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.

BackgroundArrhythmia and obsessive-compulsive disorder （OCD） frequently co-occur in clinical and epidemiological settings， yet their shared genetic basis and potential heart-brain axis mechanisms remain unclear. ObjectiveTo systematically evaluate the genetic correlation between arrhythmia and OCD， and to elucidate their underlying molecular genetic mechanisms， so as to provide molecular evidence for the "heart-brain axis" to support risk assessment and integrated clinical strategies for these comorbidities. MethodsThe aggregated data from the genome-wide association study （GWAS） of arrhythmia in the UK Biobank （7 207 cases and 477 391 controls） and the GWAS data of OCD released by the Psychiatric Genomics Consortium （2 688 cases and 7 037 controls） were integrated， all of which were limited to individuals of European ancestry. The genome-wide genetic correlations were estimated using the linkage disequilibrium score regression （LDSC） and the high-definition likelihood （HDL）. Local genetic correlation analysis was conducted using the local analysis of variance annotation （LAVA）. Multi-trait analysis of GWAS （MTAG） was employed to identify pleiotropic loci. Shared risk genes were identified by combining summary-data based Mendelian randomization （SMR） and transcriptome-wide association study （TWAS）. Functional enrichment analysis was performed based on the functional mapping and annotation （FUMA） platform. ResultsBoth LDSC （r_g=0.248， 95% CI： 0.159–0.336， P=4.82×10^-3） and HDL （r_g=0.294， 95% CI： 0.237–0.351， P=5.87×10^-4） revealed significant positive genetic correlation between arrhythmia and OCD. LAVA identified 23 significantly local correlated regions in the genome （P<2.0×10^-5）. MTAG discovered 11 genome-wide significant pleiotropic SNPs， among which rs12754189 （intron of KCNN3） had potential functional harmfulness （CADD>12.37）. SMR and TWAS jointly identified 20 shared genes， enriched in neural-cardiovascular tissues such as the cerebral cortex， amygdala， and left ventricle， and involved in DNA damage response， RNA metabolism， transcriptional regulation， and FAS signaling pathway （FDR<0.05）. ConclusionArrhythmia and OCD share a common genetic basis. The co-morbidity mechanism may involve the common vulnerability of neurons and cardiac muscle cells in terms of gene expression regulation and stress response， supporting the role of the brain-heart axis in the pathophysiology of both conditions.

Occupational disease diagnostician (ODD) is the core technology professional who is responsible for occupational disease diagnosis and identification and the main inspection work for occupational medical examination. The implementation of regular assessment management for ODDs is a key component of standardized workforce management, which facilitates dynamic evaluation of professional competence, regulation of medical practice, and assurance of medical safety. Since January 2025, Guangdong Province has implemented regular assessment management for ODDs within its administrative region. The assessment adopts an integrated model consisting of three components including professional competency evaluation, performance appraisal, and professional ethics evaluation, with each assessment cycle lasting three years. ODDs who passed all three components are classified as qualified ODD, whereas those who failed to pass any one of the three components result in an unqualified assessment outcome. In the implementation of ODD regular assessment management, Guangdong Province has emphasized integrating assessment with quality evaluation, strengthening full-cycle supervision of ODDs′ professional conduct, optimizing assessment strategies for special groups of ODDs, and reinforcing the primary management responsibility of medical institutions. Meanwhile, ODDs′ professional competence, service quality, and professional integrity have been continuously promoted by adopting human-computer interactive assessments, information-based assessment management, and "elimination" mechanism.

