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 investigate the efficacy and safety of retroperitoneal soft tissue sarcoma resection combined with nephrectomy.Methods:The clinical data of 27 cases undergoing retroperitoneal soft tissue sarcoma resection combined with nephrectomy at the Gastrointestinal Tumor Center , Guangdong Provincial Hospital , Traditional Chinese Medicine from Jun 2017 to Aug 2022 were retrospectively analyzed for the indication of nephrectomy, postoperative progression of renal insufficiency and survival rate.Results:Twenty-six cases (96%) achieved R 0/R 1 resection and 1 case nderwent R 2 resection. Six cases underwent combined unilateral nephrectomy and 21 patients underwent combined multi-organ resection with a median number of resections of 4 (2,5). Postoperative pathology suggested that the combined resected kidney was positive for tumor infiltration in 17 cases. Five cases had Clavien-Dindo grade 3 or higher complications and no deaths occurred within 30 days after surgery. At the 90th day after surgery, 19 cases (70%) had decreased renal function ( Z=2.88, P=0.04), with a median decrease of -3.96 (-30.36, 0.31)ml·(min·1.73 m 2) -1, including 8 cases of preoperative Chronic Kidney Disease(CKD)1 stage progression (6 cases of CKD 2 stage, 2 cases of CKD 3 stage); 2 cases of CKD 2 stage progressed to CKD 3 stage; 1 case of preoperative CKD 3 stage progressed to CKD 4 stage. During the follow-up period of 3-38 months, no patient progressed to CKD 5 stage and no patient required dialysis treatment. Conclusion:Retroperitoneal soft tissue sarcoma resection combined with nephrectomy is safe and feasible while improving tumor radicality.

Benign tumors of the parotid gland are common tumors of the head and neck. Surgical resection is considered the main treatment. For the treatment of benign parotid tumors, different surgical approaches can be applied based on many factors, such as tumor type, size, location, depth of tumor and patient requirements, such as improved periauricular incision and improved facial wrinkle removal incision, to achieve the best therapeutic effect. In parotidectomy, the facial nerve, great auricular nerve and parotid duct should be protected as much as possible to preserve the function of the nerve and gland and reduce postoperative complications. In addition, complications after parotidectomy, such as facial nerve injury, salivary fistula, Frey syndrome, postoperative facial depression, abnormal ear sensation and recurrence, should be actively prevented and treated early after the operation, consequently minimizing the impact on patients' postoperative life and improving patients' satisfaction with the operation.

Objective:To understand the changing trend and influencing factors of lens power (LP) in children aged 3-12 in Jing'an District, Shanghai.Methods:A cross-sectional study was conducted.One hundred and thirty-one eyes of 131 patients with refractive errors were included in the Optometry Clinic of Shanghai Eye Hospital from October 2019 to January 2020.The 1% atropine sulfate was employed to dilate pupils for children aged 6 years or younger, and 0.5% topiramate for children older than 6 years.The axial length, mean keratometry (Km), anterior chamber depth (ACD), lens thickness (LT) and central corneal thickness (CCT) were measured using an IOL Master.The spherical equivalent (SE) and best corrected visual acuity (BCVA) were measured after cycloplegia using autorefractor and phoropter, and the LP was calculated using the Bennett formula.The patients were divided into different age groups, including 3-4 years group (16 eyes), 5-6 years group (20 eyes), 7-8 years group (25 eyes), 9-10 years group (33 eyes) and 11-12 years group (37 eyes). There were 57 eyes in the male group and 74 eyes in the female group.The patients were also divided into different refractive groups, including mild myopia group (38 eyes), moderate myopia group (12 eyes), high myopia group (25 eyes), emmetropia group (11 eyes), mild hyperopia group (9 eyes), moderate hyperopia group (13 eyes), and high hyperopia group (23 eyes). The differences in ocular biological parameter measurements between different age groups, different gender groups and different refractive groups were compared and the correlations between age, eye parameters and LP were analyzed using Pearson correlation analysis.The contribution of multiple influencing factors to LP was analyzed by multiple linear regression models.The study protocol followed the Declaration of Helsinki and was approved by an Ethics Committee of Shanghai General Hospital, Shanghai Jiao Tong University Hospital (No.2020KY018). Written informed consent was obtained from each guardian of the subject.Results:The average LP of children in the 3-4 years group, 5-6 years group, 7-8 years group, 9-10 years group and 11-12 years group were (27.35±1.88), (24.71±1.92), (22.92±1.87), (21.49±1.54) and (21.25±1.55) D, respectively.With the increase of age, the LP value was decreased gradually.There were significant differences between 3-4 years group and 5-6 years group, 5-6 years group and 7-8 years group, 7-8 years group and 9-10 years group (all at P<0.05). The average LP value of girls was obviously higher than that of boys ( t=-3.38, P<0.01). The LP value of the high myopia group was significantly lower than that of the emmetropia group, and the LP values of the moderate myopia and the low myopia group were significantly lower than that of the hyperopia group, and the LP values of the low hyperopia group and the moderate hyperopia group were significantly higher than that of the emmetropia group (all at P<0.05). The LP value was negatively correlated with age, AL, ACD and CCT ( r=-0.76, -0.79, -0.38, -0.18; all at P<0.05), and was positively correlated with SE and LT ( r=0.62, P<0.05; r=0.68, P<0.01). There was no obvious correlation between Km and LP ( r=0.07, P=0.45). The independent influencing factors of LP were analyzed through multiple linear regression equations, showing that LP=-0.430×AL+ 0.329×LT-0.267×age-0.108×gender-0.084×CCT (male=1, female=0). The standardized coefficients of each factor arranged in descending order were AL, LT, age, gender and CCT (all at P<0.05). Conclusions:The LP of children aged 3-12 in Jing'an District of Shanghai decreases with age and increases with SE.LP values of girls are higher than those of boys.

