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 clinical application pathway of the CT generative adversarial networks (CTGANs) algorithm in mandibular reconstruction surgery, aiming to provide a valuable reference for this procedure.Methods:A clinical exploratory study was conducted, 27 patients who visited the Department of Oral and Maxillofacial Surgery, Xiangya Hospital of Central South University between January 2022 and January 2024 and required mandibular reconstruction were selected. The cohort included 16 males and 11 females, with the age of (46.6±11.5) years; among them, 7 cases involved mandibular defects crossing the midline. The CTGANs generator produced 100 images, and the mean squared error (MSE) was calculated for differences between any two generated images. Preoperative cone-beam CT data from 5 patients were used to construct a labeled test database, divided into groups: normal maxilla, normal mandible, diseased mandible, and noise (each group containing 70 cross-sectional images). The CTGANs discriminator was used to evaluate the loss values for each group, and one-way ANOVA and intergroup comparisons were performed. Using the self-developed KuYe multioutcome-option-network generation system (KMG) software, the three-dimensional (3D) completion area of the mandible under cone-beam CT was defined for the 27 patients. The CTGANs algorithm was applied to obtain a reference model for the mandible. Virtual surgery was then performed, utilizing the fibular segment to reconstruct the mandible and design the surgical expectation model. The second-generation combined bone-cutting and prebent reconstruction plate positioning method was used to design and 3D print surgical guides, which were subsequently applied in mandibular reconstruction surgery for the 27 patients. Postoperative cone-beam CT was used to compare the morphology of the reconstructed mandible with the surgical expectation model and the mandibular reference model to assess the three-dimensional deviation.Results:The MSE for the CTGANs generator was 2 411.9±833.6 (95% CI: 2 388.7-2 435.1). No significant difference in loss values was found between the normal mandible and diseased mandible groups ( P>0.05), while both groups demonstrated significantly lower loss values than the maxilla and noise groups ( P<0.001). All 27 patients successfully obtained mandibular reference models and surgical expectation models. In total, 14 162 negative deviation points and 15 346 positive deviation points were observed when comparing the reconstructed mandible morphology with the surgical expectation model, with mean deviations of -1.32 mm (95% CI:-1.33- -1.31 mm) and 1.90 mm (95% CI: 1.04-1.06 mm), respectively. Conclusions:The CTGANs algorithm is capable of generating diverse mandibular reference models that reflect the natural anatomical characteristics of the mandible and closely match individual patient morphology, thereby facilitating the design of surgical expectation models. This method shows promise for application in patients with mandibular defects crossing the midline.

Many factors contribute to a successful total knee arthroplasty, and postoperative coronal lower limb alignment has always been a focus of joint surgeons. Previous researches have suggested that neutral alignment can bring higher prosthesis survival rate and better knee function. However, the theory has been challenged in recent years.In this article, the author introduces the axis, alignment and osteotomy of total knee arthroplasty briefly and reviews the studies on the neutral alignment and kinematic alignment of recent years in order to provide some advice for the clinical operation.

BACKGROUND:Fast track surgery, also cal ed enhanced recovery after surgery, is a series of optimal measures adopted during the perioperative period on the basis of evidence-based medicine, to reduce the physical and mental trauma brought to the patient and accelerate their recovery. It has become the research focus of orthopedic clinic as the surgery and anesthesia skil s are improved a lot in recent years, especial y the articular surgery, which has been widely used in clinics. OBJECTIVE:To summarize the clinical study of the application of optimal measures in joint replacement surgery both at home and abroad in recent years. METHODS:The first author searched related articles in PubMed and Chinese Journal Ful-text Database from January 1997 to September 2016. The key words were“joint replacement, enhanced recovery after surgery, multi-mode analgesia, diet management, steroid hormones”. 81 articles were found at last and one monograph was included. RESULTS AND CONCLUSION:(1) We found that the recovery plan reduced the hospital stays of the patients from 4-12 days to 1-3 days, including pre-operative health education, shortening fasting and water-depriving duration before surgery, super-anesthesia before surgery and do not place catheter;adopting general anesthesia and appropriate adductor canal to relieve the pain, and stopping bleeding using tranexamic acid during operation;multi-mode analgesia, faster function exercise after anesthesia recovery, and drinking water in early phase after surgery during the perioperative period of joint replacement surgery conducted by the cooperation of surgeon, anesthetist, nurse and nutritionist. There were no significant improvements of postoperative complications rate and rehospitalization rate. (2) The research found that, enhanced recovery after surgery is suitable for most of the patients receiving joint replacement surgery, including those in advanced age, combined heart and lung disease before surgery, type 2 diabetes and smoking and drinking before surgery.

Objective To investigate the prevalence of 16S rRNA methylase genes in Klebsiella pneumoniae isolates from Guangzhou.Methods K-B test was used to determine the resistant rates of these stains.Five 16S rRNA methylase genes,armA,rmtA,rmtB,rmtC,and rmtD,were detected by PCR.Results All 55 K.pneumoniae isolates showed resistant to arbekacin,gentamicin,tobramycin,and neomycin.Susceptibility rates were 5.5%,20.0%,72.7%,and 100% to ceftazidime,ciprofloxacin,piperacillin/tazobactam,and imipenem respectively.ESBLs were positive in 52 of 55 (94.5%) isolates.Among 55 K.pneumoniae isolates,34 were positive for armA and 1 for rmtB.Conclusions In K.pneumoniae resistant to arbekacin,the positive rate of 16S rRNA methylase genes was high,predominantly with armA positive.These strains were highly resistant to some antibiotics.