Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy. Approximately 50% to 60% of patients with OSCC are diagnosed at a locally advanced stage (clinical staging III-IVa). Even with comprehensive and sequential treatment primarily based on surgery, the 5-year overall survival rate remains below 50%, and patients often suffer from postoperative functional impairments such as difficulties with speaking and swallowing. Programmed death receptor-1 (PD-1) inhibitors are increasingly used in the neoadjuvant treatment of locally advanced OSCC and have shown encouraging efficacy. However, clinical practice still faces key challenges, including the definition of indications, optimization of combination regimens, and standards for efficacy evaluation. Based on the latest research advances worldwide and the clinical experience of the expert group, this expert consensus systematically evaluates the application of PD-1 inhibitors in the neoadjuvant treatment of locally advanced OSCC, covering combination strategies, treatment cycles and surgical timing, efficacy assessment, use of biomarkers, management of special populations and immune related adverse events, principles for immunotherapy rechallenge, and function preservation strategies. After multiple rounds of panel discussion and through anonymous voting using the Delphi method, the following consensus statements have been formulated: 1) Neoadjuvant therapy with PD-1 inhibitors can be used preoperatively in patients with locally advanced OSCC. The preferred regimen is a PD-1 inhibitor combined with platinum based chemotherapy, administered for 2-3 cycles. 2) During the efficacy evaluation of neoadjuvant therapy, radiographic assessment should follow the dual criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and immune RECIST (iRECIST). After surgery, systematic pathological evaluation of both the primary lesion and regional lymph nodes is required. For combination chemotherapy regimens, PD-L1 expression and combined positive score need not be used as mandatory inclusion or exclusion criteria. 3) For special populations such as the elderly (≥ 70 years), individuals with stable HIV viral load, and carriers of chronic HBV/HCV, PD-1 inhibitors may be used cautiously under the guidance of a multidisciplinary team (MDT), with close monitoring for adverse events. 4) For patients with a poor response to neoadjuvant therapy, continuation of the original treatment regimen is not recommended; the subsequent treatment plan should be adjusted promptly after MDT assessment. Organ transplant recipients and patients with active autoimmune diseases are not recommended to receive neoadjuvant PD-1 inhibitor therapy due to the high risk of immune related activation. Rechallenge is generally not advised for patients who have experienced high risk immune related adverse events such as immune mediated myocarditis, neurotoxicity, or pneumonitis. 5) For patients with a good pathological response, individualized de escalation surgery and function preservation strategies can be explored. This consensus aims to promote the standardized, safe, and precise application of neoadjuvant PD-1 inhibitor strategies in the management of locally advanced OSCC patients.

Objective To explore the association between air pollution and the pregnancy outcome in a severe air pollution city and to provide the evidence for health related policy-making.Methods The subject population included the newborns from 1997 to 2004 in Taiyuan and the data of air pollution in the same time were collected.Logistic regression was used to analyze OR in the case-control design.Results Statistically,the prevalence of premature birth,birth defects and the mortality of infants and fetuses were significantly associated with PM10 air pollution.For premature birth,odds ratios were ranged from 1.17 to 1.76,the highest OR,1.76(95%CI:1.64-1.90),was found during the first 3 months of pregnancy.For birth defects,odds ratios were from 1.37 to 1.67,the highest OR,1.67(95%CI:1.28-2.17),was found in the third month.Concerning mortality of infants and fetuses,it only showed a significant association in the third trimester and the OR was 1.66(95%CI:1.26-2.19).Regarding SO2 air pollution,it only showed the significant effect on premature birth during the first and second month,the odds ratios were 1.27(95%CI:1.21-1.34)and 1.07(95%CI:1.01-1.14)respectively.Conclusion Air pollution in the investigated city had an adverse effect on the pregnancy outcome and the stringent measures should be taken to abate the air pollution and to reduce the risk for reproductive health.