Objective:To investigate the clinical effect of free fibula flap transplantation in repairing the defect of mandibular osteoradionecrosis (ORN).Methods:A total of 151 mandibular ORN patients undergoing free fibular flap transplantation were selected from August 2005 to September 2020 in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Among them, 109 patients were males and 42 patients were females, aged (54.1±10.1) (ranged 31-85) years old. The clinical data of the patients was collected and the survival rate of the flaps and postoperative function were calculated to evaluate the surgical efficacy. The χ 2 test was used for difference analysis. Results:Among the 151 patients, mandibular ORN caused by radiotherapy for nasopharyngeal carcinoma accounted for 79.5% (120/151). The average time for mandibular ORN appeared was 5(6) years after radiotherapy. Facial artery [57.2%(87/152)] and superior thyroid artery [32.9%(50/152)] were the main anastomotic arteries in the recipient area. There was no significant difference in the necrosis rates of the two flaps [10.3%(9/87) and 12.5% (5/50), respectively, P=0.949]. The main anastomotic veins in the recipient area were the external jugular vein [48.4%(135/279)] and the common facial vein [26.5%(74/279)]. Twenty-five cases (16.6%) had one vein anastomosed, and 126 cases (83.44%) had two veins anastomosed. There was no significant difference in the flap necrosis rate between the two conditions [20.0%(5/25) and 7.1%(9/126), respectively, P=0.100]. Ninety-seven cases (64.2%) used the peroneal musculocutaneous-fascia composite flap to repair the maxillofacial soft and hard tissue defects. Thirteen cases (8.6%) underwent the restorations with digital virtual surgery design, of which 5 cases were repaired with dental implants at the same time. After the operations, lower respiratory tract infection occurred in 17 patients (11.3%), and upper respiratory tract obstruction occurred in 3 cases (2.0%). The survival rate of the flap after operation was 90.7% (136/151), and 21 patients (13.9%) had flap vascular crisis. Delayed healing of maxillofacial wounds occurred in 33 cases (21.9%). After 3 to 24 months of follow-ups, 110 patients (76.9%) had no fistula inside/outside the oral cavity, 118 patients (82.5%) had an improvement in opening mouth of increasing (≥0.5 cm) after surgery, 135 patients (94.4%) had pain relief, 97 cases (67.8%) could eat normal diet, semi-liquid or soft food, and 137 cases (95.8%) were satisfied or basically satisfied with the treatment effects. Conclusions:The free fibular flap transplantation is an effective method to repair mandibular ORN defects. Preoperative vascular assessment is helpful for the selection of recipient vessels. Facial artery, superior thyroid artery, external jugular vein and common facial vein can be used as the main recipient vessels. The repair of the peroneal musculocutaneous-fascia composite flap facilitates the closure of internal and external fistulas. Digital technology can help to restore the maxillofacial shape more accurately, improve the patient′s occlusal and chewing function and enhance the quality of life of mandibular ORN patients.

Objective: To investigate the role of lncRNAs in the invasion and metastasis of salivary adenoid cystic carcinoma (SACC) cells. Methods: With SACC-LM as the experimental group and SACC83 as the control group, lncRNA chips were used to screen the differentially expressed lncRNAs. The differentially expressed lncRNAs were further verified by real-time quantitative RT-PCR (qRT-PCR). The invasion and migration abilities of the adenoid cystic carcinoma cell lines before and after transfection with lncRNA siRNAs were detected by invasion and migration experiments. The clinicopathological features and prognosis of patients with different expression of lncRNAs and SACC were analyzed. Results: The microarray showed that ADAMTS9-AS2 was highly expressed in the SACC-LM cells. Real-time quantitative RT-PCR further confirmed that ADAMTS9-AS2 was significantly upregulated in the SACC-LM cells. Invasion and migration experiments showed that the invasion and migration were significantly reduced after the expression level of ADAMTS9-AS2 was downregulated (P ＜ 0.001). Analysis of the clinicopathological data showed that ADAMTS9-AS2 was highly expressed in SACC. High expression of ADAMTS9-AS2 was associated with poor prognosis and a high tumor metastasis rate in SACC patients. Conclusion High expression of ADAMTS9-AS2 promotes the migration and invasion of SACC cells. ADAMTS9-AS2 is upregulated in the SACC tissues and is related to a high metastasis rate and poor prognosis.

