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 develop QingNangTCM, a specialized large language model (LLM) tailored for expert-level traditional Chinese medicine (TCM) question-answering and clinical reasoning, addressing the scarcity of domain-specific corpora and specialized alignment. Methods: We constructed QnTCM_Dataset, a corpus of 100 000 entries, by integrating data from ShenNong_TCM_Dataset and SymMap v2.0, and synthesizing additional samples via retrieval-augmented generation (RAG) and persona-driven generation. The dataset comprehensively covers diagnostic inquiries, prescriptions, and herbal knowledge. Utilizing P-Tuning v2, we fine-tuned the GLM-4-9B-Chat backbone to develop QingNangTCM. A multi-dimensional evaluation framework, assessing accuracy, coverage, consistency, safety, professionalism, and fluency, was established using metrics such as bilingual evaluation understudy (BLEU), recall-oriented understudy for gisting evaluation (ROUGE), metric for evaluation of translation with explicit ordering (METEOR), and LLM-as-a-Judge with expert review. Qualitative analysis was conducted across four simulated clinical scenarios: symptom analysis, disease treatment, herb inquiry, and failure cases. Baseline models included GLM-4-9B-Chat, DeepSeek-V2, HuatuoGPT-II (7B), and GLM-4-9B-Chat (freeze-tuning). Results: QingNangTCM achieved the highest scores in BLEU-1/2/3/4 (0.425/0.298/0.137/0.064), ROUGE-1/2 (0.368/0.157), and METEOR (0.218), demonstrating a balanced and superior normalized performance profile of 0.900 across the dimensions of accuracy, coverage, and consistency. Although its ROUGE-L score (0.299) was lower than that of HuatuoGPT-II (7B) (0.351), it significantly outperformed domain-specific models in expert-validated win rates for professionalism (86%) and safety (73%). Qualitative analysis confirmed that the model strictly adheres to the “symptom-syndrome-pathogenesis-treatment” reasoning chain, though occasional misclassifications and hallucinations persisted when dealing with rare medicinal materials and uncommon syndromes. Conclusion Combining domain-specific corpus construction with parameter-efficient prompt tuning enhances the reasoning behavior and domain adaptation of LLMs for TCM-related tasks. This work provides a technical framework for the digital organization and intelligent utilization of TCM knowledge, with potential value for supporting diagnostic reasoning and medical education.

The European Association for Cardio-Thoracic Surgery (EACTS) has recently updated and published the "2024 EACTS guidelines on perioperative medication in adult cardiac surgery". Based on the latest evidence, the guidelines have been updated in multiple aspects including underlying disease management, antithrombotic medication, arrhythmia treatment and other supportive care, etc. This paper aims to summarize and interpret the guidelines, in order to promote clinicians’ understanding and optimize perioperative medical treatment in adult cardiac surgery.

Objective To explore the mechanism of electroacupuncture in treating rats with urinary incontinence after suprasacral spinal cord injury based on EP3-HCN1 signaling pathway.Methods Totally 48 female SD rats were divided into sham-operation group(12 rats)and modeling group(36 rats,prepared as urinary incontinence model rats after suprasacral spinal cord injury)according to the random number table method.The molded rats were randomly divided into the model group,electroacupuncture group and electroacupuncture+EP3 agonist group after successful modeling,with 11 rats in each group.The electroacupuncture group stimulated"Guanyuan","Zhongji"and"Sanyinjiao"acupoints,and the electroacupuncture+EP3 agonist group injected EP3 agonist sulprostone into the tail vein before electroacupuncture treatment once a day for 7 days.The urodynamic indexes of rats were detected,the morphology of the bladder tissues were observed by HE staining,Western blot and RT-qPCR were used to detect the protein and mRNA expressions of c-Kit,EP3 and hyperpolarized activated cyclic nucleotide gated channel protein(HCN)1 in bladder tissue,respectively.Immunofluorescence was used to detect the positive expressions of c-Kit,EP3 and HCN1 in bladder tissue.Results Compared with the sham-operation group,the model group rats showed an increase in bladder basal pressure and leak point pressure(P<0.01),and a decrease in bladder maximum capacity and compliance(P<0.01);the arrangement of epithelial cells in bladder tissue was disordered,leading to pathological phenomena such as inflammatory cell infiltration,tissue edema and bleeding;the protein and mRNA expressions of c-Kit,EP3 and HCN1 in bladder tissue significantly increased(P<0.05,P<0.01).Compared with the model group,the electroacupuncture group showed a decrease in bladder basal pressure and leak point pressure(P<0.01),while the bladder maximum capacity and compliance increased(P<0.05,P<0.01);the morphology of bladder tissue was relatively normal;the protein and mRNA expressions of c-Kit,EP3 and HCN1 in bladder tissue were all decreased(P<0.05,P<0.01).Compared with the electroacupuncture group,the electroacupuncture+EP3 agonist group showed an increase in bladder basal pressure and leak point pressure(P<0.05,P<0.01),a decrease in bladder maximum capacity and compliance(P<0.05,P<0.01);aggravated pathological damage to bladder tissue;the protein and mRNA expressions of c-Kit,EP3 and HCN1 in bladder tissue increased(P<0.05,P<0.01).Conclusion Electroacupuncture of"Zhongji","Guanyuan"and"Sanyinjiao"alleviates excessive contraction of the bladder detrusor muscle by inhibiting the activation of the EP3-HCN1 pathway,thereby improving urinary incontinence symptoms after suprasacral spinal cord injury in rats.

