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 Amid global climate change, extreme environmental events are occurring more frequently, and it is imperative to investigate the impacts of combined exposure to fine particluate matter (PM_2.5) and cold spells (CS) on population mortality. Objective To analyze the association between sequential extreme PM_2.5-cold spell (EP-CS) events and non-accidental mortality among residents in Zigong City from 2016 to 2021. Methods Using time-series study design, meteorological data in Zigong were collected from the Zigong Meteorological Bureau for the period from January 1, 2016 to December 31, 2021, while daily non-accidental mortality data were obtained from the mortality surveillance system of the Zigong Center for Disease Control and Prevention. We adopted the percentile method to define extreme PM_2.5 events and cold spells. We analyzed the risk effect of EP-CS events on non-accidental mortality among residents in this city and explored the potential amplification of damage resulting from different patterns of consecutive extreme events by using distributed lag nonlinear model (DLNM). We also conducted stratified analyses based on age, gender, education level, and marital status. Results The EP-CS events demonstrated a significant impact on non-accidental mortality among the local residents, exhibiting a certain lagged effect. The effects on the overall residents lasted from lag0 (RR=1.030, 95%CI: 1.013, 1.048) to lag14 (RR=1.035, 95%CI: 1.019, 1.052). Notably, the effects were more pronounced among females, individuals aged 65 years and above, and those who were never married, divorced, or widowed. Different patterns of EP-CS events all associated with adverse effects, the health impact of EP-CS events was significantly greater than that of individual PM_2.5 pollution or CS events. The analysis of lag effects across different event patterns revealed that the overall effect of EP-CS events with shorter intervals (0–7 d) had a stronger effect compared to EP-CS with longer intervals (8–14 d), and the RR values of lag14 were 1.034 (95%CI: 1.015, 1.054) and 1.017 (95%CI: 1.007, 1.027), suggesting that the damaging effect of compound events occurring in the short term was more significant. Conclusion All sequential extreme EP-CS events have an impact on non-accidental mortality among residents in this city, with compound events demonstrating a stronger effect. Females, individuals aged ≥65 years, and those who were never married, divorced, or widowed are more sensitive to EP-CS events.

Objective: To explore the effect of different obesity indicators in predicting cardiovascular and cerebrovascular diseases (CVD) risk among patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for the early identification of CVD risk among T2DM patients. Methods: The patients with T2DM under community management in Qingpu District, Shanghai Municipality were selected as the study subjects in January 2025. Basic information such as gender, age, and blood glucose control status were collected through the Shanghai Chronic Disease Information Management System, while history of CVD were obtained from residents' electronic health records and the Shanghai Disease Control Information Platform. Obesity was assessed using body mass index (BMI), waist circumference (WC), BMI combined with WC, waist-to-height ratio (WHtR), and triglyceride (TG) combined with WC indicators. The association between obesity and CVD was analyzed using multivariable logistic regression models. The predictive effect of each obesity indicators for CVD was evaluated using the area under the receiver operating characteristic curve (AUC). Results: A total of 4 367 patients with T2DM were included, including 2 121 males (48.57%) and 2 246 females (51.43%). The average age was (68.71±8.05) years. The prevalence of CVD was 44.49%. Multivariable logistic regression analysis showed that after adjusting for age, education level, history of hypertension, duration of T2DM, use of glucose-lowering medications, renal function, and blood glucose control status, obese T2DM patients had a 389.4% increased risk of CVD compared to those with normal BMI; centrally obese T2DM patients had a 100.4% increased risk compared to those with normal WC; T2DM patients with isolated general obesity and compound obesity had 161.0% and 241.1% increased risks of CVD, respectively, compared to those with normal BMI and WC; centrally obese T2DM patients had a 100.4% increased risk compared to those with normal WHtR; T2DM patients with normal TG-high WC and high TG-high WC phenotypes had 83.1% and 68.8% increased risks of CVD, respectively, compared to those with normal TG and normal WC (all P<0.05). BMI had the highest AUC, at 0.714, with sensitivity and specificity of 0.675 and 0.642, respectively. This was followed by BMI combined with WC, which had an AUC of 0.707, with sensitivity and specificity of 0.635 and 0.679, respectively. Conclusions Obesity defined by BMI, WC, BMI combined with WC, WHtR, and TG combined with WC increases the risk of CVD among patients with T2DM. BMI and BMI combined with WC have better predictive effect in predicting CVD risk among patients with T2DM, and can be used as the primary obesity indicators for CVD risk screening.

