Dental treatments for children and adolescents have unique clinical characteristics that differ from dental care for adults in terms of children's physiology, psychology, and behavior. These differences impose specific requirements on the application of local anesthesia in pediatric dental procedures. This article presents expert consensus on the principles of local anesthesia techniques in pediatric dental therapies, including the use of common anesthetic drugs and dosage control, safety and efficacy evaluation, and prevention and management of complications. The aim is to improve the safety and quality of pediatric dental treatments and offer guidance for clinical application by dentists.
Humans ; Child ; Anesthesia, Local/methods* ; Consensus ; Anesthesia, Dental/methods* ; Adolescent ; Anesthetics, Local/administration & dosage* ; Dental Care for Children

Objective:To investigate the construction of fluorinated human serum albumin (F-HSA) nanoparticles loaded with epirubicin (EPI) EPI@F-HSA and its potential in urothelium penetration after bladder perfusion in female C57 mice.Methods:From January 2023 to December 2023, HSA and EPI were selected as raw materials to synthesize albumin nanoparticles loaded with EPI (EPI@HSA) based on the principles of biomineralization. EPI@F-HSA was synthesized through an amide reaction. The molecular descriptor of hydrated particles were measured by dynamic light scattering and potentiometric analyzer, and the release curve of EPI in vitro was plotted at 0.25, 0.5, 1, 2, 4, 8, 12, 24 and 48 h. The inhibitory effect of EPI@HSA and EPI@F-HSA nanoparticles on MB49 tumor cell activity was determined by MTT assay. The fluorescence distribution of EPI in mouse bladder sections after drug infusion was recorded by confocal microscope and the difference of fluorescence density of EPI was examined by Tukey post-hoc test to reflect the urothelium permeability.Results:The average hydrated particle sizes of EPI@HSA and EPI@F-HSA were 28.2 nm and 32.7 nm, respectively, and the polydispersity index (PDI) were 0.102 and 0.154. The cumulative EPI release of EPI@HSA and EPI@F-HSA nanoparticles within 12 h were 60.5% and 58.2% respectively in pH 5.0 buffer solution, and were 32.8% and 27.1% in pH 7.4 buffer solution. The median inhibitory concentrations of EPI@HSA and EPI@F-HSA nanoparticles on MB49 bladder cancer cells were 1.848 μmol/L and 1.650 μmol/L respectively. After perfusion with EPI, EPI@HSA, and EPI@F-HSA, the fluorescence intensities of EPI in the bladder wall were 2.63±0.43, 3.22±0.20 and 8.71±0.70, respectively, and the EPI fluorescence intensity of EPI@F-HSA was significantly higher than that of EPI@HSA ( P<0.01) and free EPI ( P<0.01). Conclusions:The fluorinated albumin nanoparticles had uniform particle size, good stability, significant inhibition of tumor cell activity and osmotic potential in urothelium, which had the potential to improve the anti-tumor efficacy and were expected to become a new drug delivery system targeting bladder cancer.

