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.

Currently, the quality control of traditional Chinese medicine (TCM) encounters substantial technical challenges, necessitating the urgent development of innovative evaluation methods for key quality attributes. This study proposes the construction of a quality assurance system centered on key quality attributes, with systems biology and chemical biology serving as its core components: utilizing multi-omics technologies to systematically analyze the core functional modules of TCM, integrating pharmacological approaches to precisely identify key bioactive components; applying chemical biology to elucidate the interaction mechanisms between components and their targets, while screening for quality markers associated with specific functions and clinical indications; establishing an integrated quality control system based on quality markers and biological potency to ensure comprehensive quality management from raw herb materials through to finished products. Additionally, it emphasizes the formulation of compatibility rules grounded in TCM theory, integrates clinical practice and multi-dimensional value assessments, and establishes a novel quality evaluation model with distinct TCM characteristics.This offers a comprehensive and systematic approach to ensuring the safety and efficacy of TCM while facilitating the high-quality development of the TCM industry.

Complex liver resection (CLR) is a collective term for surgical procedures addre-ssing complex invasion of intrahepatic vasculobiliary structures that cannot be radically resected through conventional methods. The ex vivo liver resection and autotransplantation (ELRA) and its modified techniques have significantly enhanced the technical feasibility of CLR implementation. In recent years, advancements in modified ELRA techniques and derivative procedures, including conversion resection, in-situ hypothermic perfusion, and auxiliary liver transplantation, have further diversified CLR methodologies, offering more personalized treatment options for CLR candidates. Given the complexity of such cases and substantial variations in surgical approach selection, improving procedural safety and scalability remains a critical challenge in CLR practice. The authors review the current application of modified techniques based on ELRA in CLR, evaluate the clinical significance based on institutional experiences, and propose future directions and individual selection for advancing the safe implementation of CLR.

Objective To evaluate the clinical outcomes of robot-assisted percutaneous vertebroplasty(PVP)versus manual PVP in treating osteoporotic vertebral compression fractures(OVCF),and explore the advantages of robotic assistance for clinical decision-making.Methods Patients who underwent single-level PVP for OVCF at the Department of Joint Surgery and Bone Tumor,Beijing Shijitan Hospital,Capital Medical University,between April 2021 and April 2025 were enrolled.The robot group(n=29)and manual PVP group(control,n=88)were followed-up for 1 month.Parameters compared included:total hospital stay,operative time,cement volume,cement leakage rate,nerve injury rate,intraoperative fluoroscopy number,first-attempt success rate of puncture,postoperative versus preoperative anterior vertebral height difference,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)scores preoperatively,at 1-day and 1-month postoperatively.Results No statistically significant differences existed in baseline characteristics(gender,age,fracture-to-surgery interval,and fracture distribution)between groups(P>0.05).The number of intraoperative fluoroscopy times and the ODI index on the first day after surgery in the robot group were significantly lower than those in the control group(P<0.05),and the first-attempt success rate of puncture was significantly higher than that in the control group(P<0.05).There were no statistically significant differences in the other parameters between the two groups(P>0.05).Conclusion Both robot-assisted PVP and manual PVP have good clinical efficacy in the treatment of OVCF.Robot-assisted PVP can reduce the number of intraoperative fluoroscopy times and may have more advantages in improving the first-attempt success rate of puncture and early postoperative lumbar function.However,its reliability needs to be further verified through large-sample randomized controlled studies with multivariate analysis.