Ojbective To predicte the HLAⅠrestricted CTL epitopes and B cell antigen epitopes derived from tumor antigen SCCAg. Methods The linear B cell epitopes and conformational B cell epitopes of tumor antigen SCCAg were predicted by Ellipro program. In addition, the HLAⅠrestricted CTL epitopes of SCCAg were predicted by NetCTL, Prot-Param and so on. Results B cell epitopes analysis revealed that SCCAg had 10 potential linear B cell epitopes and 5 conformational B cell epitopes; Combined with peptide HLAⅠbinding, proteasomal C - terminal cleavage and TAP transport efficiency, the NetCTL predicts that multiple HLAⅠrestricted CTL epitopes were present in the tumor antigen SCCAg. Conclusion The B cell epitopes and HLAⅠrestricted CTL epitopes can be predicted by multiple methods, which may lay the foundation for the further research on immunotherapy for targeting SCCAg.

Objective To investigate CT findings of abnormal bronchovascular bundle in patients with peripheral small cell lung cancer (SCLC).Methods The CT findings of abnormal bronchovascular bundle in 78 peripheral SCLC patients confirmed by pathology were retrospectively reviewed.Abnormal bronchovascular bundle of peripheral SCLC was divided into three types:type Ⅰ (thickening of the bronchovascular bundle),type Ⅱ (string beads of bronchovascular bundle) and type Ⅲ (bronchial cast with bronchus cut-off).Results 41 of 78 patients had abnormal bronchovascular bundle,in which 26 cases were in type Ⅰ,10 in type Ⅱ,5 in type Ⅲ.Except for 1 case with no mediastinal lymph node metastasis among 41 cases with abnormal bronchovascular bundle,all other 40 cases had mediastinal lymph node metastasis.Conclusion The abnormal bronchovascular bundle could reflect the biologic character of SCLC.Abnormal bronchovascular bundle is associated with advanced patients.

OBJECTIVE To assess the treatment reliability of covered stent for carotid artery blowout after head and neck tumors resection. METHODS Five cases with postoperative rupture of carotid artery invaded by the head and neck tumor were reviewed. They presented with life threatening massive neck or oral bleedings. All of them were treated with self expanding covered stents through intervention therapy approach. RESULTS The covered stent were successfully deployed in the target arteries in all cases,the instant isolation effect was quite satisfactory. After treatment, angiography showed successful occlusion of the pseudoaneurysm, patency of carotid artery lumen, and significant improvement of clinical symptoms without neurologic dysfunction. Following up 2 to 36 months, 3 patients were alive with no disease, two patients died of recurrence. CONCLUSION For the treatment of carotid blowout, endovascular occlusion with covered stent is a minimally-invasive, safe and reliable methods.

OBJECTIVETo analyze the clinical features of patients with gallbladder cancer from 17 hospitals in 5 Northwestern provinces (autonomous region) of China from 2009 to 2013.

METHODSA total of 2 379 cases with gallbladder cancer in 17 tertiary hospitals from 5 Northwestern provinces of China from January 2009 to December 2013 were reviewed retrospectively. The clinical data was collected by standardized "Questionnaire for Clinical Survey of Gallbladder Cancer in Northwestern Area of China". χ² test was used to analyze the data.

RESULTS(1) Gallbladder cancer from 17 hospitals accounted for 1.6%-6.8% of all bile tract diseases from 2009 to 2013 in Northwestern China, average was 2.7%. Gallbladder cancer accounted for 0.4%-0.9% of abdominal surgery, average was 0.7%. (2) The incidence of gallbladder cancer was higher in the aged females, the ration of female to male was 1.0 to 2.1. The average age of gallbladder cancer was (64 ± 11) years. The occupation of patients was mainly farmers (χ² = 147.10, P < 0.01). (3) 57.2% of the gallbladder cancers were associated with gallstones. (4) The main pathological patterns of gallbladder cancer were moderate and poor differentiated adenocarcinoma, showing an aggressive malignancy. TNM stage IV accounted for 55.1% of all cases, which was associated with the poor prognosis. (5) The curative resection rate was 30.4%.

CONCLUSIONSGallbladder cancer is common in the aged females and mainly at advanced stage. The screening and follow-up of high-risk groups with ultrasound and other methods regularly could increase the early diagnosis rate of gallbladder cancer, aggressive surgical resection combined with other comprehensive treatment could improve the prognosis of patients.

Adenocarcinoma ; epidemiology ; pathology ; Aged ; China ; epidemiology ; Female ; Gallbladder Neoplasms ; epidemiology ; pathology ; Gallstones ; epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Prognosis ; Retrospective Studies