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.

Polycystic ovary syndrome （PCOS） is a common endocrine and metabolic disorder among women of reproductive age. Hyperandrogenism （HA）， one of its core pathological features， is closely associated with the clinical manifestations and metabolic complications of the disease. Current western medical treatments for PCOS-HA mainly include anti-androgen therapy and ovulation induction， such as short-acting oral contraceptives like Diane-35 and Yasmin. However， long-term use of these medications may result in adverse reactions like increasing the risk of liver dysfunction and exacerbating lipid metabolism disorders， with unsatisfactory long-term efficacy when used alone. Traditional Chinese medicine offers unique advantages in the treatment of PCOS-HA due to its holistic approach and multi-target regulatory mechanisms. In the view of traditional Chinese medicine， PCOS-HA is classified under the categories such as "delayed menstruation"， "amenorrhea"， and "infertility"， with kidney deficiency as the root， as well as liver stagnation and spleen deficiency as the manifestations. Phlegm and blood stasis are considered to be intertwined throughout the disease course. Modern studies have shown that traditional Chinese medicine is significantly effective in improving the androgen levels， restoring ovulation， and improving insulin resistance in PCOS-HA patients. Representative prescriptions， such as Erxian Tang， Jiawei Xiaoyaosan， Guizhi Fulingwan， and Cangfu Daotantang， exert therapeutic effects through various mechanisms including regulation of the hypothalamic-pituitary-ovarian axis， reduction of ovarian androgen synthase activity， improvement of insulin signaling pathways， and inhibition of inflammation and oxidative stress， which demonstrates the characteristics of comprehensive treatment with traditional Chinese medicine. Based on the perspectives of etiology and pathogenesis of traditional Chinese medicine， modern medical cognition， typical prescriptions， and action mechanisms， this paper reviewed the research progress of traditional Chinese medicine in the treatment of PCOS-HA， aiming to provide a reference for in-depth research and clinical applications in this field.

Polycystic ovary syndrome （PCOS） is a common endocrine and metabolic disorder among women of reproductive age. Hyperandrogenism （HA）， one of its core pathological features， is closely associated with the clinical manifestations and metabolic complications of the disease. Current western medical treatments for PCOS-HA mainly include anti-androgen therapy and ovulation induction， such as short-acting oral contraceptives like Diane-35 and Yasmin. However， long-term use of these medications may result in adverse reactions like increasing the risk of liver dysfunction and exacerbating lipid metabolism disorders， with unsatisfactory long-term efficacy when used alone. Traditional Chinese medicine offers unique advantages in the treatment of PCOS-HA due to its holistic approach and multi-target regulatory mechanisms. In the view of traditional Chinese medicine， PCOS-HA is classified under the categories such as "delayed menstruation"， "amenorrhea"， and "infertility"， with kidney deficiency as the root， as well as liver stagnation and spleen deficiency as the manifestations. Phlegm and blood stasis are considered to be intertwined throughout the disease course. Modern studies have shown that traditional Chinese medicine is significantly effective in improving the androgen levels， restoring ovulation， and improving insulin resistance in PCOS-HA patients. Representative prescriptions， such as Erxian Tang， Jiawei Xiaoyaosan， Guizhi Fulingwan， and Cangfu Daotantang， exert therapeutic effects through various mechanisms including regulation of the hypothalamic-pituitary-ovarian axis， reduction of ovarian androgen synthase activity， improvement of insulin signaling pathways， and inhibition of inflammation and oxidative stress， which demonstrates the characteristics of comprehensive treatment with traditional Chinese medicine. Based on the perspectives of etiology and pathogenesis of traditional Chinese medicine， modern medical cognition， typical prescriptions， and action mechanisms， this paper reviewed the research progress of traditional Chinese medicine in the treatment of PCOS-HA， aiming to provide a reference for in-depth research and clinical applications in this field.