Aim To clarify the mechanism by which Qishen Yixin Granules improved microcirculation vas-cular endothelial dysfunction(VED)in mice,through activating the Nrf2/HO-1 signaling pathway to regulate oxidative stress.Methods C57 mice were randomly divided into six groups:blank group,model group,pos-itive drug group,and low-,medium-,and high-dose groups of Qishen Yixin Granules.The VED model was established by long-term infusion of Ang Ⅱ combined with a high-fat diet.Each treatment group received the corresponding drug intervention.After four weeks of drug intervention,cardiac function was assessed by echocardiography.Carstairs staining was used to ob-serve the formation of microthrombi in myocardial tis-sue.The micro vascular ischemia was evaluated by Hei-denhain staining.The ultrastructure of endothelial cells was observed by electron microscopy.The levels of EMPs,ROS,NO,ET-1,TF,TM,VWF,and TXA2 in serum were measured by ELISA.The expression levels of MDA,SOD,and GSH-Px in mouse heart tissue were determined by chemical methods.Cardiac microvascu-lar density and the expression of Nrf2,Keap1,and HO-1 proteins were detected by Immunohistochemical stai-ning.The protein expressions of Keap1,cytoplasmic Nrf2,nuclear Nrf2,and HO-1 in myocardial tissue were detected by Western blot.Results Qishen Yixin Granules could effectively improve the cardiac function of mice,alleviate the damage of endothelial cells and endothelial function.They could up-regulate serum NO levels and the activities of antioxidant enzymes SOD and GSH-Px,while down-regulating the expression of ROS and vascular inflammatory injury factors such as ET-1,VWF,TXA2,TF,TM,and EMPs.Qishen Yixin Granules also increased the positive counts of CD34,Nrf2,and HO-1,as well as microvessel density.Fur-thermore,they inhibited the expression of MDA,Keap1,and cytoplasmic Nrf2 protein in myocardial tis-sue,while increasing the expression of nuclear proteins HO-1 and Nrf2.Conclusions Qishen Yixin Granules may inhibit oxidative stress and inflammatory response by regulating the Nrf2/HO-1 signaling pathway,thereby improving vascular endothelial damage and cardiac function in VED mice.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Persistent atrial fibrillation and other factors can cause mitral and tricuspid annular dilation and leaflet regurgitation,leading to severe functional mitral and tricuspid regurgitation.Patients often experience significant heart failure symptoms and poor prognosis.For patients with severe mitral or tricuspid regurgitation who are at high risk or contraindicated for surgical procedures,transbronchial repair(TEER)is an important alternative therapy that can effectively reduce valve regurgitation and improve cardiac function;Although there is a lack of large-scale data on atrial functional reflux,existing experience still shows that TEER can significantly reduce reflux and improve patients'quality of life.However,double valve intervention therapy poses challenges,especially when combined with TEER repair,which is technically more complex,time-consuming,and carries higher risks.Foreign data shows that simultaneous or staged double valve intervention can safely improve cardiac function and increase survival rates,but the optimal intervention strategy still needs further research.Due to the fact that tricuspid TEER devices have not yet been launched in China,only staged treatment can be adopted at present.This case report shows a patient with severe atrial functional mitral and tricuspid regurgitation who underwent staged transcatheter edge to edge repair surgery successfully.During a 1-year follow-up,bilateral valve regurgitation continued to improve,indicating that staged repair of bilateral atrioventricular valve regurgitation through the catheter margin is a feasible and effective treatment option.

Objectives:To investigate the clinical value of cardiac magnetic resonance imaging(CMR)feature-tracking strain analysis in risk stratification of diabetic heart failure with preserved ejection fraction(HFpEF).Methods:In this retrospective study,a total of 215 patients with diabetic HFpEF who underwent CMR at Chinese Academy of Medical Sciences Fuwai Hospital from January 2012 to December 2018 were included.Myocardial strain parameters were calculated using CMR feature-tracking technology.Patients were followed up by medical records or telephone calls.Composite endpoint event,all-cause death or heart failure hospitalization during follow-up were recorded.Patients were divided into event group and event-free group.Univariable and multivariable Cox proportional hazard regression analyses were performed to determine the risk factors for the outcomes in diabetic HFpEF.The effects of hypertension and obesity on the prognosis of diabetic HFpEF patients and whether they affect the prognostic value of CMR feature-tracking strain analysis were also analyzed.Results:During a follow-up of(7.1±1.8)years,93(43.3%)patients had endpoint events(event group),including 28 all-cause deaths and 65 heart failure hospitalization.Compared with the event-free group(n=122),patients in the event group had significantly lower left ventricular ejection fraction,higher prevalence and extent of late gadolinium enhancement,and significantly reduced global longitudinal strain(GLS),global circumferential strain,global radial strain,and global systolic longitudinal strain rate(all P<0.05).The absolute GLS value was significantly lower in event group than in event-free group,regardless of the presence of hypertension and obesity.Multivariate Cox regression analysis showed that estimated glomerular filtration rate(HR=0.983,95%CI:0.972-0.993,P=0.001),left atrial volume index(HR=1.015,95%CI:1.005-1.026,P=0.004),and GLS(HR=1.142,95%CI:1.060-1.231,P<0.001)were independent risk factors for adverse cardiovascular events in diabetic HFpEF patients.However,adjusted N-terminal pro-brain natriuretic peptide was not an independent prognostic factor.The cut-offvalue of GLS to predict outcome was-14.09%from ROC curve analysis.The Kaplan-Meier curve showed that in patients with and without hypertension and obesity,patients with the GLS>-14.09%had lower event-free survival compared to patients with GLS≤-14.09%(all P<0.05),and the ability of GLS to predict adverse outcomes was not affected by hypertension and obesity.Conclusions:GLS obtained by CMR feature-tracking strain analysis is an independent predictor of adverse outcomes in diabetic HFpEF,and its ability to predict adverse outcomes is independent of hypertension and obesity.

