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 analyze the unexamined items and situations in occupational health examinations of radiation workers, and provide a reference for the revision of occupational health examination standards for radiation workers. Methods A total of 29 630 radiation workers who underwent occupational health examinations at The Third People’s Hospital of Henan Province in 2023 were selected, and the non-examination rates were statistically analyzed according to occupation, gender, and age. Results The overall non-examination rate of non-medical radiation workers was significantly lower than that of the medical radiation workers (P<0.05). The non-examination rate of chest X-rays among medical radiation workers was significantly higher than that of non-medical radiation workers (P<0.05), while no significant differences were found in other items (P>0.05). Gender-stratified analysis showed that the non-examination rate of routine urine tests was higher in females than in males in both medical and non-medical radiation workers (P<0.05). Age-stratified analysis revealed no significant differences in non-examination rates among different age groups in non-medical radiation workers (P>0.05), whereas the chest X-ray non-examination rate was relatively high in medical radiation workers under 30 years old (P<0.05). Conclusion Significant differences were observed in the non-examination rates of occupational health examinations among radiation workers based on occupation, gender, and age. The overall non-examination rate was relatively low in non-medical radiation workers.

BACKGROUND: Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization. METHODS: Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality. RESULTS: Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases. CONCLUSION In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Cardiovascular Diseases/etiology* ; China/epidemiology* ; Life Style ; Pneumonia/etiology* ; Prognosis ; Risk Factors ; Smoking

The aim of this investigation was to determine the optimal storage medium for testicular hypothermic transportation and identify the ideal concentration for the application of the protective agent 5-aminolevulinic acid (5-ALA). Furthermore, this study aimed to explore the underlying mechanism of the protective effects of 5-ALA. First, we collected and stored mouse testicular fragments in different media, including Hank's balanced salt solution (HBSS; n = 5), Dulbecco's Modified Eagle Medium/Nutrient Mixture F-12 (DMEM/F12; n = 5), and alpha-minimum essential medium (αMEM; n = 5). Storage of testicular tissue in HBSS preserved the integrity of testicular morphology better than that in the DMEM/F12 group ( P < 0.05) and the αMEM group ( P < 0.01). Testicular fragments were subsequently placed in HBSS with various concentrations of 5-ALA (0 [control], 1 mmol l -1 , 2 mmol l -1 , and 5 mmol l -1 ) to determine the most effective concentration of 5-ALA. The 2 mmol l -1 5-ALA group ( n = 3) presented the highest positive rate of spermatogonial stem cells compared with those in the control, 1 mmol l -1 , and 5 mmol l -1 5-ALA groups. Finally, the tissue fragments were preserved in HBSS with control ( n = 3) and 2 mmol l -1 5-ALA ( n = 3) under low-temperature conditions. A comparative analysis was performed against fresh testes ( n = 3) to elucidate the underlying mechanism of 5-ALA. Gene set enrichment analysis (GSEA) for WikiPathways revealed that the p38 mitogen-activated protein kinase (MAPK) signaling pathway was downregulated in the 2 mmol l -1 5-ALA group compared with that in the control group (normalized enrichment score [NES] = -1.57, false discovery rate [FDR] = 0.229, and P = 0.019). In conclusion, these data suggest that using 2 mmol l -1 5-ALA in HBSS effectively protected the viability of spermatogonial stem cells upon hypothermic transportation.
Male ; Animals ; Testis/cytology* ; Aminolevulinic Acid/pharmacology* ; Mice ; Organ Preservation/methods* ; Organ Preservation Solutions/pharmacology* ; Cryopreservation/methods*

Objective:To explore the distribution and clearance of 99mTc labeled diethylenetriamine pentaacetic acid(99mTc-DTPA)in different brain regions of adult rats after administration through brain extracellular space(ECS)pathway.Methods:After the injection of a volume of 2 μL and radioactive activity of about 3.7 MBq(100 μCi)of 99mTc-DTPA into the caudate nucleus and thalamus of SD rats through stereotactic positioning of rat brain,the single photon emission computed tomography/computed tomography(SPECT/CT)for small animals was used for imaging at different time points,and the dyna-mic distribution and clearance of the tracer in the whole body were observed continuously.The SD rats were injected with 99mTc-DTPA into thalamus and caudate nucleus respectively for biological distribution in vivo.They were put to death 4 h later.Their blood and urine were collected.The brain,cerebellum,heart,liver,spleen,lung,and kidney were taken and weighed by γ counter to measure its radioactivity.Results:SPECT/CT imaging results showed that after 99mTc-DTPA was administered through brain ECS,the radioactivity was concentrated in the brain,kidney and bladder.The tracer administered to the left caudate nucleus was preferentially drained to the right cerebellum,while the tracer administered to the right caudate nucleus was preferentially drained to the left cerebellum.There was a phenomenon of"con-tralateral cerebellar dominant drainage"in the caudate nucleus.The thalamic area preferentially drained to the ipsilateral cerebellum after administration.Four hours after administration via ECS,high radioac-tive uptake appeared in urine,cerebellum and brain,followed by blood and kidney.The radioactive up-take values of heart,liver,spleen and lung were low,which were mainly excreted through urinary sys-tem.Conclusion:Intracerebral ECS administration is a promising method of administration,but there are significant differences in distribution and clearance in different brain regions.This study further ex-pands the content and significance of"ECS regions",and also provides an important theoretical founda-tion for the treatment of encephalopathy and the research of new drugs through brain ECS in the future.