Objective:To investigate the construction of fluorinated human serum albumin (F-HSA) nanoparticles loaded with epirubicin (EPI) EPI@F-HSA and its potential in urothelium penetration after bladder perfusion in female C57 mice.Methods:From January 2023 to December 2023, HSA and EPI were selected as raw materials to synthesize albumin nanoparticles loaded with EPI (EPI@HSA) based on the principles of biomineralization. EPI@F-HSA was synthesized through an amide reaction. The molecular descriptor of hydrated particles were measured by dynamic light scattering and potentiometric analyzer, and the release curve of EPI in vitro was plotted at 0.25, 0.5, 1, 2, 4, 8, 12, 24 and 48 h. The inhibitory effect of EPI@HSA and EPI@F-HSA nanoparticles on MB49 tumor cell activity was determined by MTT assay. The fluorescence distribution of EPI in mouse bladder sections after drug infusion was recorded by confocal microscope and the difference of fluorescence density of EPI was examined by Tukey post-hoc test to reflect the urothelium permeability.Results:The average hydrated particle sizes of EPI@HSA and EPI@F-HSA were 28.2 nm and 32.7 nm, respectively, and the polydispersity index (PDI) were 0.102 and 0.154. The cumulative EPI release of EPI@HSA and EPI@F-HSA nanoparticles within 12 h were 60.5% and 58.2% respectively in pH 5.0 buffer solution, and were 32.8% and 27.1% in pH 7.4 buffer solution. The median inhibitory concentrations of EPI@HSA and EPI@F-HSA nanoparticles on MB49 bladder cancer cells were 1.848 μmol/L and 1.650 μmol/L respectively. After perfusion with EPI, EPI@HSA, and EPI@F-HSA, the fluorescence intensities of EPI in the bladder wall were 2.63±0.43, 3.22±0.20 and 8.71±0.70, respectively, and the EPI fluorescence intensity of EPI@F-HSA was significantly higher than that of EPI@HSA ( P<0.01) and free EPI ( P<0.01). Conclusions:The fluorinated albumin nanoparticles had uniform particle size, good stability, significant inhibition of tumor cell activity and osmotic potential in urothelium, which had the potential to improve the anti-tumor efficacy and were expected to become a new drug delivery system targeting bladder cancer.

Objective : To explore from the perspective of microorganisms the changes in plaque microbial community of children with severe early childhood caries (S-ECC) before and 3 months after dental treatment. Meanwhile to show the effect of treatment on the maintenance of long- term caries-free state. Methods: S-ECC children completed dental treatment under general anesthesia. We collected plaque from caries-free dental surfaces before treatment (caries, C) and at the postoperative follow-up review time points of 7 days (C-7D), 1 month (C-1 M), and 3 months (C-3 M). We included caries-free children (caries free, CF) as the control group to analyze the dynamic modification process of the plaque microbial community in the short-term pre- and postdental treatment. Results: Species clustering analysis showed that the compositions of the microbial communities of the S-ECC and CF groups were highly similar. The α diversity index was not statistically significant (P>0.05). From the analysis of the relative abundance, Leptotrichia spp. and Aggregatibacter spp. decreased after treatment compared with before treatment (P<0.05). Streptococcus sanguinis in the C-7D group increased compared with that in the C group and gradually decreased within 3 months. Veillonella spp., Actinomyces spp., Allprevotella spp., Capnocytophaga spp., and Streptococcus mutans differed between the C and CF groups (P<0.05), Streptococcus mutans did not differ significantly between the C-7D and C-1 M groups and the CF group after treatment, while C-3 M showed an increase compared with the CF group (P<0.01). Conclusion The rapid change in the structure of the flora of children with S-ECC after treatment. The plaque microbial community structure in a caries-free state gradually starts to be established 1-3 months after treatment. There is a "core microbiota" in the oral plaque community that jointly maintains microecological stability. Veillonella spp., Allprevotella spp. and Streptococcus mutans have potential as possible microbial markers.

Via an insufficient coat protein complex I (COPI) retrieval signal, the majority of SARS-CoV-2 spike (S) is resident in host early secretory organelles and a tiny amount is leaked out in cell surface. Only surface-exposed S can be recognized by B cell receptor (BCR) or anti-S therapeutic monoclonal antibodies (mAbs) that is the trigger step for B cell activation after S mRNA vaccination or infected cell clearance by S mAbs. Now, a drug strategy to promote S host surface exposure is absent. Here, we first combined structural and biochemical analysis to characterize S COPI sorting signals. A potent S COPI sorting inhibitor was then invented, evidently capable of promoting S surface exposure and facilitating infected cell clearance by S antibody-dependent cellular cytotoxicity (ADCC). Importantly, with the inhibitor as a probe, we revealed Omicron BA.1 S is less cell surface exposed than prototypes because of a constellation of S folding mutations, possibly corresponding to its ER chaperone association. Our findings not only suggest COPI is a druggable target against COVID-19, but also highlight SARS-CoV-2 evolution mechanism driven by S folding and trafficking mutations.