AIM: To analyze the factors affecting non-contact intraocular pressure(IOPNCT)measurements after femtosecond laser-assisted small incision lenticule extraction(SMILE), explore the correlation of IOPNCT with central corneal thickness(CCT)and corneal curvature after SMILE, and construct the corresponding regression model which will provide scientific basis for clinical evaluation of the true IOP of patients after SMILE.METHODS: Data from a retrospective analysis of 107 myopic patients(206 eyes)who underwent SMILE and 107 myopic patients(201 eyes)received femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery from June 2023 to May 2024 were examined. IOPNCT, CCT, and corneal curvature before surgery and at 1 and 3 mo were collected. The preoperative and postoperative IOPNCT, CCT and corneal curvature were analyzed by ANOVA and Pearson correlation analysis, and multiple linear regression models were constructed to evaluate the association of postoperative changes of IOPNCT, CCT and corneal curvature.RESULTS: There were significant differences in IOPNCT, CCT, and corneal curvature of both SMILE and FS-LASIK patients(all P<0.001), there was no significant difference between two groups and interaction effects(all P>0.05), and the IOPNCT, CCT and corneal curvature at 1 and 3 mo post-surgery were significantly lower than preoperative(all P<0.05). Pearson correlation analysis showed a positive correlation between IOPNCT and CCT at 1 and 3 mo after SMILE(r=0.261, 0.267, all P<0.001), but no significant correlation with corneal curvature(all P>0.05). Multiple linear regression analysis of IOPNCT with CCT and corneal curvature at 1 mo after SMILE indicated that the regression equation was: Y=3.426+0.019X1-0.058X2(Y represents IOPNCT, X1 represents the CCT, and X2 represents the corneal curvature), with statistical significant difference in the equation(F=7.654, P=0.001); the regression equation for 3 mo after surgery was: Y=2.056+0.020X1-0.038 X2(Y represents IOPNCT, X1 represents the CCT, and X2 represents the corneal curvature), with statistically significance in the equation(F=7.903, P<0.001). The regression equation of postoperative IOPNCT change(△IOPNCT)and intraoperative cutting corneal thickness(△CCT)and corneal curvature at 1 mo was Y=-2.252+0.008X1+0.587X2(Y represents △IOPNCT, X1 stands for the △CCT, X2 represents the corneal curvature change value), with statistical significant difference in the equation(F=17.550, P<0.001); the regression equation for 3 mo after surgery was: Y=-2.168+0.024X1+0.281X2(Y represents △IOPNCT, X1 represents △CCT, X2 indicates the corneal curvature change values), with statistical significant difference in the equation(F=16.030, P<0.001).CONCLUSION: After SMILE and FS-LASIK surgery, the IOPNCT value of patients was mainly affected by CCT compared with preoperative surgery, and the short-term use of hormone eye drops, fluorometholone, did not cause a significant increase in IOP; both the IOP correction formula at 1 and 3 mo postoperatively can be used clinically to evaluate and correct actual IOP in patients after SMILE.

AIM: To analyze the factors affecting non-contact intraocular pressure(IOPNCT)measurements after femtosecond laser-assisted small incision lenticule extraction(SMILE), explore the correlation of IOPNCT with central corneal thickness(CCT)and corneal curvature after SMILE, and construct the corresponding regression model which will provide scientific basis for clinical evaluation of the true IOP of patients after SMILE.METHODS: Data from a retrospective analysis of 107 myopic patients(206 eyes)who underwent SMILE and 107 myopic patients(201 eyes)received femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery from June 2023 to May 2024 were examined. IOPNCT, CCT, and corneal curvature before surgery and at 1 and 3 mo were collected. The preoperative and postoperative IOPNCT, CCT and corneal curvature were analyzed by ANOVA and Pearson correlation analysis, and multiple linear regression models were constructed to evaluate the association of postoperative changes of IOPNCT, CCT and corneal curvature.RESULTS: There were significant differences in IOPNCT, CCT, and corneal curvature of both SMILE and FS-LASIK patients(all P<0.001), there was no significant difference between two groups and interaction effects(all P>0.05), and the IOPNCT, CCT and corneal curvature at 1 and 3 mo post-surgery were significantly lower than preoperative(all P<0.05). Pearson correlation analysis showed a positive correlation between IOPNCT and CCT at 1 and 3 mo after SMILE(r=0.261, 0.267, all P<0.001), but no significant correlation with corneal curvature(all P>0.05). Multiple linear regression analysis of IOPNCT with CCT and corneal curvature at 1 mo after SMILE indicated that the regression equation was: Y=3.426+0.019X1-0.058X2(Y represents IOPNCT, X1 represents the CCT, and X2 represents the corneal curvature), with statistical significant difference in the equation(F=7.654, P=0.001); the regression equation for 3 mo after surgery was: Y=2.056+0.020X1-0.038 X2(Y represents IOPNCT, X1 represents the CCT, and X2 represents the corneal curvature), with statistically significance in the equation(F=7.903, P<0.001). The regression equation of postoperative IOPNCT change(△IOPNCT)and intraoperative cutting corneal thickness(△CCT)and corneal curvature at 1 mo was Y=-2.252+0.008X1+0.587X2(Y represents △IOPNCT, X1 stands for the △CCT, X2 represents the corneal curvature change value), with statistical significant difference in the equation(F=17.550, P<0.001); the regression equation for 3 mo after surgery was: Y=-2.168+0.024X1+0.281X2(Y represents △IOPNCT, X1 represents △CCT, X2 indicates the corneal curvature change values), with statistical significant difference in the equation(F=16.030, P<0.001).CONCLUSION: After SMILE and FS-LASIK surgery, the IOPNCT value of patients was mainly affected by CCT compared with preoperative surgery, and the short-term use of hormone eye drops, fluorometholone, did not cause a significant increase in IOP; both the IOP correction formula at 1 and 3 mo postoperatively can be used clinically to evaluate and correct actual IOP in patients after SMILE.

