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 observe the value of self-supervised deep learning artificial intelligence(AI)noise reduction technology based on the nearest adjacent layer applicated in ultra-low dose CT(ULDCT)for urinary calculi.Methods Eighty-eight urinary calculi patients were prospectively enrolled.Low dose CT(LDCT)and ULDCT scanning were performed,and the effective dose(ED)of each scanning protocol were calculated.The patients were then randomly divided into training set(n=75)and test set(n=13),and a self-supervised deep learning AI noise reduction system based on the nearest adjacent layer constructed with ULDCT images in training set was used for reducing noise of ULDCT images in test set.In test set,the quality of ULDCT images before and after AI noise reduction were compared with LDCT images,i.e.Blind/Referenceless Image Spatial Quality Evaluator(BRISQUE)scores,image noise(SDROI)and signal-to-noise ratio(SNR).Results The tube current,the volume CT dose index and the dose length product of abdominal ULDCT scanning protocol were all lower compared with those of LDCT scanning protocol(all P＜0.05),with a decrease of ED for approximately 82.66％.For 13 patients with urinary calculi in test set,BRISQUE score showed that the quality level of ULDCT images before AI noise reduction reached 54.42％level but raised to 95.76％level of LDCT images after AI noise reduction.Both ULDCT images after AI noise reduction and LDCT images had lower SDROI and higher SNR than ULDCT images before AI noise reduction(all adjusted P＜0.05),whereas no significant difference was found between the former two(both adjusted P＞0.05).Conclusion Self-supervised learning AI noise reduction technology based on the nearest adjacent layer could effectively reduce noise and improve image quality of urinary calculi ULDCT images,being conducive for clinical application of ULDCT.

Objective:To analyze the perioperative clinical characteristics of patients with oral cancer underwent radical resection and flap reconstrution and the nursing managements.Methods:From January 2020 to December 2020, 658 patients with oral cancer underwent radical resection and flap reconstrution in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University were retrospectively analyzed. All patients were divided into the elderly group (≥60 years) and the younger group (< 60 years), including 279 cases in the elderly group and 379 cases in the younger group. The perioperative clinical data of the patients were collected, and the perioperative general situation, postoperative complications and influencing factors of complications were analyzed.Results:There were differences between the two groups in the aspects of sex ( χ2 = 12.38, P<0.001), preoperative BMI ( t = 2.43, P = 0.015), smoking history ( χ2 = 18.34, P<0.001), preoperative anesthesia grade ( χ2 = 25.61, P = 0.001), preoperative coexisting disease ( χ2 = 46.97, P<0.001), whether oral floor or tongue cancer ( χ2 = 16.68, P<0.001), whether free flap ( χ2 = 6.81, P = 0.003), operation time ( t = 2.19, P = 0.029), preoperative test index hemoglobin ( t = 4.96, P<0.001), albumin ( t = 5.44, P<0.001), D-dimer( Z = -13.52, P<0.001), calcium levels ( t = 4.07, P<0.001) and postoperative complications ( χ2 = 14.55, P<0.001). Multivariate analysis of postoperative complications showed that the age ( OR = 1.021, 95% CI = 1.005-1.037, P = 0.011), preoperative D-dimer ( OR = 1.219, 95% CI = 1.026-1.447, P = 0.024) and the preoperative coexisting disease ( OR = 1.642, 95% CI = 1.108-2.432, P = 0.013) were the risk factors for the postoperative complications. Multivariate analysis of discharge with tube showed that the age ( OR = 1.017, 95% CI = 1.003-1.031, P = 0.017), preoperative BMI ( OR = 0.917, 95% CI = 0.873-0.963, P = 0.001), whether oral floor or tongue cancer ( OR = 2.135, 95% CI = 1.475-3.091, P<0.001), and operation time ( OR = 1.220, 95% CI = 1.120-1.328, P<0.001) were the related factors for the discharge with tube. Conclusion:In view of the above risk factors, it is beneficial for the physical and mental recovery of patients to pay attention to preoperative evaluation, make adequate preoperative preparation, postoperative nursing and observation, improve swallowing function training, prepare for discharge, pay attention to continuous nursing, and establish a tertiary hospital-community-family rehabilitation system.