40 patients with choronic periodontitis underwent periodontal basic treatment were randomly divided into 2 groups(n=20).The patients in control group used special toothpaste and toothbrush to brush their teeth after meals,those in the experimental group brushed their teeth with special toothpaste and toothbrush in the morning,evening and after meals,and wore personalized film pressing trays containing cymene care solution while sleeping at night.Gingival bleeding,periodontal pocket depth and attachment loss were ob-served after 4,6 and 10 weeks respectively.The personalized tray combined with cymbidium reduced the depth of periodontal pocket(P＜0.05)and the rate of probing bleeding sites(P＜0.05)more effectively,and showed no statistical significance in the change of attachment loss(P＜0.05).Cymene care solution is effective in the improvement of periodontal health.

Objective:This paper measures and analyzes the supply levels across districts,and explore the equity status and spatial-temporal evolution characteristics of medical resource supply during the 13th Five-Year Plan to the14th Five-Year Plan periods,aiming to provide references for future planning.Methods:Based on the public service population radiation model,the radiation population numbers of each district in Beijing in each year are calculated.Literature-based relevant indicators are selected.The improved CRITIC-entropy weight method is used to measure the supply level of each medical and health institutions.District-level supply levels per 100,000 radiated population were calculated using population density weighting.And the Gini coefficient and Moran's index are used to analyze its spatial and temporal distribution equilibrium.Results:During the 13th Five-Year Plan to the 14th Five-Year Plan periods,the overall medical resource supply level in Beijing showed an upward trend,with a slight decline in core areas and significant growth in urban development new towns.Regional disparities narrowed,and the global Moran's index values indicated positive spatial correlations in supply levels.Conclusion:The decentralization of non-capital functions in Beijing has achieved notable results,though improvements in outer suburbs remain gradual.Future efforts should strengthen cross-regional coordination,integrate innovations like internet-based medical consultations,and promote a more balanced healthcare resource supply structure aligned with public health needs.

Objective To investigate the clinical features,treatment and prognosis of primary testicular lymphoma(PTL),so as to provide reference for the standardized diagnosis and treatment of this disease.Methods Clinical data of 13 PTL cases treated in Xijing Hospital during Jan.2014 and Dec.2024 were retrospectively collected.The patients' diagnosis,treatment methods and prognosis were summarized.Results All 13 patients underwent orchiectomy of the affected side.According to the postoperative pathological results,11 cases were diagnosed as diffuse large B-cell lymphoma and 2 as NK/T-cell lymphoma.Among the 11 cases with diffuse large B-cell lymphoma,10 received immunotherapy and chemotherapy according to the international standardized treatment plan,and 5 received preventive myeloablative injection therapy.Recurrence in the contralateral testis occurred in 3 cases,1 complicated with central nervous system infiltration died,and another 1 refusing chemotherapy had contralateral testicular metastasis.Of the 2 cases with NK/T-cell lymphoma,1 received systemic chemotherapy and died after central nervous system recurrence,and another 1 died 1 month after surgery whithout undergoing chemotherapy.Conclusion Primary testicular lymphoma is highly invasive with poor prognosis.Patients with NK/T-cell lymphoma have extremely poor prognosis,while those with diffuse large B-cell lymphoma have relatively better prognosis.However,even after comprehensive treatment,it is still prone to recurrence in the testis and the central nervous system.

