Objective To investigate the clinical efficacy of minimally invasive mitral valvuloplasty (MVP) in the treatment of infective endocarditis (IE) with mitral regurgitation (MR). Methods A retrospective analysis was conducted on the clinical data of patients who underwent MVP for IE with MR at the Department of Cardiovascular Surgery in Zhongshan Hospital, Fudan University from 2016 to 2020. Patients were divided into two groups based on the surgical incision: those with a right mini-thoracotomy were classified as a minimally invasive surgery (MIS) group, and those with a median sternotomy (MS) were classified as an MS group. All patients had isolated mitral valve involvement. Perioperative data were analyzed, and mid- to long-term outcomes were compared between the two groups. Results A total of 86 patients were included, with 40 in the MIS group [22 males and 18 females, with a mean age of (39.78±15.36) years ranging from 14 to 75 years] and 46 in the MS group [27 males and 19 females, with a mean age of (49.94±16.13) years ranging from 14 to 71 years]. The patients in the MIS group were relatively younger (P=0.004) with better preoperative cardiac function (P=0.004). There was no statistical difference in preoperative fever, gender, or comorbidities between the two groups (P>0.05). The MIS group had shorter postoperative ventilation times, less postoperative 24-hour drainage, less blood transfusion, and shorter total hospital stays compared to the MS group (P＜0.05). There was no statistical difference in cardiopulmonary bypass times or ICU stays between the two groups (P>0.05). The perioperative complication rates and mortality rates were not significantly different between the two groups (P>0.05). Follow-up was conducted for 11-92 months, with a mean duration of (49±19) months and an overall follow-up rate of 91.9%. During the follow-up, 3 patients in each group required reoperation for mitral valve issues, with no statistical difference in incidence (7.5% vs. 6.5%, P=0.691). There were no warfarin-related complications, recurrences, or deaths in either group during follow-up. Multivariate regression analysis identified age, preoperative cardiac function, and surgeon experience as influencing factors for the choice of surgical approach. Conclusion Minimally invasive MVP for IE with MR is relatively safe in the perioperative period and shows significant efficacy, with clear mid- to long-term outcomes. It is recommended for younger patients with better preoperative cardiac function and when performed by surgeons with extensive experience in mitral valvuloplasty.

Denosumab, a human monoclonal antibody, is used for the prevention of malignant tumor-related bone events and the treatment of osteoporosis with high fracture risk. Since its approval in China in 2019, denosumab-related osteonecrosis of the jaw (DRONJ) has attracted increasing attention. DRONJ, similar to bisphosphonate-related osteonecrosis of the jaw, often occurs after tooth extraction and manifests as exposed bone necrosis, purulent discharge, facial swelling and pain, severely impacting patients′ quality of life. However, the perioperative management strategies for DRONJ differ from those for bisphosphonate-related osteonecrosis of the jaw. This article summarizes the perioperative management strategies for high-risk DRONJ patients from aspects such as oral hygiene care, antibiotic use, drug discontinuation during the perioperative period, and surgical strategy selection, aiming to provide guidance for oral surgeons in managing tooth extraction in denosumab-treated patients.

Nerve dysfunction is a common postoperative complication of dental extractions. In dental extraction, the nerves involved mainly include the inferior alveolar nerve, lingual nerve, buccal nerve, chin nerve and nasopalatine nerve. Nerve dysfunction will seriously affect the patient′s quality of life and may lead to medical disputes. This review firstly summarizes the clinical manifestations and pathological mechanisms of post-dental extraction nerve dysfunction, then summarizes its clinical risk factors and preventive strategies, then analyzes the clinical characteristics and physiological mechanisms of natural sensory recovery after dental extraction nerve dysfunction, and finally summarizes the cutting-edge therapeutic tools and research directions in the treatment of post-dental extraction nerve dysfunction in recent years. The aim of this article is to comprehensively review the cutting-edge advances in post-dental extraction nerve dysfunction from clinical to molecular mechanisms, and from pathogenesis to prevention and treatment strategies, and seeks to provide reference for oral surgeons in preventing and responding to the treatment of nerve dysfunction after dental extraction.

Postoperative infection is one of the most common complications of tooth extraction.It may manifest as lo-calized infection or develop to systemic infection.Clinically,oral surgeons can prevent postoperative infections by urg-ing patients to strengthen oral hygiene,applying antibiotics in a rational and compliant manner,and choosing appropriate surgical methods for tooth extraction.For the treatment of infection,the oral surgeon should formulate a response strate-gy on the basis of different diagnoses.For local infections such as dry socket,delayed alveolar osteitis,gap infection,and marginal osteomyelitis of the jaws,the infection can be controlled by local debridement,therapeutic use of antibiotics,and incise and drain if necessary.For patients suspected of necrotizing fasciitis,timely extensive debridement should be made to reduce the area of tissue necrosis.For those who have received radiotherapy or anti-resorptive drugs,tooth extraction should follow the recommenda-tions of the relevant clinical guidelines or expert consen-sus to minimize the risk of osteonecrosis of the jaws.For patients with poor systemic health or dysfunction of the immune system,attention should be paid to identifying infective endocarditis and intracranial infection to ensure the life safety of patients.In this study,the author intends to combine lit-erature review and clinical experience to tackle postextraction infection and its prevention to provide a reference for col-leagues on oral and maxillofacial surgery.