Traumatic brain injury(TBI)is mostly caused by motor vehicle traffic accidents or competitive sports,with high mortality and disability.TBI mainly includes primary injury and secondary injury.Primary injuries were caused directly by external forces.Secondary injuries include brain edema,excitotoxic effect of neuron cells,oxidative stress and neuroinflammation,etc.Effective intervention of secondary injury not only helps to improve the prognosis of patients with TBI,but also reduces the risk of Parkinson's disease and other neurodegenerative diseases related to TBI.Autophagy is one of approaches to regulate homeostasis in cells,and autophagy dysfunction has been found in several neurodegenerative diseases and TBI.It is speculated that autophagy dysfunction may play an important role in TBI and explain why patients with TBI have higher risk of neurodegenerative disease.Discovering the role of autophagy in the pathological mechanism of TBI may provide new targets for TBI clinical treatment and cognitive impairment prevention in patients with TBI.

To explore the clinical efficacy of the modified segmented peroral endoscopic myotomy (POEM) for the treatment of achalasia (AC), AC patients admitted to the Jianhu People's Hospital from December 2019 to December 2021 were included in a retrospective cohort study. Patients received segmented POEM were included in the segmented POEM group, while patients treated with progressive POEM were included in the progressive POEM group. Perioperative indicators (including Eckardt scores preoperatively and at 6 months postoperatively), clinical efficacy, and complications were compared between the two groups. A total of 65 AC patients were included, among them, 28 patients were in the segmented POEM group, and 37 patients in the progressive POEM group. There were no significant differences in the general information of the two groups, including gender, age, lesion type, or Eckardt scores before the operation ( P>0.05). There were significant differences in the incidence of postoperative complications, including subcutaneous emphysema [3.6% (1/28) VS 24.3% (9/37), P=0.035] and small pleural effusion [7.1% (2/28) VS 27.0% (10/37), χ2=4.186, P=0.041] between the two groups. Postoperative chest pain duration (36.5±10.5 hours VS 44.3±11.8 hours, t=2.765, P=0.008), severity (4.1±2.1 VS 6.2±2.3, t=3.783, P<0.001), and fever days (2.1±1.3 days VS 3.1±1.5 days, t=2.816, P=0.007) also showed statistical difference. However, there was no significant difference in the incidence of postoperative pneumothorax between the two groups [0.0% (0/28) VS 2.7% (1/37), P=1.000]. At the 6-month follow-up, the segmented POEM group had a lower incidence of retrosternal pain and gastroesophageal reflux compared to the progressive POEM group ( P<0.05), and the Eckardt score was significantly improved (2.2±1.1 VS 2.9±1.3, t=2.294, P=0.025). Both segmented and progressive POEM are effective treatments for AC, but segmented POEM has higher safety, lower incidence of postoperative chest pain and gastroesophageal reflux complications, and better clinical efficacy.