ObjectiveTo explore the diagnostic value of resting-state functional magnetic resonance imaging (rs-fMRI) for mild cognitive impairment (MCI) stage of Alzheimer's disease (AD), and to investigate the changes in brain functional connectivity in default mode network (DMN) and medial temporal lobe (MTL) regions. MethodsLiteratures were retrieved from multiple databases including CNKI, PubMed, Medline, and Embase, etc. from January, 2020 to October, 2025, investigating the changes in functional connectivity of DMN and MTL in patients with MCI compared to health control (HC) using rs-fMRI. Two researchers independently screened and extracted the literatures and methodological quality was assessed using QUADAS-2. Review Manager 5.4 was used to perform a meta-analysis of neuroimaging indicators in MCI patients and HC subjects. Stata and SDM were utilized to summarize diagnostic efficacy and brain functional connectivity, calculating the over all sensitivity, specificity and summary receiver operating characteristic-area under the curve (SROC-AUC). Deeks funnel plots were drawn, literature weights were analyzed, and subgroup analyses were conducted. ResultsA total of ten literatures were ultimately included, involving 1 010 patients with MCI and 1 714 HC subjects. MCI patients showed decreased or abnormal blood oxygen level dependence signals in DMN, focusing on bilateral medial prefrontal cortex (mPFC) and posterior cingulate cortex. The SROC-AUC was 0.91. In MTL, there was a characteristic decrease of spontaneous neural functional connectivities between the hippocampus and other regions, reflecting the obstruction of information transmission from episodic memory to the central nodes. Abnormal functional connectivity in DMN and MTL resulted in compensatory resting-state functional connectivity enhancement in other subnetworks or local functional connections, such as frontoparietal network and the hippocampal-parietal network. Abnormal activation of mPFC suggested atrophy of the hippocampus or abnormal brain function. The decline in functional connectivity between DMN and MTL indicated impairment of memory and information processing in the early stage. ConclusionThe early functional decoupling between DMN and MTL is a crucial neural mechanism at the MCI stage of AD, providing important neuroimaging evidence for the early diagnosis of AD.

BACKGROUND:Traditional total knee arthroplasty has limited preoperative preparation. We propose a digital precision total knee arthroplasty based oncomputer simulation and 3D printing technology,aiming to enhance surgical outcomes through comprehensive preoperative planning. OBJECTIVE:To establish a digital precision total knee arthroplasty using computer simulation and personalized surgical guides,and to compare the clinicaloutcomes between the new and traditional approaches.METHODS:A retrospective analysis was conducted on 97 patients who underwent total knee arthroplasty. Patients were divided into two groups based on the surgical method they received. The control group (n=48) underwent total knee arthroplasty using traditional methods and used conventional film templates. The observation group (n=49) underwent surgery using the digital precision total knee arthroplasty and utilized computer-assisted technology to select prosthetic sizes. Surgical time,intraoperative blood loss,preoperative and postoperative Hospital for Special Surgery knee joint function scores,as well as the differences in femoral alignment,knee joint line angle and tibial slope,and hip-knee-ankle angle compared to standard angles were compared between the two groups.RESULTS AND CONCLUSION:(1) There were no significant differences in gender,age,body mass index,Hospital for Special Surgery knee scores,as well as the differences in tibial slope,femoral alignment,knee joint line angle,hip-knee-ankle angle compared to standard angles between the two groups (P>0.05). (2) Compared to the control group,the observation group showed shorter surgical time,reduced blood loss,and significant increases in knee joint Hospital for Special Surgery knee scores at 3 months postoperatively compared to preoperative scores (P>0.05). Additionally,the postoperative Hospital for Special Surgery knee scores were higher in the observation group than in the control group (P>0.05). (3) The differences in tibial slope,femoral alignment,knee joint line angle,and hip-knee-ankle angle compared to standard angles were significantly different between the two groups;the observation group was better than the control group (P<0.05). (4) The accuracy of predicting femoral implant size was 94％ in the observation group and 58％ in the control group,while the accuracy of predicting tibial implant size was 96％ in the observation group and 62％ in the control group. (5) It is indicated that digital precision total knee arthroplasty results in shorter surgical time,reduced blood loss,and better postoperative knee joint function scores and alignment compared to traditional total knee arthroplasty. It demonstrates favorable clinical outcomes.

