected by Western blot.Results:Compared with the model group, the degree of atrophy and inflammatory infiltration of spinal cord neurons in the positive drug group and electroacupuncture group were reduced. The PWMT value in the positive drug group increased ( P<0.05), and the PWTL value decreased ( P<0.05); compared with the model group, the levels of TNF-α, IL-1β and IL-6 in the spinal cord tissue of the electroacupuncture group and the positive drug group decreased ( P<0.05), and the expressions of AGE, RAGE, p-ERK1/2/ERK1/2, JNK, p-NF-κB/NF-κB and AP-1 decreased ( P<0.05); compared with the positive drug group, the levels of TNF-α, IL-1β and IL-6 in the spinal cord tissue of the electroacupuncture group decreased ( P<0.05), and the protein expressions of AGE, RAGE, p-ERK1/2/ERK1/2, JNK, p-NF-κB/NF-κB and AP-1 decreased ( P<0.05). Conclusion:Electroacupuncture can improve neuroinflammation in PHN rats, the mechanism of which may be related to the regulation of AGE-RAGE mediated pro-inflammatory signaling pathway.

Objective To compare the clinical outcomes of mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for infective endocarditis, and to investigate the effect of MVP under different surgical risks. Methods A retrospective study was done on the patients with mitral infective endocarditis, who underwent surgical treatment in our department from January 2018 to March 2022. According to the procedures, the patients were divided into a MVP group and a MVR group. Propensity score matching method was applied with a ratio of 1:1 to eliminate the biases. The early and midterm outcomes were compared between the two groups after matching. According to the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE-Ⅱ), the effect of MVP was compared between high and low risk patients. Results A total of 195 patients were collected. There were 141 patients in the MVP group (120 males, 85.1%) and 54 patients in the MVR group (41 males, 75.9%). The mean follow-up time was (34.0±16.1) months. Patients in the MVP group were younger [(42.7±14.6) years vs. (56.8±13.0) years, P<0.001] and had better preoperative conditions. The patients in the MVP group had a shorter ICU stay [3.0 (2.0, 5.0) d vs. 4.0 (3.0, 8.0) d, P=0.004], and lower incidences of low cardiac output syndrome (0.7% vs. 9.3%, P=0.007), in-hospital mortality (0.0% vs. 3.7%, P=0.023), and follow-up mortality (4.3% vs. 15.4%, P=0.007). However, after 1:1 propensity score matching, there were no statistical differences in the baseline data or postoperative and follow-up adverse events between the two groups (P>0.05). Also, there was no statistical difference in the mortality of high-risk patients between MVP and MVR group (P>0.05). There was no statistical difference in the reoperation or recurrent severe mitral regurgitation between high and low-risk patients in the MVP group (P>0.05). Conclusion MVP is feasible for treating mitral lesions caused by infective endocarditis with good early and midterm outcomes. For patients with severer preoperative conditions, if the leaflet damage is not severe, MVP may be a viable option, but validation with larger sample sizes is needed.

Objective To analyze the short- and mid-term outcomes of patients undergoing reconstruction of intervalvular fibrous body (IVFB) via double valve replacement (Commando procedure) or aortic valve replacement and mitral valve repair (Hemi-Commando procedure). Methods The patients who underwent Commando or Hemi-Commando procedure between September 2014 and September 2022 in Guangdong Provincial People’s Hospital were collected. The perioperative and follow-up data were reviewed and analyzed for the assessment of short- and mid-term outcomes. Results Eleven patients received Commando procedure (a Commando group), including 4 males and 7 females with a median age of 61 (33, 68) years; 7 patients received Hemi-Commando procedure (a Hemi-Commando group), including 5 males and 2 females with a median age of 50 (36, 58) years. Two patients died in the postoperative 30 days (1 patient in the Commando group and 2 patients in the Hemi-commando group). Low cardiac output syndrome complicated with multiple organ dysfunction syndrome was the main cause of death. Fifteen patients were discharged and followed up for 13 (6, 42) months, with a survival rate of 100%. The rates of free from recurrent endocarditis or re-operation were both 100%. Conclusion Commando and Hemi-Commando procedures are effective strategies for IVFB reconstruction, and can achieve excellent mid-term outcomes if patients survive from the frailest period of early postoperative stage.

Objective:To explore the efficacy of immune checkpoint inhibitors combined with adjuvant chemotherapy in patients with phase III gastric cancer and esophagogastric junction cancer.Methods:This study used a retrospective cohort study method based on real-world data. Clinical data of 403 patients with stage III gastric/esophagogastric junction cancer who underwent gastrectomy followed by adjuvant therapy in the Department of Gastric Surgery at Sun Yat-sen University Cancer Center from January 2020 to December 2023 were retrospectively collected. The study cohort comprised 147 (36.5%) patients with stage IIIA, 130 (32.3%) with stage IIIB, and 126 (31.3%) with stage IIIC gastric/esophagogastric junction cancer. Of them, 15 (3.7%) were HER-2 positive, 25 (6.2%) dMMR, and 22 (5.5%) patients Epstein-Barr virus encoding RNA (EBER) positive. Based on treatment plans, the patients were divided into immune checkpoint inhibitor combined with chemotherapy group (immune therapy group, n=110, 71 males and 39 females, median age 59 years old) and chemotherapy alone group (chemotherapy group, n=293, 186 males and 107 females, median age 60 years old). All patients in the immunotherapy group received immune checkpoint inhibitors targeting the programmed cell death protein-1 (PD-1) and its ligand (PD-L1). Of them, 85 received pembrolizumab, 10 received sintilimab, 8 received tislelizumab, 4 received camrelizumab, 2 received toripalimab, and 1 received pabocizumab. The adjuvant chemotherapy regimens used among the chemotherapy alone group includes SOX regimen (132 cases), XELOX (102 cases), S-1 monotherapy (44 cases), and other regimens (15 cases). The 3-year DFS rate of the two groups was compared, and subgroup analysis was conducted based on different ages, molecular phenotypes, pTNM staging, extranodal infiltration, and tumor length. Results:The median follow-up was 20.5 months (range 3.1~46.3), with a 3-year overall DFS rate of 61.4% for the entire 403 patients. The 3-year DFS rate for the immunotherapy group was 82.7%, higher than the chemotherapy alone group (58.8%), with a statistically significant difference ( P=0.021). Multivariate analysis showed that postoperative immunotherapy was a protective factor for DFS (HR=0.352, 95%CI: 0.180~0.685). Subgroup analysis showed that stage IIIC (HR=0.416, 95%CI: 0.184~0.940), aged ≥60 years (HR=0.336, 95%CI: 0.121~0.934) and extranodal invasion (HR=0.378, 95%CI: 0.170~0.839) were associated with benefit from the combined immune adjuvant chemotherapy, while no association was observed for MMR, HER-2 or EBER status. Conclusion:Stage III gastric/esophagogastric junction cancer patients may benefite from postoperative immune checkpoint inhibitor combined with adjuvant chemotherapy in real-world settings.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

The overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.