Objective: To investigate trends of incidence, mortality, and years of life lost (YLL) rate of lung cancer in cancer registration areas of Guizhou Province from 2017 to 2021, so as to provide references for formulating lung cancer prevention and control strategies and reducing the disease burden of lung cancer. Methods: The qualified lung cancer registration data from cancer registration areas of Guizhou Province from 2017 to 2021 were collected, the crude incidence and mortality of lung cancer were calculated by urban/rural areas, genders and ages. The standardized incidence and standardized mortality was calculated using the age structure of the standard population from the Fifth National Population Census in 2000. YLL was calculated using the standard life table from the Global Burden of Disease Study 2019. The disease burden of lung cancer was assessed using incidence, mortality, and YLL rate, and the trend in the disease burden of lung cancer from 2017 to 2021 was calculated using annual percent change (APC). Results : From 2017 to 2021, the crude incidence, standardized incidence, crude mortality, standardized mortality, YLL and YLL rate in Guizhou Province were 53.13/100 000, 37.58/100 000, 42.77/100 000, 29.44/100 000, 98.19 thousand person-years and 10.95‰, respectively. The standardized incidence and standardized mortality of lung cancer were higher in rural areas than in urban areas (39.45/100 000 vs. 34.23/100 000, 30.68/100 000 vs. 27.18/100 000). The standardized incidence and standardized mortality of lung cancer were higher in males than in females (49.34/100 000 vs. 26.47/100 000, 41.31/100 000 vs. 18.28/100 000). The crude incidence and crude mortality of lung cancer increased with age, peaking in the 80-<85 age group (360.84/100 000) and the ≥85 age group (414.85/100 000), respectively. From 2017 to 2021, the standardized incidence demonstrated downward trends in the total population, urban areas and males (APC=-6.590%, -5.829%, and -6.729%, all P<0.05). The standardized mortality demonstrated downward trends in urban areas and females (APC=-3.710% and -5.378%, both P<0.05). The YLL rate also showed downward trends in urban areas and females (APC=-3.957% and -3.631%, both P<0.05). Conclusions From 2017 to 2021, the overall disease burden of lung cancer in registration areas of Guizhou Province showed a decreasing trend. However, the disease burden remained relatively heavier in rural areas and males, with a relatively gradual change.

Objective To explore the mechanism of myocardial toxicity caused by N-methyl-3,4-methyle-nedioxyamphetamine(MDMA),the changes of intracellular calcium oscillation mode and calcium han-dling proteins during acute exposure to different concentrations of MDMA were detected,and the in-volvement of nuclear factor κB(NF-κB)and its effect on calcium handling proteins were investigated.Methods Primary rat cardiomyocytes were cultured to establish MDMA acute exposure model,and a control group was set up.The MDMA poisoning model was divided into three concentration groups of 10,100 and 1 000 μmol/L.After 1 h of exposure,the morphological changes of cardiomyocytes were ob-served,the cytotoxicity and changes in calcium signals were measured,and the changes in calcium handling proteins RyR2,SERCA2a,PLN,NCX1 and Cav1.2 were detected.The changes of NF-κB activity and the expression of nucleoprotein p-p65(Ser311)and PKCζ after MDMA exposure,and the intervention of NF-κB inhibitors pyrrolidine dithiocarbamate ammonium(PDTC)and protein kinase C(PKC)inhibitor chelerythrine(CHE)were detected by electrophoretic mobility shift assay(EMSA)and Western blotting.The effects of PDTC intervention on calcium signals,and the expressions of RyR2,SERCA2a,PLN,NCX1 and Cav1.2 after acute MDMA exposure were also observed.Results No obvious changes were observed in the morphology of cardiomyocytes after acute exposure to MDMA,whereas the oscillation waveform of intracytoplasmic calcium ion showed irregular changes with increased oscillation amplitude,intense fluctuations,irregular frequency,and increased fluctuation range of relative optical density values.The expression of RyR2,SERCA2a and NCX1 increased,while the expression of Cav1.2 and PLN de-creased.Acute MDMA exposure could increase NF-κB activity,while PDTC and CHE intervention could inhibit NF-κB activity.In MDMA exposed group,the expression of PKCζ and nucleoprotein p-p65(Ser311)both increased and could be inhibited by CHE.After the intervention of PDTC to block NF-κB,the amplitude of calcium oscillation was lower than that of the MDMA exposed group,and the expres-sion of RyR2,SERCA2a and NCX1 decreased.There was no significant change in PLN,while the ex-pression of Cav1.2 increased.Conclusion MDMA can lead to an increase of calcium ion concentration in cardiomyocytes.Calcium ions are involved in myocardial toxicity of MDMA.The mechanism is re-lated to changes in calcium handling proteins,mainly associated with the increased expression of RyR2.MDMA can up-regulate the intracellular activity of NF-κB through the PKCζ-NF-κB pathway and affect calcium handling proteins,which aggravate intracellular calcium overload during acute MDMA exposure.