Objective:To evaluate the value of intraoperative cone beam CT (CBCT) in robot-assisted iliosacral screw fixation for posterior pelvic ring injuries.Methods:The 70 patients' data with posterior pelvic ring injuries treated in Tianjin Hospital from March 2020 to October 2023 were retrospectively analyzed. According to the operation method and whether there was intraoperative CBCT verification, the patients were divided into the robot-assisted iliosacral screw fixation group verified by CBCT with 15 cases (robot+CT group), the simple robot-assisted iliosacral screw fixation group with 25 cases (robot group), the freehand iliosacral screw fixation group verified by CBCT with 10 cases (freehand+CT group), and the freehand iliosacral screw fixation group with 20 cases (freehand group). The operation time, the number of intraoperative fluoroscopies, the frequency of guide needle adjustment of each iliosacral screw, Majeed function score, Matta score, fracture healing time, Gras classification of screw position of the four groups were compared, and the iliosacral screw's perforation site were recorded.Results:All patients were followed up, and the follow-up time was 18.89±4.13 months (range, 12-30 months). There were no statistically significant differences in postoperative fracture Matta score, Majeed score and fracture healing time among the four groups ( P>0.05). Specifically, 26, 45, 15, and 32 iliacsacral screws were inserted in the robot+CT group, the robot group, the freehand+CT group, and the freehand group, respectively. The operation times for these groups were 20.19±1.24, 18.78±1.00, 38.13±2.32, and 37.56±1.80 min, respectively. The number of intraoperative fluoroscopies per screw were 20.50±1.37, 18.47±1.06, 39.80±3.56, and 39.34±1.93, respectively. The guide needle adjustment times were 0.54±0.15, 0.47±0.10, 9.33±1.34, and 8.56±0.86, respectively. Statistically significant differences were observed in the above three indicators among the four groups ( P<0.05). There was no statistically significant difference in Gras classification of screw positions among the four groups ( P>0.05). However, in the CBCT verification group (robot+CT group and freehand+CT group), the Gras classification results were 36 screws in Grade I, 4 in Grade II, 1 in Grade III, and 0 in Grade IV. In contrast, in the non-CBCT verification group (robot group and freehand group), there were 48 screws in Grade I, 17 in Grade II, 11 in Grade III, and 1 in Grade IV, with a statistically significant difference (χ 2=8.945, P=0.030). The screw perforation rate in the CBCT verification group was 2% (1/41), with no perforation observed in the robot+CT verification group, compared to 16% (12/77) in the non-CBCT verification group, showing a statistically significant difference (χ 2=4.716, P=0.030). Among the 13 perforating iliosacral screws, two were located in the anterior slope of the sacrum, while 11 were positioned in the posterior and inferior dangerous triangle area of the sacral vertebral body, and the screws were penetrated into the sacral nerve root channel. Conclusions:Robot-assisted iliosacral screw with short operation time, less fluoroscopies and less guide needle adjustments, the screws can be accurately placed according to the plan, with satisfactory clinical outcomes. The penetration sites of robot-assisted iliosacral screw based on two-dimensional X-ray planning were mostly located in the posterior and inferior of the vertebral body at the pedicle level. Intraoperative CBCT can significantly improve the accuracy of sacroiliac screw placement.

A case of traumatic complete lumbosacral spondylolisthesis combined with unstable pelvic fracture is reported. A 55-year-old male patient was admitted to the hospital 8 h after being hit by a heavy object on the lumbosacral region. Admission diagnosis: (1) traumatic hemorrhagic shock; (2) bilateral pulmonary contusion with pleural effusion, and dislocation of the right 12th costovertebral joint; (3) left renal contusion with subcapsular hematoma; (4) traumatic lumbosacral spondylolisthesis (Meyerding grade V), L 5 lamina fracture, L 2 and L 5 spinous process fractures, left L 3-L 5 transverse process fractures, right L 5 inferior articular process fracture, and L 1-L 3 and L 5 transverse process fractures; (5) lumbosacral Morel-Lavallée lesion; (6) pubic symphysis separation, left sacral wing fracture, and sacroiliac joint dislocation (Young-Burgess APC type III); (7) Multiple incomplete injuries of bilateral lumbosacral nerves, and cauda equina syndrome (Gibbons type Ⅳ). The patient underwent open reduction of pelvic fracture and pubic symphysis separation, closed reduction of sacroiliac joint dislocation and combined internal and external fixation, and open reduction and internal fixation of lumbosacral spondylolisthesis. At the 1-year follow-up after surgery, the pelvis achieved anatomical reduction with good fracture healing, the spinal anatomical alignment returned to normal, and lumbosacral bony fusion was observed, and weakness of both lower limbs and abnormal urodynamics caused by residual lumbosacral nerve injury were observed.