OBJECTIVETo develop a brief version scale with good validity and reliability to evaluate self-management knowledge, attitude and behavior (KAB) of diabetes patients in a shorter time.

METHODS20 authority experts who specialized in the field of diabetes clinical and non-communicable disease self-management, and familiar with the relevant content of diabetes self-management were selected. Face to face and Email consultation methods were applied in two rounds delphi expert consultations to choose items from the Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale (DSKAB, total scale, 98 items). In the first round of expert consultation, experts were asked to select the core items from every dimension and score the extent of familiarity and basis of judgment. In the second round of expert consultation, the significance of the core items which were selected by experts in first round, were graded. The items which entered into the brief scale were determined by harmonious condition of expert opinions.

RESULTSTwo rounds of consultation reclaimed 16 and 15 responses respectively, Positive coefficients of experts were 80% and 94% respectively, and both authoritative coefficients were 0.90. In the first round of consultation, experts selected 44.3 ± 6.2 items on average, 42 items were selected according to the integrity of the scale for measuring dimension and content at last. In the second round of consultation, experts thought that the 42 items could measure the important contents of each dimension comprehensive and representative, the item importance scores of knowledge, attitude, and behavior subscale were 8.42 ± 1.17, 8.61 ± 1.24, 8.61 ± 1.02 respectively, and the coordination coefficients of the three subscale were 0.36, 0.20, 0.49 (χ(2) were 89.74, 11.13, 96.03, P<0.05). The total coordination coefficient was 0.38 (χ(2) =199.36, P<0.001), which indicated the concentration of experts(')opinion was acceptable, showed the brief scale with good face validity and content validity.

CONCLUSIONThe brief scale could evaluate Diabetes Self-management KAB Scale rapidly and relatively comprehensive in groups or individuals diabetes with good face validity and content validity.

Objective To evaluate the validity, reliability, and acceptability of the brief version of the self-management knowledge, attitude, and behavior (KAB) assessment scale for diabetes patients. Methods Diabetes patients who were managed at the Xinkaipu Community Health Service Center of Tianxin in Changsha, Hunan Province were selected for survey by cluster sampling. A total of 350 diabetes patients were surveyed using the brief scale to collect data on knowledge, attitudes, and behaviors of self-management. Content validity was evaluated by Pearson correlation coefficient between the brief scale and subscales of knowledge, attitude, and behavior. Structure validity was evaluated by factor analysis, and discrimination validity was evaluated by an independent sample t-test between the high-score and low-score groups. Reliability was tested by internal consistency reliability and split-half reliability. The evaluation indexes of internal consistency reliability were Cronbach's α coefficients, θ coefficient, and Ω coefficient. Acceptability was evaluated by valid response rate and completion time of the brief scale. Results A total of 346(98.9%) valid questionnaires were returned, with average survey time of (11.43±3.4) minutes. Average score of the brief scale was 78.85 ± 11.22; scores of the knowledge, attitude, and behavior subscales were 16.45 ± 4.42, 21.33 ± 2.03, and 41.07 ± 8.34, respectively. Pearson correlation coefficients between the brief scale and the knowledge, attitude, and behavior subscales were 0.92, 0.42, and 0.60, respectively;P-values were all less than 0.01, indicating that the face validity and content validity of the brief scale were achieved to a good level. The common factor cumulative variance contribution rate of the brief scale and three subscales was from 53.66%to 61.75%, which achieved more than 50%of the approved standard. There were 11 common factors;41 of the total 42 items had factor loadings above 0.40 in their relevant common factor, indicating that the brief scale and three subscales had good construct validity. Patients were divided into a high-score group and a low-score group, then scores of the brief scale and three subscales were compared between the groups using a t-test. The results were all significant, indicating that the brief scale and three subscales had good discriminate validity. Mean scores of the brief scale and three subscales of the high-score group were 91.55±6.81, 19.51±2.17, 22.74±1.88, and 49.30±6.20, respectively;these were higher than the low-score group (65.89 ± 5.79, 12.29 ± 4.76, 20.22 ± 1.88, and 33.39 ± 6.17, respectively) with t-values 27.76, 13.31, 9.20, and 17.56 (P-values were less than 0.001). The Cronbach's α coefficient, θ coefficient,Ω coefficient, and split-half reliability of the brief scale were 0.83, 0.87, 0.96, and 0.84, respectively. These values for the three subscales were all above 0.70, except for theθcoefficient of the attitude subscale with 0.64, indicating that the brief scale and three subscales had acceptable internal consistency reliability. Conclusion The brief version of the diabetes self-management knowledge, attitude, and behavior assessment scale showed good acceptability, validity, and reliability, to responsibly evaluate self-management KAB among patients with diabetes.

