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.

This paper systematically summarizes the practical experience of the 2025 Dingri earthquake emergency medical rescue in Tibet. It analyzes the requirements for earthquake medical rescue under conditions of high-altitude hypoxia, low temperature, and low air pressure. The paper provides a detailed discussion on the strategic layout of earthquake medical rescue at the national level, local government level, and through social participation. It covers the construction of rescue organizational systems, technical systems, material support systems, and information systems. The importance of building rescue teams is emphasized. In high-altitude and cold conditions, rapid response, scientific decision-making, and multi-party collaboration are identified as key elements to enhance rescue efficiency. By optimizing rescue organizational structures, strengthening the development of new equipment, and promoting telemedicine technologies, the precision and effectiveness of medical rescue can be significantly improved, providing important references for future similar disaster rescues.

[摘 要] 目的：探究泛素特异性蛋白酶20（USP20）在胰腺癌组织中的表达及其对胰腺癌细胞增殖和迁移的作用及分子机制。方法：用癌症基因组图谱（TCGA）数据库数据分析USP20和扭曲家族碱性螺旋-环-螺旋转录因子（TWIST）在胰腺癌组织中的表达，通过Kaplan-Meier曲线评估其与患者预后的相关性。常规培养正常胰腺细胞HPNE和胰腺癌细胞MIAPaca2、BxPC3、PANC1、SW1990和Aspc1，用WB法检测USP20蛋白在其中的表达。将PANC1和SW1990细胞分为shNC组、shUSP20-1组和shUSP20-2组，用转染试剂将相应的慢病毒感染各组细胞，用qPCR法和WB法验证敲减效率，用CCK-8法、克隆形成实验、划痕愈合实验、Transwell实验和流式细胞术分别检测各组细胞的增殖、迁移能力和细胞周期，WB法检测各组细胞中的上皮-间质转化转录因子相关蛋白的表达。免疫共沉淀和泛素化实验检测USP20是否与TWIST相互作用，阐明USP20是否通过泛素化途径调控TWIST表达。结果：USP20、TWIST mRNA在胰腺癌组织中均呈高表达（均P < 0.05），其表达水平与患者预后呈负相关（均P < 0.05）。USP20蛋白在PANC1 、SW1990、MIAPaca2和BxPC3细胞中均呈高表达（均P < 0.001）。敲减USP20均可明显抑制PANC1和SW1990细胞的增殖、迁移能力（均P < 0.001）。USP20与TWIST相互结合（P < 0.05或P < 0.01），USP20通过降低TWIST泛素化水平稳定其表达（P < 0.01）。结论：USP20在胰腺癌组织中呈高表达，通过去泛素化TWIST稳定其表达，从而促进胰腺癌细胞的增殖和迁移，提示USP20可能成为胰腺癌诊断和治疗的潜在靶点。

Objective To understand the epidemiological characteristics of new occupational pneumoconiosis in Zigong City from 2018 to 2022, and to provide the basis for further prevention and treatment of local pneumoconiosis. Methods The information of newly diagnosed and reported cases of pneumoconiosis in Zigong City from 2018 to 2022 was collected through the occupational disease and occupational health information monitoring system, and the characteristics of the distribution of pneumoconiosis in three regions, the composition of diseases and the length of service of exposure to dust were analyzed. Results From 2018 to 2022, the top 3 newly diagnosed pneumoconiosis diseases in Zigong City were silicosis, coal workers&#39; pneumoconiosis and asbestosis. Silicosis cases were mainly distributed in small and medium-sized employers, accounting for 81.41%. Coal workers&#39; pneumoconiosis was mainly distributed in large and medium-sized employers, accounting for 97.24%. Asbestosis mainly distributed in large scale employers, accounting for 96.36%. There was significant difference in dust handling age of different scale employers (H=11.453, P<0.05). The median ages of silicosis, coal workers' pneumoconiosis and other pneumoconiosis were 47.0 years, 52.0 years and 48.2 years, respectively. The median age of dust handling was 3.3 years, 22.0 years and 23.2 years, respectively. The age of onset of coal workers' pneumoconiosis was higher than that of silicosis and other pneumoconiosis (H=72.547, P<0.05), and the age of dust exposure of silicosis was shorter than that of coal workers' pneumoconiosis and other pneumoconiosis (H=10.453, P<0.05). Conclusion The current situation of pneumoconiosis in Zigong City is still severe, with obvious clustering in disease types and industries. Prevention and treatment of pneumoconiosis in key industries should be further strengthened to protect the health rights and interests of workers.