Purpose To evaluate the effectiveness of deep learning image reconstruction(DLIR)algorithms in reconstructing lumbar vertebrae images from abdominal CT scans,aiming to reduce radiation dose and eliminate the need for repeat lumbar CT examinations.Materials and Methods A retrospective collection was conducted from March to May 2024 in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine.Thirty-two patients who underwent both abdominal and lumbar CT scans in a supine head-first position were enrolled.The abdominal CT(DLIR group)utilized a tube voltage of 120 kVp and a current of 200 mA with high-intensity DLIR for lumbar reconstruction.The standard lumbar CT(lumbar group)used the same voltage with a tube current of 260 mA and was reconstructed using 60%weighted adaptive statistical iterative reconstruction.Objective assessments was used to measure the CT values,noise(standard deviation,SD value),signal-to-noise ratio and contrast-to-noise ratio(excluding adipose tissue)at the third lumbar vertebral pedicle level and the L2/L3 intervertebral disc level for muscle,adipose tissue,cancellous bone,intervertebral discs,dura mater and cortical bone.Subjective assessments employed a five-point scale to evaluate image contrast,noise and sharpness.Results The volume CT dose index in lumbar group and DLIR group were 15.25 mGy and 11.74 mGy,respectively.There was no statistical difference in CT values between the structures of both groups(all P>0.05).Compared with the lumbar group,the DLIR group showed significant reductions in SD values across the measured tissues by 31.09%,35.66%,13.48%,27.82%,24.93%and 15.09%(t=5.09-7.21,all P<0.05).The signal-to-noise ratio improved by 36.40%,52.31%,16.56%,34.13%,38.39%and 18.81%,and the contrast-to-noise ratio improved by 51.70%,51.32%,36.24%,34.47%and 53.56%(t=-9.58--4.23,all P<0.001).The DLIR group significantly outperformed the lumbar group in image contrast[4.45(4.00,5.00)points vs.4.75(4.00,5.00)points],image noise[4.06(4.00,4.00)points vs.4.39(4.00,5.00)points],and spatial resolution of fine structures[4.00(4.00,4.00)points vs.4.27(4.00,5.00)points](Z=-3.80,-4.38,-3.55,all P<0.001).Conclusion Using high-intensity DLIR for abdominal examinations can achieve high-quality lumbar CT images with a 25%reduction in radiation dose,enabling simultaneous abdominal and lumbar scanning in a single session.

Purpose To evaluate the effectiveness of deep learning image reconstruction(DLIR)algorithms in reconstructing lumbar vertebrae images from abdominal CT scans,aiming to reduce radiation dose and eliminate the need for repeat lumbar CT examinations.Materials and Methods A retrospective collection was conducted from March to May 2024 in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine.Thirty-two patients who underwent both abdominal and lumbar CT scans in a supine head-first position were enrolled.The abdominal CT(DLIR group)utilized a tube voltage of 120 kVp and a current of 200 mA with high-intensity DLIR for lumbar reconstruction.The standard lumbar CT(lumbar group)used the same voltage with a tube current of 260 mA and was reconstructed using 60%weighted adaptive statistical iterative reconstruction.Objective assessments was used to measure the CT values,noise(standard deviation,SD value),signal-to-noise ratio and contrast-to-noise ratio(excluding adipose tissue)at the third lumbar vertebral pedicle level and the L2/L3 intervertebral disc level for muscle,adipose tissue,cancellous bone,intervertebral discs,dura mater and cortical bone.Subjective assessments employed a five-point scale to evaluate image contrast,noise and sharpness.Results The volume CT dose index in lumbar group and DLIR group were 15.25 mGy and 11.74 mGy,respectively.There was no statistical difference in CT values between the structures of both groups(all P>0.05).Compared with the lumbar group,the DLIR group showed significant reductions in SD values across the measured tissues by 31.09%,35.66%,13.48%,27.82%,24.93%and 15.09%(t=5.09-7.21,all P<0.05).The signal-to-noise ratio improved by 36.40%,52.31%,16.56%,34.13%,38.39%and 18.81%,and the contrast-to-noise ratio improved by 51.70%,51.32%,36.24%,34.47%and 53.56%(t=-9.58--4.23,all P<0.001).The DLIR group significantly outperformed the lumbar group in image contrast[4.45(4.00,5.00)points vs.4.75(4.00,5.00)points],image noise[4.06(4.00,4.00)points vs.4.39(4.00,5.00)points],and spatial resolution of fine structures[4.00(4.00,4.00)points vs.4.27(4.00,5.00)points](Z=-3.80,-4.38,-3.55,all P<0.001).Conclusion Using high-intensity DLIR for abdominal examinations can achieve high-quality lumbar CT images with a 25%reduction in radiation dose,enabling simultaneous abdominal and lumbar scanning in a single session.