Objective To evaluate the validity, reliability, and acceptability of the brief version of the self-management knowledge, attitude, and behavior (KAB) assessment scale for diabetes patients. Methods Diabetes patients who were managed at the Xinkaipu Community Health Service Center of Tianxin in Changsha, Hunan Province were selected for survey by cluster sampling. A total of 350 diabetes patients were surveyed using the brief scale to collect data on knowledge, attitudes, and behaviors of self-management. Content validity was evaluated by Pearson correlation coefficient between the brief scale and subscales of knowledge, attitude, and behavior. Structure validity was evaluated by factor analysis, and discrimination validity was evaluated by an independent sample t-test between the high-score and low-score groups. Reliability was tested by internal consistency reliability and split-half reliability. The evaluation indexes of internal consistency reliability were Cronbach's α coefficients, θ coefficient, and Ω coefficient. Acceptability was evaluated by valid response rate and completion time of the brief scale. Results A total of 346(98.9%) valid questionnaires were returned, with average survey time of (11.43±3.4) minutes. Average score of the brief scale was 78.85 ± 11.22; scores of the knowledge, attitude, and behavior subscales were 16.45 ± 4.42, 21.33 ± 2.03, and 41.07 ± 8.34, respectively. Pearson correlation coefficients between the brief scale and the knowledge, attitude, and behavior subscales were 0.92, 0.42, and 0.60, respectively;P-values were all less than 0.01, indicating that the face validity and content validity of the brief scale were achieved to a good level. The common factor cumulative variance contribution rate of the brief scale and three subscales was from 53.66%to 61.75%, which achieved more than 50%of the approved standard. There were 11 common factors;41 of the total 42 items had factor loadings above 0.40 in their relevant common factor, indicating that the brief scale and three subscales had good construct validity. Patients were divided into a high-score group and a low-score group, then scores of the brief scale and three subscales were compared between the groups using a t-test. The results were all significant, indicating that the brief scale and three subscales had good discriminate validity. Mean scores of the brief scale and three subscales of the high-score group were 91.55±6.81, 19.51±2.17, 22.74±1.88, and 49.30±6.20, respectively;these were higher than the low-score group (65.89 ± 5.79, 12.29 ± 4.76, 20.22 ± 1.88, and 33.39 ± 6.17, respectively) with t-values 27.76, 13.31, 9.20, and 17.56 (P-values were less than 0.001). The Cronbach's α coefficient, θ coefficient,Ω coefficient, and split-half reliability of the brief scale were 0.83, 0.87, 0.96, and 0.84, respectively. These values for the three subscales were all above 0.70, except for theθcoefficient of the attitude subscale with 0.64, indicating that the brief scale and three subscales had acceptable internal consistency reliability. Conclusion The brief version of the diabetes self-management knowledge, attitude, and behavior assessment scale showed good acceptability, validity, and reliability, to responsibly evaluate self-management KAB among patients with diabetes.