The health and well-being of the elderly have become a focal point for all sectors of society. As an effective means of preventing and controlling infectious diseases, vaccination plays a critical role in safeguarding human health. For older adults, timely and scientifically guided vaccination can significantly reduce the risk of serious illnesses while alleviating the associated economic burdens and pressure imposed on society. However, in practice, deficiencies in policy support, accessibility of vaccination services, and public awareness hinder some elderly individuals from fully benefiting from the protective effects of vaccines. This paper analyzes current vaccination practices for the elderly globally and proposes strategies to improve vaccination coverage, providing a scientific basis for advancing effective vaccination initiatives for this demographic in China.

Objective To understand the current situation as well as the implementation of infection prevention and control measures against bacterial contamination of external and vaginal ultrasound probes in medical institutions(MIs),and explore the risk of ultrasound probe-related infection under current prevention and control measures.Methods Through on-site sampling,external ultrasound probes from 179 MIs and vaginal ultrasound probes from 83 MIs in 15 prefecture-level cities in Henan Province underwent quantitative bacterial detection,and the implemen-tation of relevant infection prevention and control measures was assessed using questionnaire survey.Results A to-tal of 513 ultrasound probe specimens were detected.Bacterial detection rate and exceedance rate of the disinfected vaginal ultrasound probes were 18.02％(20/111)and 2.70％(3/111),respectively,which were both lower than external ultrasound probes(40.05％[161/402]and 5.22％[21/402],respectively).Bacterial detection rate of dis-infected specimens was lower than that of the towel-wiping group([33.86％,149/440]vs[50.00％,27/54],x2=5.46,P=0.019).Bacterial detection rate of the quaternary ammonium salt disinfectant group was lower than that of the alcohol disinfectant group([17.31％,18/104]vs[40.63％,128/315],x2=18.74,P＜0.001).The quali-fied rates of specimens using different disinfection methods and with different probe types showed no statistically significant differences(all P＞0.05).The implementation rates of"single disinfection for every use"for external ul-trasound probes and vaginal ultrasound probes were 60.34％(108/179)and 70.54％(79/112),respectively.The disinfectants used were mainly quaternary ammonium salts(57.27％)and alcohols(36.36％).The coupling agents used for external and vaginal ultrasound examinations were mainly large packaged products for multiple time use,accounting for 93.85％and 57.89％,respectively.33.33％(56/168)of external ultrasound coupling agents and 20.00％(11/55)of vaginal ultrasound coupling agents were used for more than 7 days.In vaginal ultrasound exa-minations,the usage rates of disinfectant coupling agents and sterile coupling agents were 28.42％(27/95)and 14.74％(14/95),respectively.In vaginal ultrasound examinations,50.00％(56/112)of MIs used condoms as probe co-vers,and 45.54％(51/112)used sound-transmission ultrasound isolation membranes.60.55％(66/109)of MIs didn't change gloves after cleaning and disinfecting the vaginal ultrasound probe and before examination.Conclusion Ultrasound probes have cross infection risks in key processes such as reprocessing(disinfection/sterilization),phy-sical barrier use,coupling agent selection,and glove replacement.It is urgent to develop and implement standar-dized ultrasound probe infection prevention and control technical specifications based on evidence-based research.

Objective:To explore the effectiveness of diaphragm exercises in mechanical ventilation patients with severe pneumonia.Methods:Convenience sampling was used to select 166 mechanical ventilation patients with severe pneumonia admitted to the First Affiliated Hospital of Zhengzhou University from May 2021 to August 2023 for the study. Seventy-nine patients admitted from May 2021 to June 2022 were set up as control group and 87 patients admitted from July 2022 to August 2023 were set up as experimental group. Patients in control group received routine nursing, and experimental group carried out diaphragm exercise on the basis of control group. Post-intervention recovery, and the incidence of complications were compared between the two groups.Results:In experimental group, the patients' mechanical ventilation time was shorter than that in control group, the withdrawal success rate was higher than that in control group, and the ventilator-associated pneumonia (VAP) and total complication incidences were lower than those in control group, and the differences were all statistically significant ( P<0.05) . Conclusions:Diaphragm exercise reduces the risk of VAP and promotes recovery in mechanical ventilation patients with severe pneumonia.