Objective:To explore the distribution and clearance of 99mTc labeled diethylenetriamine pentaacetic acid(99mTc-DTPA)in different brain regions of adult rats after administration through brain extracellular space(ECS)pathway.Methods:After the injection of a volume of 2 μL and radioactive activity of about 3.7 MBq(100 μCi)of 99mTc-DTPA into the caudate nucleus and thalamus of SD rats through stereotactic positioning of rat brain,the single photon emission computed tomography/computed tomography(SPECT/CT)for small animals was used for imaging at different time points,and the dyna-mic distribution and clearance of the tracer in the whole body were observed continuously.The SD rats were injected with 99mTc-DTPA into thalamus and caudate nucleus respectively for biological distribution in vivo.They were put to death 4 h later.Their blood and urine were collected.The brain,cerebellum,heart,liver,spleen,lung,and kidney were taken and weighed by γ counter to measure its radioactivity.Results:SPECT/CT imaging results showed that after 99mTc-DTPA was administered through brain ECS,the radioactivity was concentrated in the brain,kidney and bladder.The tracer administered to the left caudate nucleus was preferentially drained to the right cerebellum,while the tracer administered to the right caudate nucleus was preferentially drained to the left cerebellum.There was a phenomenon of"con-tralateral cerebellar dominant drainage"in the caudate nucleus.The thalamic area preferentially drained to the ipsilateral cerebellum after administration.Four hours after administration via ECS,high radioac-tive uptake appeared in urine,cerebellum and brain,followed by blood and kidney.The radioactive up-take values of heart,liver,spleen and lung were low,which were mainly excreted through urinary sys-tem.Conclusion:Intracerebral ECS administration is a promising method of administration,but there are significant differences in distribution and clearance in different brain regions.This study further ex-pands the content and significance of"ECS regions",and also provides an important theoretical founda-tion for the treatment of encephalopathy and the research of new drugs through brain ECS in the future.

Objective:To explore the effects of 10Hz repetitive transcranial magnetic stimulation(rTMS)on verbal and spatial working memory with different loads in patients with stroke. Method:Twenty-nine patients with working memory impairments after the left hemisphere stroke were random-ly assigned into the rTMS group(n=14)and control group(n=15).The patients in the rTMS group were treated with 10Hz rTMS while the patients in the control group received sham stimulation.Before and after the intervention,digital/spatial N-back tasks and digit span forward(DSF)and digit span backward(DSB)tests were used to assess work memory.Montreal Cognitive Assessment(MoCA)and the Functional Indepen-dence Measure(FIM)was used to assess cognitive function. Result:There were statistically significant differences before and after the intervention in the scores of DSF,the accuracy rates of 1-back and 2-back tasks of digit and space,the scores of MoCA,attention,memory,executive function,and FIM for the rTMS and control groups,and the scores of DSB in the rTMS group(P＜0.05).Post-intervention differences in DSB,digit 1 and 2-back,spatial 2-back,FIM,MoCA total score,and subtests of memory and executive function were significant between the groups(P＜0.05).The linear mixed-ef-fect analysis showed that improvements in the accuracy rates of digital N-back tasks in the rTMS group were more affected by load compared to the control group(P＜0.05).Controlling for the confounding factors such as age and effects of different content working memory tasks,improvements in the accuracy rates of digital 1-back and 2-back tasks were positively correlated with the improvements in the score on FIM(P＜0.05),and the improvements of the digital 2-back task was positively correlated with the improvement of MoCA scores and executive function(P＜0.05). Conclusions:rTMS can significantly improve verbal and spatial working memory manipulation in stroke pa-tients,with more significant improvement in high cognitive demand working memory(2-back).In addition,the improvement in higher-load verbal working memory brought by rTMS is associated with the improvement in cognition,self-care,and survival ability of patients with stroke.