Objective:To investigate the efficacy and safety of plasma exchange(PE) in the treatment of autoimmune hemolytic anemia in children.Methods:The data from 8 hospitals in China during November 2014 to April 2017 were collected, and the clinical characteristics of PE in children with AHA were analyzed retrospectively.Results:A total of 21 children with AHA were included in the study, including 17 cases from PICU and 4 cases from pediatric kidney ward, with 11 boys and 10 girls, and the median age was 3.64(0.25, 11.10)years old, and median hospital stay was 12(4, 45)days.There were 15 cases(71.4%) with infection, 2 cases(9.5%)with autoimmune diseases, 4 cases(19.0%) with unknown.Consciousness disturbance occurred in 4 patients before replacement and recovered to normal after PE.The volume of blood decreased in two cases(9.5%) and completely relieved.There were 20 cases of anemia (95.2%), 15 cases were normal after PE, and 5 cases were improved.Jaundice occurred in 18 cases (85.7%), 12 cases were normal after PE, 6 cases were improved.Hepatosplenomegaly was found in 11 cases, 10 cases were normal after PE, 1 case was improved.After PE, the hemoglobin and red blood cell count increased, while the total bilirubin, indirect bilirubin, urea nitrogen and lactate dehydrogenase decreased, there were significant differences between pre-and post-replacement ( P<0.05). Only 1 case had allergic reaction, which was improved after symptomatic treatment, and PE was continued.After PE, 2 cases (9.5%) had complete remission, 16 cases (76.2%) had partial remission and 3 cases (14.3%) had been discharged. Conclusion:PE therapy can obviously improve the clinical symptoms and laboratory indexes of children with AHA who have failed to respond to conservative treatment.It can be used as a treatment measure for children with severe AHA and has a good safety.

Pancreatic cancer remains one of the most lethal malignancies worldwide. The combination of the first-line standard agent gemcitabine (GEM) with the molecular-targeted drug erlotinib (Er) has emerged as a promising strategy for pancreatic cancer treatment. However, the clinical benefit from this combination is still far from satisfactory due to the unfavorable drug antagonism and the fibrotic tumor microenvironment. Herein, we propose a membrane-camouflaged dual stimuli-responsive delivery system for the co-delivery of GEM and Er into pancreatic cancer cells and tissues to block the antagonism, as well as reshapes profibrotic tumor microenvironment via simultaneous delivery of small interference RNA (siRNA) for synergistic pancreatic cancer treatment. This "all-in-one" delivery system exhibits sensitive GSH and pH-dependent drug release profiles and enhances the inhibitory effects on the proliferation and migration of tumor cells in vitro. Excitingly, the systemic injection of such a biomimetic drug co-delivery system not only resulted in superior inhibitory effects against orthotopic pancreatic tumor and patient-derived tumor (PDX), but also greatly extended the survival rate of tumor-bearing mice. Our findings provide a promising therapeutic strategy against pancreatic cancer through the enhanced synergistic effect of target therapy, chemotherapy and anti-fibrotic therapy, which represents an appealing way for pancreatic cancer treatment.

Programmed death-1(PD-1)is a major co-suppression receptor expressed on T cells.Binding with its ligands (PD-L1 and PD-L2),PD-1 can inhibit T cell proliferation,activation and cytokine secretion.In normal organs,PD-1 /PD-Ls signaling pathway plays an important role in maintaining immune tolerance,while during tumorigenesis,it can suppress T cell immune response and promote tumor immune escape.This article reviewed the research progress on PD-1 /PD-Ls signaling pathway,comprised of structure and expression of PD-1 /PD-Ls, mechanism of the signaling pathway,as well as the expression characteristics of soluble form of PD-1 /PD-L1 (sPD-1 /sPD-L1),and summarized the categories of anti-PD-1 /PD-Ls antibodies and their clinical trials in canc-er immunotherapy.

Objective To discuss clinical,electroencephalogram(EEG) and PRRT2 gene mutation by reporting a febrile seizure (FS) with paroxysmal kinesigenic dyskinesia (PKD) family.Methods Detailed clinical data of the family were collected.The proband (Ⅳ1) and another 4 patients (Ⅲ1,Ⅲ4,Ⅳ2,Ⅳ3)were studied through clinical examinations.Clinical symptoms of Ⅳ2 were not typical,who was diagnosed as a suspected case.Mutation analysis of PRRT2 gene was screened by polymerase chain reaction (PCR) and DNA direct sequencing in 5 patients (Ⅳ1,Ⅲ1,Ⅲ4,Ⅳ2,Ⅳ3) and 4 unaffected family members (Ⅱ2,Ⅲ2,Ⅲ5,Ⅳ4).Results PKD patients had brief involuntary movements in the limbs or trunk induced by sudden voluntary movement when patients were in the stationary state since the teenagers.Two cases (Ⅲ,Ⅲ4) were accompanied by FS.Three cases(Ⅳ1,Ⅲ1 and Ⅲ4)had abnormal EEG records.The PRRT2 gene mutation (c.649dupC mutation) was identified in a healthy member (Ⅳ4) and 4 patients (Ⅳ1,Ⅲ1,Ⅲ4,Ⅳ3).Conclusions FS with PKD family has a PRRT2 gene mutation.The diagnosis is mainly based on family history,typical clinical manifestations and genetic test.This kind of disease may have pre-symptomatic patients.

Objective To analyze the curative effect of adult urethrocutaneous fistula after hypospadias repair with X-V dartos flap technique.Methods In the experimental group,the closed fistulas were wrapped with X-V dartos flap in the 22 cases of adult hypospedias fistulas from February 2007 to October 2010.In the control group,the routine fistulas repairs were preformed in the 35 cases of adult hypospadias fistulas from January 2000 to January 2007.The operative effects were compared between the two groups.Results All cases were followed up for 3-49(5.6±12.0)months,no fistula was found in the experimental group,while 7 fistulas(20.0%,7/35)were found in the control group.The fistulas rate had statistic difference between the two groupe(P<0.05).Conclusion The use of the X-V dartos flap technique can prevent adult urethroeutaneous fistula after failed hypospadias fistulas repair and raise the success rate.