Persistent atrial fibrillation and other factors can cause mitral and tricuspid annular dilation and leaflet regurgitation,leading to severe functional mitral and tricuspid regurgitation.Patients often experience significant heart failure symptoms and poor prognosis.For patients with severe mitral or tricuspid regurgitation who are at high risk or contraindicated for surgical procedures,transbronchial repair(TEER)is an important alternative therapy that can effectively reduce valve regurgitation and improve cardiac function;Although there is a lack of large-scale data on atrial functional reflux,existing experience still shows that TEER can significantly reduce reflux and improve patients'quality of life.However,double valve intervention therapy poses challenges,especially when combined with TEER repair,which is technically more complex,time-consuming,and carries higher risks.Foreign data shows that simultaneous or staged double valve intervention can safely improve cardiac function and increase survival rates,but the optimal intervention strategy still needs further research.Due to the fact that tricuspid TEER devices have not yet been launched in China,only staged treatment can be adopted at present.This case report shows a patient with severe atrial functional mitral and tricuspid regurgitation who underwent staged transcatheter edge to edge repair surgery successfully.During a 1-year follow-up,bilateral valve regurgitation continued to improve,indicating that staged repair of bilateral atrioventricular valve regurgitation through the catheter margin is a feasible and effective treatment option.

Objective:To investigate the ultrasound characteristics and outcomes of congenital hepatic hemangioma (CHH).Methods:A retrospective study was conducted on 14 cases of CHH diagnosed by prenatal ultrasound and postnatal mother-infant rooming-in ultrasound examination at Women and Children's Hospital Affiliated to Ningbo University from April 2021 to March 2024. Prenatal and postnatal ultrasound findings, clinical manifestations, treatments, and outcomes of these cases were analyzed.Results:Among the 14 cases, the male-to-female ratio was 1∶1; six cases were preterm infants, including two low birth weight infants. Ten cases were diagnosed by prenatal ultrasound, and four with no abnormality in the prenatal ultrasound findings were identified through postnatal abdominal ultrasound. Eleven cases had a single hepatic lesion, and three cases had multiple lesions. Ten cases had lesions in the right lobe of the liver, three had lesions in the left lobe, and one had both lobes involved. One case presented with a giant hepatic hemangioma. The echogenicity of hepatic hemangioma lesions varied, including hyperechoic, hypoechoic, and heterogeneous echopattern. Two cases were complicated by arteriovenous fistulas. All 14 cases underwent regular ultrasound examinations and were followed up to an average of (1.2±0.9) years old, ranging from 42 d after birth to 4 years old. Eight cases received medication, while six cases were treated conservatively. One case developed progressive severe pulmonary hypertension and heart failure after birth, which was unresponsive to medication. The patient received interventional embolization one month after birth and recovered well after the surgery. The latest follow-up ultrasound findings showed that the lesions in seven cases had completely disappeared, among which five cases were solitary lesions in the right lobe of the liver, mostly 10-20 mm in size, with the largest being 33 mm×24 mm, all of which were treated conservatively. One case of single lesion in the right lobe of the liver, measuring 37 mm × 28 mm, was treated with oral propranolol and the lesion disappeared after the age of one. One case had multiple lesions in the left and right lobes of the liver. After intervention, oral propranolol was continued, and the lesions disappeared at the age of 2. And the other seven cases were still under follow-up.Conclusions:Ultrasound has high accuracy and specificity for diagnosing CHH. Close postnatal follow-up and timely management result in good outcomes and prognosis.