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.

Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

OBJECTIVE To evaluate the long-term cost-effectiveness of canagliflozin or semaglutide in patients with type 2 diabetes mellitus（T2DM）poorly controlled with metformin. METHODS Based on the perspective of China’s health system， a Markov model was used to calculate the long-term costs and utilities of canagliflozin or semaglutide combined with metformin for T2DM patients in China for 30 years based on the data from SUSTAIN 8 study. The incremental cost-effectiveness ratio（ICER） and incremental net monetary benefit （INMB） were calculated using one time the 2024 per capita gross domestic product（GDP） as the willingness-to-pay（WTP） threshold. One-way sensitivity analysis， probability sensitivity analysis and scenario analysis were conducted to confirm the stability of the conclusions. RESULTS Compared with canagliflozin + metformin， ICER of semaglutide combined with metformin was 260 485.67 yuan/quality-adjusted life year （QALY），which was higher than the WTP threshold set in this study （95 749 yuan/QALY），and the corresponding INMB was －61 576.24 yuan，indicating that the canagliflozin + metformin regimen was more cost-effective. The cost of diabetes without complications treatment in the semaglutide + metformin group had the greatest influence on INMB，but changes in parameters within the selected range did not drive decision reversal. With the increasing of WTP threshold，the economic acceptability of semaglutide + metformin regimen increased. Under the current WTP threshold，the annual cost of semaglutide should be reduced by 42.95% to make the semaglutide + metformin regimen more cost- effective. CONCLUSIONS From the perspective of China’s health system， canagliflozin + metformin is more cost-effective than semaglutide + metformin for T2DM patients yueru. with poor glycemic control with metformin alone.

Objective:To evaluate the effect of ultrasound-guided anterior quadratus lumborum block at the supra-arcuate ligament (SA-AQLB) on the quality of postoperative recovery in patients undergoing laparoscopic surgery.Methods:In this randomized controlled study, 110 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged 18-80 yr, with a body mass index of 18-28 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to 2 groups( n=55 each) using a random number table method: transversus abdominis plane block (TAPB) group (group T) and SA-AQLB group (group S). The patients were sent to postanesthesia care unit and connected to patient-controlled intravenous analgesia (PCIA) pump after surgery. T group received ultrasound-guided bilateral TAPB and S group received ultrasound-guided bilateral SA-AQLB at 5 min after removal of the endotracheal tube under ultrasound guidance, with 30 ml of 0.25% ropivacaine injected on each side. Oxycodone 3-5 mg or diazoxide 5 mg was intravenously injected when the numerical rating scale score ≥4, and the requirement for rescue analgesia was recorded. The time to the first pressing and effective pressing times of PCIA were recorded, and the equivalent consumption of sufentanil at 24 h after operation was also recorded.The Quality of Recovery-15 scores were recorded at 24 and 48 h after surgery. The time to first ambulation and postoperative length of hospital stay were recorded. The occurrence of postoperative dizziness, nausea and vomiting, respiratory depression and nerve block complications was recorded. Results:Compared with group T, the equivalent consumption of sufentanil at 24 h postoperatively was significantly decreased, the effective pressing times of PCIA were reduced, the rate of rescue analgesia was decreased, the time to the first pressing of PCIA was prolonged, Quality of Recovery-15 scores were increased at 24 and 48 h after surgery, and the time to first ambulation and postoperative length of hospital stay were shortened in group S( P<0.05). Conclusions:Ultrasound-guided SA-AQLB is more effective than TAPB in improving the quality of postoperative recovery in patients undergoing laparoscopic surgery.

Objective To investigate the prevalence of specific IgE antibodies against Alternaria alternata and Aspergillus fumigatus in serum samples from clinical allergy patients across selected provinces in China.Methods Data on specific IgE antibodies for Alternaria A.and Aspergillus F.were collected from 20 hospital laboratories in 17 cities spanning 11 provinces.The study analyzed the levels of specific IgE and their variations across different provinces and seasons.Results A total of 27 471 cases of Alternaria A.and 32 843 cases of Aspergillus F.specific IgE data were included.The national average positive rate of Alternaria A.IgE was 10.40%,with the highest rate of 22.68%in Jiangsu and the lowest rate of 2.06%in Guangxi.For Aspergillus F.specific IgE,the average positive rate was 4.24%,with Hubei province having the highest rate(7.25%)and Hunan province the lowest(1.23%).The difference in IgE levels for both Alternaria A.and Aspergillus F.among provinces were statistically significant(H=9 955,16 993,all P<0.0001).Among patients,5.85%had Alternaria A.specific IgE levels at grade 3 or above,while only 0.57%had Aspergillus F.specific IgE levels at this level.When examining seasonal variations using data from Liaoning,Hunan and Anhui provinces,significant seasonal changes were observed for both Alternaria A.and Aspergillus F.IgE antibodies(HAlternaria A=347.6,338.0,401.3,HAspergillus F=196.6,133.7,231.7,all P<0.0001).Conclusion The sensitization to Alternaria A.and Aspergillus F.exhibits distinct geographical characteristics and vary significantly with seasons.Given the relatively high IgE levels associated with Alternaria A.,it should be given adequate clinical attention.