Objective:To establish three machine learning prediction models based on CT imaging characteristics of papillary thyroid carcinoma (PTC) , and use SHAP (shapley additive explanations) analysis to investigate the contribution of each CT image features in the best model.Methods:CT imaging features in 426 cases of 440 PTCs confirmed pathologically from Jan. 2016 to Jan. 2021 at the affiliated Hangzhou First People’s Hospital of Westlake University Medical School were retrospectively analyzed. compared with 467 cases of 528 nodular goiter (NG) , evaluating the distribution of four CT characteristics: cookie bite sign, enhanced range of narrowing/blur (ERNB) , microcalcifications, and irregular shape. We split the data into 8∶2 ratio for training and testing sets, then constructed three machine learning models using XGBoost, RF, and SVM. Based on AUC, accuracy, F1 score, and other metrics, we selected the best model. Lastly, we used SHAP values to assess each CT feature’s contribution and positive/negative effects on the model.Results:Among 440 PTC and 528 NG nodules, CT features like cookie bite sign, ERNB, microcalcifications, and irregular shape occurred in 326 and 30 ( χ 2=483.05, P<0.001) , 363 and 106 ( χ 2=374.45, P<0.001) , 158 and 53 ( χ 2=94.24, P<0.001) , and 354 and 52 ( χ 2=491.34, P<0.001) nodules, respectively. The machine learning models built using XGBoost, RF, and SVM had AUC, accuracy, and F1 scores ranging from 0.884~0.925, 0.867~0.873, and 0.844~0.854 respectively on the training set. On the test set, the scores ranged from 0.869~0.923, 0.845~0.871, and 0.803~0.845. Among them, the XGBoost model demonstrated the highest diagnostic performance on the test set. Among the four CT features, irregular shape had the highest absolute SHAP value, positively contributing to PTC diagnosis. Conclusion:XGBoost model showed the highest PTC diagnostic performance. Irregular shape had the greatest positive impact on PTC diagnosis.

Objective:Papillary thyroid carcinoma with a maximum tumor diameter of ≤1 cm was defined as papillary thyroid carcinoma (PTC). To explore the clinical risk factors of central lymph node metastasis (CLNM) in PTC at different locations.Methods:The clinical and pathological data of 1383 cases with solitary PTC in Hangzhou First People’s Hospital were retrospectively analyzed, and they were divided into isthmus group (175 cases), near-isthmus group (95 cases) and lateral lobe group (1113 cases) according to their tumor location. Univariate and multivariate analyses were used to analyze the relationship between gender, age, tumor maximum diameter, Hashimoto’s thyroiditis (HT) and CLNM, and the threshold for the occurrence of CLNM in each group of age and tumor maximum diameter was determined by the area under the receiver operating characteristic (ROC) .Results:The proportion of CLNM in the isthmus group, near-isthmus group and the lateral lobe group were 39.4% (69/175), 35.8% (34/95) and 29.6% (329/1113), respectively ( χ2=7.84, P=0.020). The intra-group comparison showed that there were statistical differences between the isthmus group and the lateral lobe group ( χ2=6.90, P=0.011), and there were no statistical differences between the isthmus group and near-isthmus group ( χ2=0.35, P=0.601), and near-isthmus group and the lateral leaf group ( χ2=1.62, P=0.313). Univariate and multivariate analysis showed that male ( OR: 3.697) and age < 38.5 years ( OR: 4.727) were independent risk factors for CLNM in PTC in the Isthmus Group, while male ( OR: 2.193), without HT ( OR: 1.702), tumor maximum diameter > 6.5 mm ( OR: 2.535) and age < 45.5 years ( OR: 3.030) were independent risk factors for CLNM in PTC in the lateral lobe group. Conclusions:Male sex and age are independent risk factors for CLNM in isthmus and lateral lobe PTC, and uncomplicated HT and tumor maximum diameter are also independent risk factors for CLNM in lateral lobe PTC. The incidence of CLNM in PTC in the isthmus, near-isthmus and lateral lobes decreased sequentially, and PTC in the near isthmus can not be simply regarded as the isthmus or lateral lobe PTC, and the lymph nodes in the central area should be fully evaluated before surgery to provide individualized treatment.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.