Objective:To explore the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) placed in the uterine cavity after transcervical preparation for the treatment of adenomyosis (AM).Methods:A retrospective study analyzed 219 cases of AM patients treated at Department of Obstetrics and Gynaecology, the Second Hospital of Hebei Medical University from March 2022 to February 2023. Among them, 112 cases were treated with LNG-IUS after hysteroscopy due to abnormal uterine bleeding or abnormal uterine echo suggested by gynecological ultrasound, and were recorded as the hysteroscopy+LNG-IUS group; 107 cases without the above manifestations were treated with LNG-IUS alone, and were recorded as the LNG-IUS group. The two groups were observed for dysmenorrhea severity, menstrual volume, endometrial thickness, anemia, serum CA125 levels, uterine volume, and adverse reactions such as abnormal vaginal bleeding and intrauterine contraceptive device displacement or shedding before and 1, 3, 6, and 12 months after treatment.Results:1) Postoperative pathology of hysteroscopy+LNG-IUS group after hysteroscopy included endometrial polyps [39.3% (44/112)], proliferative endometrium [16.1% (18/112)], uterine leiomyoma [11.6% (13/112)], secretory endometrium [8.9% (10/112)], irregular endometrial hyperplasia [6.2% (7/112)], simple hyperplasia [5.4% (6/112)], AM lesions [4.5% (5/112)], and others [8.0% (9/112)]. 2) The degree of dysmenorrhea and menstrual volume, as well as other indicators, improved after treatment in both groups (all P<0.001). 3) When comparing the two groups, the degree of dysmenorrhea, menstrual volume, endometrial thickness, anemia, and serum CA125 at 1, 3, 6, and 12 months of treatment, the hysteroscopy+LNG-IUS group was significantly better than those in the LNG-IUS group (all P<0.05), the difference of uterine volume at 12 months of treatment between the hysteroscopy+LNG-IUS group [(109.76±32.90) cm 3] and the LNG-IUS group [(120.84±31.30) cm 3] was statistically significant ( P=0.011). 4) The cumulative incidence of adverse reactions of the two groups was statistically significant ( P=0.001) between the hysteroscopy+LNG-IUS group [24.1% (27/112)] and the LNG-IUS group [52.3% (56/107), P=0.001]. The hysteroscopy+LNG-IUS group had lower rates of vaginal irregular bleeding [8.0% (9/112)] and ring displacement or shedding [3.6% (4/112)] than those in the LNG-IUS group [23.4% (25/107), P=0.002; 11.2% (12/107), P=0.030]. Conclusion:After treatment with hysteroscopy, the placement of LNG-IUS and the simple intrauterine placement of LNG-IUS both significantly improve the severity of dysmenorrhea, endometrial thickness, anemia, menstrual volume, CA125, and uterine volume. The treatment effect of the LNG-IUS group after hysteroscopy is better and adverse reactions are milder, and it is expected to become the preferred option for the long-term management of conservative treatment of AM.

Objective:To construct a mindfulness based cancer rehabilitation training program for patients with malignant hematologic diseases based on the Liverpool mindfulness model, providing practical guidance for improving their physical and mental symptoms.Methods:The system searched for relevant literature on the application of mindfulness intervention in patients with malignant hematological diseases retrieved from Cochrane Library, PubMed, CINAHL, PsycInfo, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. The search period was from January 1, 1982 to December 26, 2023. Using the Liverpool mindfulness model as the theoretical framework, based on the literature review, group meetings and semi-structured interviews, a preliminary draft of a mindfulness cancer rehabilitation training program for patients with malignant hematologic diseases was developed. After 2 rounds of Delphi expert consultation, the final version of the intervention plan was determined.Results:Among the 19 experts, there were 4 males and 15 females, aged 30-61 (47.11 ± 7.64) years old. The effective recovery rates of the two rounds of expert inquiry questionnaires were both 19/19, and the expert authority coefficients were both 0.88. The Kendall coordination coefficients for the two rounds of inquiry were 0.214 and 0.220, respectively ( χ2=77.37, 108.66, both P<0.01).A mindfulness based cancer rehabilitation training program for patients with malignant hematologic diseases was ultimately developed, including intervention subjects, intervention personnel, intervention sites and forms, intervention timing, intervention intensity, intervention process and training theme content. Conclusions:The mindfulness based cancer rehabilitation training program for patients with malignant hematologic diseases constructed based on the Liverpool mindfulness model is necessary, scientific, and clinically suitable, and can provide a basis for clinical psychological nursing practice for patients with malignant hematologic diseases.