Objective:To integrate and analyze the trend of the disease burden of tracheal,bronchus,and lung cancer(TBL)attributable to secondhand smoke in China from 1990 to 2021 and to analyze future projections,aiming to provide data support for the prevention and treatment of TBL in China.Methods:Based on the global burden of disease(GBD)2021 database,TBL with ICD-10 disease classification C33,C34-C34.92 was studied.Using secondhand smoke as a risk factor,the data on TBL mortality and disability-adjusted life year(DALY)due to secondhand smoke in China from 1990 to 2021 were further age-standardized.Using Joinpoint 4.7.1 regression analysis model to calculate annual percentage change(APC)and average annual percentage change(AAPC),Hiplot software was used to plot disease burden data for different ages and genders,and R 4.3.1 software was used to construct a grey model GM(1,1)to predict the predicted value and trend of TBL disease burden attributed to secondhand smoke in China from 2022 to 2031.Results:From 1990 to 2021,the TBL mortality rate,age-standardized mortality rate,and DALY rate attributed to secondhand smoke in China increased from 1.76/100 000,2.63/100 000,and 49.43/100 000 to 4.08/100 000,2.80/100 000,and 95.57/100 000,respectively;the growth was 131.18%,6.45%,and 93.34%;the age-standardized DALY rate decreased from 65.04/100 000 to 63.32/100 000 with the reduction of 2.65%.The results of the Joinpoint regres-sion showed that the AAPC(95%CI)of mortality,age-standardized mortality rate,and DALY rate for TBL were 2.75(2.58-2.93)%,0.16(0.11-0.21)%,and 2.15(2.11-2.18)%,respectively,with an overall increasing trend;the AAPC(95%CI)of age-standardized DALY rate was-0.14(-0.40-0.12)%,with an overall fluctuating and unchanged trend and it was higher in males than in females.In both 1990 and 2021,the TBL mortality rate attributable to secondhand smoke in China gradually increased with age,and the DALY rate first increased and then slowed down with age.The main groups of the burden of disease were the elderly and males.The grey prediction model GM(1,1)showed that the age-standardized mortality rate of TBL attributable to secondhand smoke from 2022 to 2031 showed a slow increasing trend,and the predicted value in 2031 would increase to 2.95/100 000.The age-standardized DALY showed a slow decreasing trend,and the predicted value in 2031 would decrease to 63.83/100 000.Conclusions:From 1990 to 2021,the TBL mortality,age-standardized mortality,and DALY rates attributable to secondhand smoke in China increased,and the age-standardized DALY rate decreased.Men and the elderly are the main groups affected by TBL.Appropriate measures should be formulated to reduce exposure to and contact with secondhand smoke,tak-ing into account gender and age differences.Additionally,efforts should be made to strengthen secondhand smoke prevention and public health education.