Sarcopenia is observed to have age-related loss of skeletal muscle mass, muscle strength and physical performance, which can be an effective prognostic indicator for postoperative complications and poor survival outcomes in tumor patients. Sarcopenia could reflect tumor-host interactions and has the advantages in accuracy and generality compared with traditional predictors. This paper reviews the research progress of sarcopenia in predicting the prognosis of genitourinary tumors.

Objective:To summarize the experience and technical difficulties of complete thoracoscopic lobectomy(segmental) in the treatment of congenital pulmonary airway malformation in children.Methods:The clinical data, surgical videos and follow-up results of 38 children suffering from congenital pulmonary airway malformation and underwent complete thoracoscopic lobectomy in Children′s Hospital of Fudan University Xiamen Branch from January 2017 to December 2019 were retrospectively analyzed.A statistical comparisons of operative time, intraoperative blood loss, postoperative pain (the first time of getting out of bed), incision length and postoperative pulmonary complications were made between 28 children who underwent the total thoracoscopic lobectomy and 21 children who accepted open surgical lobectomy before January 2017 in Children′s Hospital of Fudan University Xiamen Branch.Results:Thirty-eight children with congenital pulmonary airway malformation were successfully operated by complete thoracoscopy.There were 28 lobectomies, 6 segmental lobectomies and 4 wedge lobectomies.Postoperative follow-up was conducted for more than 3 months, and no serious surgical complications occurred.Chest radiograph of 2 children with the right lower lobectomy at 48 hours after surgery had the elevation of the right diaphragm (2-3 intercostal), and it returned to normal 3 months after surgery.The CT review of 1 child with pulmonary wedge resection 1 month after surgery displayed a little residual lesion.Thoracoscopic lobectomy was significantly different from open surgery in terms of incision length[(2.0±0.5) cm vs. (10.0±0.5) cm], postoperative pain (the first time of getting out of bed)[(24.0±2.0) h vs. (48.0±1.5) h] and pulmonary complications (0 vs. 5 cases). The operative time of single lung ventilation was remarkably different from that of double lung ventilation in thoracoscopic lobectomy[(96.0±6.0) min vs. (118.0±7.0) min, t=106.501, P<0.001]. Compared with thoracoscopic lobectomy, thoracoscopic pulmonary segmentectomy has a long time and a large amount of blood loss. Conclusions:Complete thoracoscopic lobectomy (segmental) is the first choice for the treatment of congenital pulmonary airway malformation in children, with clear operative field, little trauma, less postoperative pain, quick recovery and fewer respiratory complications.Single-lung ventilation is beneficial for surgical completion.

Objectives: To examine the influence factors on axillary evaluation in ductal carcinoma in situ (DCIS) patients, and the prognosis of different choices of axillary evaluation in a single-center retrospective study. Methods: Totally 1 557 DCIS patients admitted in Department of Breast Surgery, Fudan University Shanghai Cancer Center from January 2006 to November 2016 were retrospectively enrolled. All patients were female. The median age was 49 years (range: 21 to 85 years). Surgical methods included modified radical mastectomy, simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation). Axillary evaluation included axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). T tests, χ² test and Logistic regression analysis was used to analyze influence factors on axillary evaluation, respectively. Kaplan-Meier curve and Log-rank analysis were used to evaluate recurrence-free survival (RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods. Results: Among the 1 557 DCIS patients, there were 1 226 cases received axillary evaluation, while 331 cases not received axillary evaluation. Patients were separated into 3 groups by different axillary evaluation choices: SLNB group (957 cases, 61.46%), ALND group (197 cases, 12.65%) and no evaluation group (403 cases, 25.88%). The patients in SLNB group increased significantly (P=0.000), from 3.85% (60/1 557) in 2006 to 75.19% (1 170/1 557) in 2016. The independent influence factors of receiving axillary evaluation were high nuclear grade (OR=3.191, 95%CI: 1.722 to 5.912, P=0.001) and tumor size>15 mm (OR=1.698, 95%CI: 1.120 to 2.573, P=0.012). Also, patients received breast conservation surgery were more likely to refuse axillary evaluation (OR=0.155, 95%CI: 0.103 to 0.233, P=0.000). There were no significant differences in RFS and LRRFS in patients with different axillary evaluation choices. Conclusions The investigation in trends and influence factors of different axillary evaluation choices provided basis on surgical precision medicine in DCIS patients. Patients received SLNB increased significantly. The independent influence factors of axillary evaluation were nuclear grade, tumor size and surgical methods. There was no significant differences in prognosis among the groups receiving different axillary evaluations.