Objective:To determine the median effective dose (ED 50) of oliceridine inhibiting the responses to the laryngeal mask airway insertion when combined with ciprofol in elderly patients. Methods:In this sequential trial, American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ elderly patients of either sex, aged ≥65 yr, with a body mass index of 18-30 kg/m 2, undergoing elective urological surgery under general anesthesia with laryngeal mask airway, were included in this study. Ciprofol 0.4 mg/kg was intravenously injected, the dose of oliceridine was determined by using modified Dixon′s up-and-down method (increment or decrement of 0.005 mg/kg), and the initial dose of oliceridine was 0.01 mg/kg. A positive response was defined as an increase in maximum mean arterial pressure or heart rate ≥20% within 3 min after inserting the laryngeal mask airway or occurrence of any one of these signs such as movement, coughing, frowning, mouth corner twitching, tearing, laryngospasm, or bispectral index value failing to drop below 60. The trial was terminated upon observing 7 positive-to-negative transition points, starting from the first occurrence of an alternation between positive and negative responses to laryngeal mask airway insertion. The ED 50 and 95% confidence interval of oliceridine inhibiting the responses to the laryngeal mask airway insertion was calculated when combined with ciprofol in elderly patients. Results:The ED 50 of oliceridine inhibiting the response to laryngeal mask airway insertion was 0.027 mg/kg, and the 95% confidence interval was 0.008-0.048 mg/kg when combined with ciprofol 0.4 mg/kg. Conclusions:The ED 50 of oliceridine inhibiting the response to laryngeal mask airway insertion is 0.027 mg/kg when combined with ciprofol 0.4 mg/kg in elderly patients.

Objective To investigate the prevalence of specific IgE antibodies against Alternaria alternata and Aspergillus fumigatus in serum samples from clinical allergy patients across selected provinces in China.Methods Data on specific IgE antibodies for Alternaria A.and Aspergillus F.were collected from 20 hospital laboratories in 17 cities spanning 11 provinces.The study analyzed the levels of specific IgE and their variations across different provinces and seasons.Results A total of 27 471 cases of Alternaria A.and 32 843 cases of Aspergillus F.specific IgE data were included.The national average positive rate of Alternaria A.IgE was 10.40%,with the highest rate of 22.68%in Jiangsu and the lowest rate of 2.06%in Guangxi.For Aspergillus F.specific IgE,the average positive rate was 4.24%,with Hubei province having the highest rate(7.25%)and Hunan province the lowest(1.23%).The difference in IgE levels for both Alternaria A.and Aspergillus F.among provinces were statistically significant(H=9 955,16 993,all P<0.0001).Among patients,5.85%had Alternaria A.specific IgE levels at grade 3 or above,while only 0.57%had Aspergillus F.specific IgE levels at this level.When examining seasonal variations using data from Liaoning,Hunan and Anhui provinces,significant seasonal changes were observed for both Alternaria A.and Aspergillus F.IgE antibodies(HAlternaria A=347.6,338.0,401.3,HAspergillus F=196.6,133.7,231.7,all P<0.0001).Conclusion The sensitization to Alternaria A.and Aspergillus F.exhibits distinct geographical characteristics and vary significantly with seasons.Given the relatively high IgE levels associated with Alternaria A.,it should be given adequate clinical attention.

Objective:To evaluate the effect of ultrasound-guided anterior quadratus lumborum block at the supra-arcuate ligament (SA-AQLB) on the quality of postoperative recovery in patients undergoing laparoscopic surgery.Methods:In this randomized controlled study, 110 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged 18-80 yr, with a body mass index of 18-28 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to 2 groups( n=55 each) using a random number table method: transversus abdominis plane block (TAPB) group (group T) and SA-AQLB group (group S). The patients were sent to postanesthesia care unit and connected to patient-controlled intravenous analgesia (PCIA) pump after surgery. T group received ultrasound-guided bilateral TAPB and S group received ultrasound-guided bilateral SA-AQLB at 5 min after removal of the endotracheal tube under ultrasound guidance, with 30 ml of 0.25% ropivacaine injected on each side. Oxycodone 3-5 mg or diazoxide 5 mg was intravenously injected when the numerical rating scale score ≥4, and the requirement for rescue analgesia was recorded. The time to the first pressing and effective pressing times of PCIA were recorded, and the equivalent consumption of sufentanil at 24 h after operation was also recorded.The Quality of Recovery-15 scores were recorded at 24 and 48 h after surgery. The time to first ambulation and postoperative length of hospital stay were recorded. The occurrence of postoperative dizziness, nausea and vomiting, respiratory depression and nerve block complications was recorded. Results:Compared with group T, the equivalent consumption of sufentanil at 24 h postoperatively was significantly decreased, the effective pressing times of PCIA were reduced, the rate of rescue analgesia was decreased, the time to the first pressing of PCIA was prolonged, Quality of Recovery-15 scores were increased at 24 and 48 h after surgery, and the time to first ambulation and postoperative length of hospital stay were shortened in group S( P<0.05). Conclusions:Ultrasound-guided SA-AQLB is more effective than TAPB in improving the quality of postoperative recovery in patients undergoing laparoscopic surgery.