Objective : To investigate and analyze the root and root canal morphology of mandibular first molars (MFMs) in the Tibetan population using cone-beam computed tomography (CBCT) and to provide references for clinical root canal treatment in the Tibetan population. Methods: This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. CBCT imaging data of 300 mandibular first molars from 300 Tibetan patients were included. Patient age, the number of roots in mandibular first molars were recorded. The morphology and incidence of mesial root and mesial root canals and the morphology and incidence of distal root and distal root canals were statistically analyzed by Vertucci classification. Results : There were 198 double-root teeth and 102 three-root teeth in the 300 mandibular first permanent molars. Among the three-rooted molars, 1 case had mesiolingual roots, and the rest had distolingual roots. The incidence rate of the distolingual root was 33.7%(101/300). The most common root canal configuration was Vertucci Ⅳ 65.7% (197/300), followed by Vertucci Ⅱ 20.3% (61/300) in the mesial roots. The overall incidence of middle mesial canals (MMCs) was 6% (18/300), with the highest incidence of MMCs in the 20-40 year-old group at 9% (9/100). The distal roots canals of single-distal-rooted mandibular first molars were mainly Vertucci Ⅰ 66.8% (133/199), followed by Vertucci Ⅱ 14.6% (29/199) and Vertucci Ⅳ 11.6% (23/199). For the mandibular first permanent molars with two distal roots, 96% (97/101) of the distal buccal roots and 100% (101/101) of the distal lingual roots were Vertucci Ⅰ root canals. Conclusion The root and root canal morphology of mandibular first permanent molars in a Tibetan population is complex and variable. Approximately one-third of patients have distolingual roots, and clinicians should carefully explore the root canals under the guidance of CBCT.

Objective: To investigate the status and identify the influencing factors of smoking behaviors among residents in Nanshan District, Shenzhen City, so as to provide insights into tobacco control. Methods: Permanent residents at ages of more than 18 years were recruited from 17 communities in Nanshan District, Shenzhen City using the stratified multistage random sampling method from July to November, 2018. Participants&#39; demographic features, smoking, smoking cessation and exposure to secondhand smoke were collected using the Individual Questionnaire for 2018 Chinese Adult Chronic Disease and Nutrition Surveillance. The factors affecting current smoking were identified using a multivariable logistic regression model. Results: Totally 1 700 questionnaires were allocated, and 1 625 valid questionnaires were recovered, with an effective recovery rate of 95.59%. The respondents included 714 men and 911 women, with a male to female ratio of 1∶1.27, and had a mean age of ( 45.13±13.59 ) years. The prevalence of current smoking was 15.51%, with 28.15% prevalence in men and 5.60% in women. The mean age of starting daily smoke was ( 21.00±5.52 ) years, and the mean daily smoking frequency was (13.53±9.15) cigarettes/d. The prevalence of smoking cessation was 6.58%, with 10.64% in men and 3.40% in women, and the prevalence of exposure to secondhand smoke was 41.42%, including 46.63% in men and 37.32% in women. Multivariable logistic regression analysis showed that an educational level of junior high school ( OR=1.683, 95%CI: 1.088-2.602 ), an educational level of high school/technical secondary school/vocational school (OR=1.687, 95%CI: 1.185-2.402), an occupation of farmers ( OR=2.514, 95%CI: 1.404-4.500 ), and an occupation of commercial and service personnel ( OR=1.939, 95%CI: 1.093-3.439 ) were associated with current smoking. Conclusion The prevalence of current smoking is low among residents in Nanshan District, but the prevalence of current smoking in women is higher than the national level. Educational level and occupation are main factors affecting current smoking.

Objective    To characterize surgical outcomes of supra-cardiac total anomalous pulmonary venous connection (TAPVC), investigate risk factors for postoperative death, and explore informed LASSO machine learning methods to solve "small sample size problem" in research of rare congenital heart diseases. Methods    A retrospective analysis of 241 patients with supra-cardiac TAPVC who underwent surgical repair in Guangdong Provincial People&#39;s Hospital from 2009 to 2019 was conducted, including 179 males and 62 females with a median surgical age of 71 (33, 232) d. Detailed clinical data of the postoperative death-related factors were extracted. Univariable Cox proportional hazard models were used to initially screen potential risk factors for postoperative death. Factors with P鈮?.05 were retained. To solve the limitation of small sample size and the "P>n" problem, we proposed a novel LASSO method for conducting multivariable Cox regression analysis that was capable of bringing in findings of related studies to improve analysis power and to reduce false-negative findings. Results 聽 聽Univariable Cox analyses showed several potential clinical risk factors, among which highly significant factors (P<0.001) included: surgical weight鈮?.5 kg (HR=16.00), main pulmonary artery diameter (HR=0.78), prolonged cardiopulmonary bypass time (HR=1.21), aortic block time (HR=1.28), and postoperative ventilator-assisted time (HR=1.13/d). LASSO multivariable analysis revealed that independent risk factors for postoperative death included cardiopulmonary bypass time (aHR=1.308/30 min), age (aHR=0.898), postoperative ventilator-assisted time (aHR=1.023/d), weight鈮?.5 kg (aHR=2.545), right vertical venous return (aHR=1.977), preoperative pulmonary venous obstruction (aHR=1.633) and emergency surgery (aHR=1.383). Conclusion 聽 聽Our proposed informed LASSO method can use previous studies&#39; results to improve the power of analysis and effectively solve the "P>n" and small sample size limitation. Cardiopulmonary bypass time, surgical age, postoperative ventilator-assisted time, weight, right vertical venous return, preoperative pulmonary venous obstruction, and emergency surgery are risk factors for postoperative death of supra-cardiac TAPVC.