The patient, female, 27 years old. The scalp neoplasm had been found at her right temple 10 years ago. At first, the size of the tumor was just like a soybean, and did not grow obviously in the past nine and a half years. But the tumor increased fast in these six months, almost as large as the pigeon egg now. The physical examination showed that: A spherical tumor locates in the right temple near the right ear; the size of the tumor is 3 cm X 4 cm X 3 cm; the surface is smooth, no tenderness, no obvious mobile base, skull defect not touched. Primary diagnosis: the scalp cyst or lipoma. Under the local anesthesia we remove the neoplasm, during the operation we found the lesion located in the subcutaneous tissue layer, involved the galea aponeurosis layer, the skull surface are smooth and complete. The tumor was completely removed. We cut the mass and found a cystic cavity sized 3 cmX4 cm, which contained gray jerry-built materials, contained oil and a mass of hair, the capsule wall was complete. Postoperative pathological report: The tumor is cystic look throught the microscope, the capsule wall is squamous epithelium, containing keratinized material and hair. The pathological diagnosis is teratoma. The incision healed primarily, no recurrence found for about a year.
Female ; Humans ; Lipoma ; Neoplasm Recurrence, Local ; Scalp ; pathology ; Skin Neoplasms ; pathology ; surgery ; Skull ; Subcutaneous Tissue ; Teratoma ; pathology ; surgery

On the basis of Poincare scatter plot and first order difference scatter plot, a novel heart rate variability (HRV) analysis method based on scatter plots of RR intervals and first order difference of RR intervals (namely, RdR) was proposed. The abscissa of the RdR scatter plot, the x-axis, is RR intervals and the ordinate, y-axis, is the difference between successive RR intervals. The RdR scatter plot includes the information of RR intervals and the difference between successive RR intervals, which captures more HRV information. By RdR scatter plot analysis of some records of MIT-BIH arrhythmias database, we found that the scatter plot of uncoupled premature ventricular contraction (PVC), coupled ventricular bigeminy and ventricular trigeminy PVC had specific graphic characteristics. The RdR scatter plot method has higher detecting performance than the Poincare scatter plot method, and simpler and more intuitive than the first order difference method.
Arrhythmias, Cardiac ; Databases, Factual ; Heart Rate ; Humans ; Ventricular Premature Complexes

Objective To investigate the effects of schistosomiasis on malignant bio-behaviors including histological types,differentiation grade,inasie depth,lymphnode metastasis and prognosis of colorectal carcinoma among elderly people in the district of petrochemical industry,Shanghai.Methods A total of 184 cases (aged 60 years and over) with specimens of colorectal cancer were collected from January 2004 to December 2010.These specimens were divided into colorectal carcinoma with schistosomiasis (CRCS) group (102 cases) and simple colorectal carcinoma (CRC) as control group (82 cases).The prognostic data of 40 elderly cases with colorectal carcinoma from January 2004 to December 2006 were simultaneously selected and analysed Results Totally 55.4％ (102/184) cases exhibited coexistent schistosomiasis with colorectal carcinoma.lesion site(x2=16.53),growth pattern(x2 =10.81 ),differentiation degree(x2 =10.46),infiltration degree(x2 =6.71),lymph node metastasis(x2 =3.90),and TNM staging(x2=5.73) in CRCS group were closely related to schistosomiasis compared with CRC group (P＜0.05).Survival curve analysis showed that there was no significant effect of schistosomiasis on the survival time of elderly patients with colorectal carcinoma (x2 =0.14,P＞0.05).Conclusions The coexistent schistosomiasis may be associated with the malignant bio-behaviors of colorectal carcinoma among the elderly,but have no significant influence on the survival time after operation.

The anti-tumor activity of curcumin against androgen-independent prostate cancer cells in vitro and the possible mechanism were investigated. After curcumin treatment, the effect of curcumin on the proliferation of prostate cancer PC-3 cells was assessed by CFSE staining. Flow cytometery (FCM) was performed to analyze the cell cycle and the induction of apoptosis of tumor cells. A luciferase reporter gene assay was used to determine the effects of curcumin on the activities of intracellular NF-κB and AP-1 signaling pathways. The results showed curcumin could effectively inhibit the proliferation of PC-3 cells in vitro (P<0.05). Cells were arrested at G(2)/M phase. After curcumin treatment, the percentage of apoptotic cells was significantly higher than in control group (P<0.05). The results of the luciferase assay revealed that curcumin selectively inhibited the activities of the NF-κB and AP-1 signaling pathways in PC-3 cells significantly. It was suggested that curcumin could exert anti-tumor activity against androgen-independent prostate cancer cells in vitro by inhibiting cellular proliferation and inducing apoptosis, which was probably contributed to the inhibition of transcription factors NF-κB and AP-1.