Objective To evaluate the influence factors on surgical methods in DCIS (Ductal carcinoma in situ) patients,and the prognosis of different surgical methods in a 10-year single-center retrospective study.Methods We retrospectively included 1557 DCIS patients who received treatments in our center from Jan.2006 to Nov.2016.T tests,Chi-square analysis and logistic regression analysis were used to analyze influence factors on surgical methods.Kaplan-Meier and Log-rank analysis were used to evaluate recurrence-free survival(RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods.Results Of the enrolled 1557 DCIS patients,surgical methods included modified radical mastectomy,simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation).The number of DCIS cases in our center increased (P＜0.001),so did the percentage of DCIS in annual malignant surgery cases (P=-0.026).Significant decrease was found in modified radical mastectomy (P=0.012).More than half of the patients received simple mastectomy after 2010,and more than one fifth of the patients received breast conservation surgery after 2008.About 13.99％ patients who received mastectomy had breast reconstruction.The independent influence factors of refusing breast conservation surgery were age ≥ 50(P＜0.001),medium nuclear grade (P=0.044),tumor size ＞ 15mm (P＜0.001) and spontaneous discharge (P＜0.001).Patients with smaller tumor size (≤ 15mm) and no spontaneous discharge had 4.18-fold and 7.04-fold greater preference for breast conservation surgery,respectively(OR=0.232,P＜0.001;OR=0.144,P＜0.001).There were no significant differences in RFS and LRRFS in patients with different surgical methods.Conclusion The evaluation in trends and influence factors of different surgical methods provides basis on surgical precision medicine in DCIS patients.

Objectives To examine the influence factors on axillary evaluation in ductal carcinoma in situ (DCIS) patients, and the prognosis of different choices of axillary evaluation in a single?center retrospective study. Methods Totally 1 557 DCIS patients admitted in Department of Breast Surgery, Fudan University Shanghai Cancer Center from January 2006 to November 2016 were retrospectively enrolled. All patients were female. The median age was 49 years (range: 21 to 85 years). Surgical methods included modified radical mastectomy, simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation). Axillary evaluation included axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). T tests, χ2 test and Logistic regression analysis was used to analyze influence factors on axillary evaluation, respectively. Kaplan?Meier curve and Log?rank analysis were used to evaluate recurrence?free survival (RFS) and loco?regional recurrence?free survival (LRRFS) in patients with different surgical methods. Results Among the 1 557 DCIS patients, there were 1 226 cases received axillary evaluation, while 331 cases not received axillary evaluation. Patients were separated into 3 groups by different axillary evaluation choices: SLNB group (957 cases, 61.46%), ALND group (197 cases, 12.65%) and no evaluation group (403 cases, 25.88%). The patients in SLNB group increased significantly (P=0.000), from 3.85% (60/1 557) in 2006 to 75.19% (1 170/1 557) in 2016. The independent influence factors of receiving axillary evaluation were high nuclear grade ( OR=3.191, 95%CI : 1.722 to 5.912, P=0.001) and tumor size>15 mm ( OR=1.698, 95 %CI : 1.120 to 2.573, P=0.012). Also, patients received breast conservation surgery were more likely to refuse axillary evaluation ( OR=0.155, 95%CI : 0.103 to 0.233, P=0.000). There were no significant differences in RFS and LRRFS in patients with different axillary evaluation choices. Conclusions The investigation in trends and influence factors of different axillary evaluation choices provided basis on surgical precision medicine in DCIS patients. Patients received SLNB increased significantly. The independent influence factors of axillary evaluation were nuclear grade, tumor size and surgical methods. There was no significant differences in prognosis among the groups receiving different axillary evaluations.