Objective    To review the characteristics of patients who underwent atrioventricular septal defects (AVSD) repair with prosthetic valve ring implantation in our hospital, and to analyze the safety and effectiveness of this intervention. Methods    The clinical data of all patients diagnosed with AVSD who received surgery repair and prosthetic valve ring implantation from January 1, 2018 to July 12, 2020 in Guangdong Provincial People&#39;s Hospital were collected and analyzed. There were 22 patients with 9 males and 13 females at a median age of 35.00 (14.10, 53.00) years. There were 9 (40.9%) patients with prosthetic half or full rings placed on the left atrioventricular valve and 18 (81.8%) patients with prosthetic half or full rings placed on the right atrioventricular valve. Results    The median postoperative hospital stay was 7.00 (6.00, 8.80) d, and the postoperative mechanically assisted ventilation time was 11.00 (6.25, 19.00) h. There were 2 (9.1%) patients of moderate or higher postoperative atrioventricular valve regurgitation, 1 on the left and 1 on the right. There was one patient (4.5%) of the postoperative residual septal defect. There was no left ventricular inflow or outflow tract obstruction and no postoperative residual atrial septal defect during the follow-up of 152.00 (124.00, 1 030.00) d. Conclusion    Implantation of a prosthetic ring is safe and effective in patients with AVSD, and the structural strength of  the ring may be improved after the implantation. The physiological development of the AVSD annulus after prosthetic ring implantation and the results of long-term follow-up needs further attention.

AIM:To study the distribution, drug resistance and epidemic characteristics of pathogenic bacteria in neonatal eye infection in Cangnan County, Zhejiang Province from 2014 to 2018, and to provide the basis for the prevention, diagnosis and treatment of clinical conditions.

METHODS: Totally 108 strains of pathogenic bacteria isolated from 294 eyes specimens from neonatal clinic from January 2014 to December 2018 were identified, common drug sensitivity test and epidemiological characteristics were summarized and analyzed.

RESULTS: The detection rate of pathogenic bacteria in 294 ocular secretions was 36.7%(108/294). The main flora included 48 strains of Staphylococcus epidermidis(44.4%), 16 strains of Staphylococcus aureus(14.8%), 24 cases of Escherichia coli(22.2%), 12 strains of Neisseria gonorrhoeae(11.1%), 5 strains of Corynebacterium diphtheria(4.6%), 2 strains of Enterococcus(1.9%)and 1 case of Streptococcus (0.9%). The main pathogens are highly sensitive to amikacin and netilmicin, and are highly sensitive to jellithromycin and netilmicin. The activity of gentamicin is poor. It has good activity against quinolones.

CONCLUSION:Staphylococcus is the main pathogen of neonatal eye infection, and eye antibiotics commonly used in clinic have good antibacterial activity against all kinds of pathogenic bacteria.

Objective: To learn the activities of daily living（ADL）of the elderly in Chongqing and its influencing factors,so as to provide basis for developing ADL intervention measures for the elderly. Methods: Multi-stage sampling method was used to select the elderly aged 65 years or over from 2-3 communities each in 11 districts or counties of Chongqing. They were surveyed by ADL scale including physical activities of daily living（PADL）and instrumental activities of daily living（IADL）. The influencing factors for ADL disability were analyzed by multivariate logistic regression models. Results: Totally 1 341 valid questionnaires out of 1 400 distributed were recovered,with a response rate of 95.79%. There were 596（44.44%）people with ADL disability,among whom 321（53.86%）cases were mild and 275（46.14%）cases were apparently impaired. There were 385（28.71%）suffered from PADL and 575（42.88%）suffered from IADL. The results of multivariate logistic regression analysis showed that age of 70 years old and over（OR：2.858-7.507,95%CI：2.119-11.816）,not living in downtown（OR=2.073-3.709,95%CI：1.434-5.613）,having commercial insurance（OR=3.202,95%CI：1.419-7.223）and suffering from at least one chronic disease（OR：2.909-5.629,95%CI：1.562-10.681）were the risk factors for ADL disability in the elderly,while having a diploma or above（OR=0.236,95%CI：0.090-0.621）,employing a caregiver（OR=0.466,95%CI：0.260-0.835）and monthly income of 1 000 to less than 4 000 yuan（OR：0.480-0.664,95%CI：0.274-0.923）were the protective factors. Conclusions The rate of ADL impairment is 44.44% in the elderly aged 65 years or over,and is associated with old age,living away from downtown,participation in commercial insurance and suffering from chronic diseases.