Objective:To investigate the expression of Artemin (ARTN) in malignant peripheral nerve sheath tumor (MPNST), its effect on the malignant behavior of MPNST cells, and its signaling pathway.Methods:Fifty-one MPNST paraffin embedded tissues through surgical resection at Tianjin Medical University Cancer Hospital from January 1995 to November 2011 were collected, the expression of the ARTN protein was detected by immunohistochemistry, and the relationship between the ARTN protein expression and the clinical pathological characteristics and prognosis were analyzed. In human MPNST cell lines ST-8814 (NF-1) and STS26T(sporadic), ARTN overexpression and low expression cell lines were constructed by transfecting ARTN overexpression plasmids and ARTN small interfering RNA (siRNA), respectively. The expression of ARTN mRNA was detected by real time quantitative polymerase chain reaction (RT-qPCR), the expression of the ARTN protein and Phosphoinositide 3-kinase(PI3K)/Akt signaling pathway related proteins were detected by Western blot. CCK-8 assay was used to detect cell proliferation ability, and cell invasion assay was used to detect cell invasion ability. The pathway proteins that interacted with ARTN were searched in the STRING database, and the functional pathways were clarified by Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. The PI3K/Akt pathway specific inhibitor LY294002 was used to block the PI3K/Akt pathway of ST-8814 and STS26T cells to observe the changes in cell proliferation and invasion.Results:Among the 51 MPNST tissue specimens, 22 cases showed a high expression of the ARTN protein and 29 cases showed a low expression of the protein. Higher expressions of the ARTN protein was associated with larger tumor diameters and disease progression (recurrence or metastasis) (both P＜0.05). The median disease-free survival (DFS) of patients with a low expression of the ARTN protein was 26.2 months, and the median overall survival (OS) was 66.9 months. The median DFS and median OS of patients with a high expression of the ARTN protein were 10.7 months and 53.8 months, respectively. The log rank test results showed that the progression free survival rate of patients with a high expression of the ARTN protein was worse than that of patients with a low expression ( P=0.027), but the difference in overall survival rate between the two groups was not statistically significant ( P=0.790), which was also confirmed by Cox regression analysis. The CCK-8 assay results showed that after 48 hours of transfection, the absorbance ( A) values of ST-8814 and STS26T cells in the ARTN overexpression group were 1.35±0.01 and 1.10±0.02, respectively, which were higher than those in the empty plasmid control group (1.05±0.01 and 0.78±0.01, both P＜0.01), while the A values of ST-8814 and STS26T cells in the ARTN siRNA group were 0.35±0.01 and 0.61±0.01, respectively, which were lower than those in the control siRNA group (0.74±0.01 and 1.10±0.04, both P＜0.01). The results of cell invasion assay showed that the number of transmembrane cells in ST-8814 and STS26T cells overexpressing ARTN was (29.67±2.08) and (31.67±2.08), respectively, which were higher than those in the empty plasmid control group [(20.00±1.00) and (24.33±1.15), both P＜0.01]. The number of transmembrane cells in ST-8814 and STS26T cells in the ARTN siRNA group were (14.00±2.00) and (19.33±1.53), respectively, which were lower than those in the control siRNA group [(19.33±2.52) and (23.33±0.58), both P＜0.05].The KEGG results showed that ARTN is associated with multiple tumor signaling pathways, especially the PI3K/Akt signaling pathway. Western blot results showed that overexpression of ARTN upregulated the expression of p-PI3K and p-Akt proteins in ST-8814 and STS26T cells (both P＜0.01).After knocking down ARTN expression, the expression of p-PI3K and p-Akt proteins was significantly down regulated (both P＜0.01). LY294002 could significantly inhibit the effect of ARTN overexpression on ST-8814 and STS26T cells after blocking the PI3K/Akt pathway. The A values of ST-8814 and STS26T cells in the ARTN overexpression+LY294002 group were 1.09±0.06 and 0.82±0.01, respectively, which were lower than those in the ARTN overexpression group (1.50±0.01 and 1.29±0.01, respectively, both P＜0.01). The numbers of transmembrane cells in the cell invasion assay were 16.67±3.21 and 19.67±2.31, respectively, which were also lower than those in the ARTN overexpression group (29.67±2.08 and 31.67±2.08, respectively, both P＜0.01). Conclusions:In MPNST, a high expression of the ARTN protein was associated with larger tumor size, disease progression, and worse DFS. ARTN promotes the proliferation and invasion of MPNST cells through the PI3K/Akt signaling pathway.

Objective To evaluate the left ventricular systolic function of patients with type 2 diabetes mellitus(T2DM)combined with renal insufficiency(CKD)by applying automated myocardial motion quantifica-tion(aCMQ)and to investigate its correlation with clinical biochemical indexes.Methods 80 patients with T2DM were enrolled,divided into DM group(without CKD,n=40)and DN group(with CKD,n=40),and 40 healthy volunteers were selected as the control group.The general clinical data of all subjects were recorded,and routine echocardiography and aCMQ were performed to obtain routine ultrasonographic measurements and aCMQ-related parameters.Results Comparison of aCMQ-related parameters:The differences in LV global longitudinal strain(LVGLS),LV apical 2-chamber longitudinal strain(LVAP2LS),LV apical 3-chamber longitudinal strain(LVAP3LS),and LV apical 4-chamber longitudinal strain(LVAP4LS)among the three groups were all statistically significant(P<0.05).The differences in LV global circumferential strain(LVGCS)between the DN group and the other two groups were statistically significant(P<0.05).The differences in LV short-axis basal segment cyclic strain(LVSAXBCS),LV short-axis middle segment cyclic strain(LVSAXMCS),and LV short-axis apical segment cyclic strain(LVSAXACS)were not statistically significant(P>0.05).LV strain was negatively correlated with Hs-CRP,GA,HbA1c,creatinine,urea,and uric acid,and positively correlated with eGFR.Correlation.High-sensitivity C-reactive protein(Hs-CRP),glycated albumin(GA)and eGFR showed good correlation with LV strain parameters.Conclusion The aCMQ technique can detect the deterioration of left ventricular function in patients with type 2 diabetes mellitus combined with renal insufficiency at an early stage,and the correlation between left ventricular strain parameters and hs-CRP,GA and eGFR can help to better assess their cardiac involvement.