Objective To design a search and rescue simulation training system to enhance medical command,search and rescue capabilities of the PLA air force.Method A search and rescue simulation training sysgtem was designed based on the war gaming theory and developed with C/S architecture,C++language and MongoDB database for data storage,which was composed of four subsystems for scenario setting,action coordination and commanding operation simulation.The scenario setting subsystem included 3 modules of map editing setting,scenario editing and organization preparation;the action coordination subsystem had 5 modules of deduction process control,deduction coordination intervention,deduction status monitoring,perspective control and addition of deduction conditions;the commanding operation subsystem involved in 3 modules of command and control,real-time information query and operation command;the operation simulation subsy-stem consisted of 3 modules of agent search,rescue and treatment simulation,operation ruling and operation intelligence management.Results The system developed facilitated search,rescue and commanding training-related teaching and search and rescue program rehearsal verification,and thus comprehensively enhanced the trainee's capabilities in search,rescue,commanding and decision making.Conclusion The system developed integrates effectively medical commanding with operational commanding during search and rescue,providing a novel means for air force search and rescue operations and medical service simulation training.[Chinese Medical Equipment Journal,2025,46(4):15-20]

Objective To investigate the application of operation plan based on injury stress sequence in the treatment of degree Ⅲ and Ⅳ ankle fractures with Lange-Hansen classification of pronation and external rotation.Methods From May 2019 to May 2022,80 eligible patients of degree Ⅲand Ⅳ ankle fractures with Lange-Hansen classification were selected prospectively and randomely divided into 2 groups:40 patients in the study group were treated with surgical reduction according to the sequence of injury stress,and the other 40 patients in the control group were treated with traditional reduction sequence.The operative time,intraoperative blood loss,fracture healing time,full weight-bearing time,Ankle dorsoextension Angle,plantar flexion Angle,and American Orthopaedic Foot and Ankle Association were compared between the two groups Society,AOFAS)Ankle and posterior foot function scores and complications.Results The surgical time[(44.80±5.12)min vs.(47.61±6.42)min]and surgical bleeding volume[(43.81±9.02)ml vs.(51.50±12.01)ml]between the study group and the control group were statistically significant(all P＜0.05).Before surgery,there had no significant differences in ankle joint dorsiflexion angle,plantar flexion angle,AOFAS ankle and hind foot function score in 2 groups(all P＞0.05).The ankle dorsiflexion angle at 3 months after surgery[(16.84±1.77)° vs.(15.50±1.65)°],plantar flexion angle at 3 months after surgery[(45.64±4.10)° vs.(42.58±3.86)°]and at 6 months after surgery[(52.38±3.03)°vs.(50.64±3.74)°],the maximum walking distance score[(3.50±0.64)vs.(3.16±0.60)],ground walking score[(2.06±0.56)vs.(1.72±0.48)]and ankle joint anteroposterior activity score at 3 months after surgery[(4.96±1.38)vs.(4.16±1.07)]of the study group were all higher than those in the control group(all P＜0.05).There was no statistically significant difference in terms of fracture healing time,complete weight-bearing time,postoperative pain score,ankle joint function autonomous activity support score,abnormal gait score,maximum walking distance score at 6 months after surgery,ground walking score,ankle joint anterior and posterior activity score and surgical complications between 2 group(all P＞0.05).Conclusion According to the sequence of injury stress,surgical reduction for the treatment of grade Ⅲ and Ⅳ ankle fractures of Lange-Hansen classification of middle pronation and external rotation can shorten the operation time and promote the early recovery of joint function.

Objective:To investigate the incidence of hypomineralized second primary molars (HSPM) and deciduous teeth caries in school-aged children of Kaifeng City, and to discuss the association between HSPM and deciduous teeth caries, providing scientific guidance for clinical prevention and treatment.Methods:A cross-sectional study was carried out on first-grade children aged 6-7 years in five primary schools chosen from the eastern, western, southern, northern, and central areas of Kaifeng City by cluster random sampling method. The European Academy of Pediatric Dentistry criteria was used for scoring HSPM. The International Caries Detection and Assessment System (ICDAS-Ⅱ) was used to evaluate caries status.Results:This cross-sectional study was with a sample of 913 children. The prevalence of HSPM was 8.76% (80/913), with 39 boys and 41 girls, the most common type of which was atypical caries [35.00% (28/80)]. Regarding the distribution of HSPM, the incidence in maxilla [6.13% (56/913)] showed no statistically significant difference with that in the mandible [5.70% (52/913)] (χ2=0.16, P=0.692). In terms of severity, 56 cases were severe and 24 cases were mild. The association between HSPM and deciduous teeth caries was analyzed. The results showed that 56 had caries on their second primary molars among the 80 HSPM children. Children with HSPM had an increased risk of second deciduous molar decay compared to non-HSPM children ( OR=1.94, 95 %CI: 1.18-3.19, P<0.05); meanwhile, the deciduous teeth of HSPM children were more prone to suffer caries than those of non-HSPM children ( OR=2.33, 95 %CI: 1.26-4.29, P<0.05). Conclusions:The HSPM prevalence in school-aged children of Kaifeng City was 8.76%. Child with HSPM was more likely to have deciduous teeth caries than non-HSPM child. Special attention should be paid to children with HSPM after the eruption of affected molars.