Objective:To determine the median effective dose (ED 50) of oliceridine inhibiting the responses to the laryngeal mask airway insertion when combined with ciprofol in elderly patients. Methods:In this sequential trial, American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ elderly patients of either sex, aged ≥65 yr, with a body mass index of 18-30 kg/m 2, undergoing elective urological surgery under general anesthesia with laryngeal mask airway, were included in this study. Ciprofol 0.4 mg/kg was intravenously injected, the dose of oliceridine was determined by using modified Dixon′s up-and-down method (increment or decrement of 0.005 mg/kg), and the initial dose of oliceridine was 0.01 mg/kg. A positive response was defined as an increase in maximum mean arterial pressure or heart rate ≥20% within 3 min after inserting the laryngeal mask airway or occurrence of any one of these signs such as movement, coughing, frowning, mouth corner twitching, tearing, laryngospasm, or bispectral index value failing to drop below 60. The trial was terminated upon observing 7 positive-to-negative transition points, starting from the first occurrence of an alternation between positive and negative responses to laryngeal mask airway insertion. The ED 50 and 95% confidence interval of oliceridine inhibiting the responses to the laryngeal mask airway insertion was calculated when combined with ciprofol in elderly patients. Results:The ED 50 of oliceridine inhibiting the response to laryngeal mask airway insertion was 0.027 mg/kg, and the 95% confidence interval was 0.008-0.048 mg/kg when combined with ciprofol 0.4 mg/kg. Conclusions:The ED 50 of oliceridine inhibiting the response to laryngeal mask airway insertion is 0.027 mg/kg when combined with ciprofol 0.4 mg/kg in elderly patients.

Objective:To analyze the clinical effects of an anterior cruciate ligament (ACL) tunnel locator applied in the arthroscopic reduction and fixation of Schatzker type Ⅳ tibial plateau fracture plus posterolateral column collapse.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with Schatzker type IV tibial plateau fracture combined with posterolateral column collapse who had undergone arthroscopic reduction and fixation assisted by an ACL locator at Department of Orthopedics and Trauma Surgery, The Hospital Affiliated to Yunnan University from January 2020 to December 2022. There were 8 males and 4 females with an age of (44.5±6.4) years (set as an observation group). According to a 1∶1 ratio, another contemporary 12 patients of the same category were selected as a control group who had been treated by double-plate-screw fixation through internal and external double incisions. They were 7 males and 5 females with an age of (42.6±6.3) years. The operation time, incision length, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded and compared between the 2 groups. At the same time, the Rasmussen radiological and functional scores at 1, 3, and 12 months after operation were recorded for intergroup and intragroup comparisons.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, showing the 2 groups were comparable ( P>0.05). All the 24 patients were followed up for (18.2±3.5) months after operation. In the observation group, the operation time [(96.3±6.3) min], incision length [(8.5±0.6) cm], and postoperative hospital stay [(8.1±1.3) d] were significantly shorter than those in the control group [(128.2±7.5) min, (15.9±0.8) cm, and (9.3±1.2) d], and the intraoperative blood loss [50.0 (41.5, 59.0) mL] was significantly less than that in the control group [135.0 (121.5, 147.5) mL] (all P<0.05). However, intergroup comparisons showed no statistically significant differences in Rasmussen radiographic scores or functional scores at 1 month, 3 months, or 12 months postoperatively between the 2 groups ( P>0.05). Additionally, no significant differences were observed in postoperative complications between the 2 groups ( P>0.05). Conclusions:In the arthroscopic reduction and fixation of Schatzker type Ⅳ tibial plateau fracture plus posterolateral column collapse, compared with the traditional double-plate-screw fixation through double incisions, assistance of an ACL tunnel locator leads to advantages of being more minimally invasive and more surgically efficient. However, the 2 techniques lead to comparable postoperative functional recovery.