Objective:To evaluate the safety of neoadjuvant therapy with pembrolizumab combined with 5-fluorouracil (5-FU) and cisplatin in patients with advanced temporal bone squamous cell carcinoma (TBSCC), and its impact on tumor response rate and disease-free survival (DFS).Methods:This prospective, single-arm, open-label clinical study enrolled patients with advanced (Stage Ⅲ/Ⅳ) TBSCC from Sun Yat-sen Memorial Hospital. Patients received 2-3 cycles of neoadjuvant therapy with pembrolizumab, 5-FU, and cisplatin, followed by definitive surgery. Postoperatively, patients received 6 cycles of pembrolizumab combined with radiotherapy. The primary endpoint was the 2-year disease-free survival (DFS) rate. Secondary endpoints included objective response rate (ORR) and safety indicators. Survival analysis was performed using the Kaplan-Meier method. Adverse events (AE) were assessed using the National Cancer Institute′s Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Statistical analyses were conducted using SPSS software, version 22.0.Results:From August 2021 to April 2024, 16 patients with advanced TBSCC were enrolled (13 males and 3 females), with a median age of 54 years and a median follow-up time of 2.32 years. Following neoadjuvant therapy, the objective response rate (ORR) was 64.3% (9/14), and the disease control rate (DCR) was 92.9% (13/14). The 2-year DFS rate was 86.6%. Common treatment-related adverse events (TRAE) included leukopenia (56.3%, 9/16), nausea and vomiting (50.0%, 8/16), diarrhea, oral mucositis, and elevated liver function tests (25.0%, 4/16). One patient (6.25%) experienced a grade 3 adverse event.Conclusion:Neoadjuvant pembrolizumab-chemotherapy significantly enhances objective response rate and disease-free survival in advanced TBSCC.

Objective To investigate the protective effect of electrical stimulation-induced auditory brainstem response(EABR)monitoring on the cochlear nerve pathway during acoustic neuroma surgery.Methods The data of 36 patients who underwent acoustic neuroma surgery were studied,all surgeries were performed using the middle fossa approach.Among them,18 cases were monitored intraoperatively using EABR monitoring 4 times as the mo-nitoring group,while the other 18 cases underwent surgery without monitoring as the control group.The monito-ring group,preoperatively,there were 7 ears classified as grade A,6 ears as grade B,and 5 ears as grade C.The preoperative pure tone average thresholds(0.5,1.0,2.0,4.0 kHz)were 37.60±16.95 dB HL,and the maximum tumor diameter was 13.76±4.37 mm.The control group,preoperatively,there were 4 ears classified as grade A,7 ears as grade B,and 7 ears as grade C.The preoperative pure tone average was 46.80±22.64 dB HL,and the max-imum tumor diameter was 13.74±4.26 mm.Results In the monitoring group,except for the first monitoring,the V-wave evoked rate was 72.22％(13/18),and for the remaining three times,it was 100.00％(18/18).The mini-mum current stimulation intensity that could evoke the V-wave was 0.5 mA,and the V-wave latency was 3.97±0.17 ms.Follow-up was conducted for both groups of patients within 1 to 3 months postoperatively.In the monito-ring group,there were 7 ears classified as grade A,4 ears as grade B,4 ears as grade C,and 3 ears as grade D.Among them,3 patients experienced hearing loss after surgery,and the postoperative pure tone average was 52.20±38.35 dB HL.In the control group,there was 1 ear classified as grade A,1 ear as grade B,6 ears as grade C,and 10 ears as grade D.Among them,10 patients experienced hearing loss after surgery,and the postoperative pure tone average was 90.90±37.28 dB HL.Conclusion EABR monitoring during the resection of acoustic neuroma not only has positive significance for improving the hearing protection rate of acoustic neuroma surgery,but also assists the surgeons in identifying the cochlear nerve during surgery.The integrity of the auditory nerve pathway is protec-ted to the greatest extent for possible cochlear implanting.

Objective To investigate the protective effect of electrical stimulation-induced auditory brainstem response(EABR)monitoring on the cochlear nerve pathway during acoustic neuroma surgery.Methods The data of 36 patients who underwent acoustic neuroma surgery were studied,all surgeries were performed using the middle fossa approach.Among them,18 cases were monitored intraoperatively using EABR monitoring 4 times as the mo-nitoring group,while the other 18 cases underwent surgery without monitoring as the control group.The monito-ring group,preoperatively,there were 7 ears classified as grade A,6 ears as grade B,and 5 ears as grade C.The preoperative pure tone average thresholds(0.5,1.0,2.0,4.0 kHz)were 37.60±16.95 dB HL,and the maximum tumor diameter was 13.76±4.37 mm.The control group,preoperatively,there were 4 ears classified as grade A,7 ears as grade B,and 7 ears as grade C.The preoperative pure tone average was 46.80±22.64 dB HL,and the max-imum tumor diameter was 13.74±4.26 mm.Results In the monitoring group,except for the first monitoring,the V-wave evoked rate was 72.22％(13/18),and for the remaining three times,it was 100.00％(18/18).The mini-mum current stimulation intensity that could evoke the V-wave was 0.5 mA,and the V-wave latency was 3.97±0.17 ms.Follow-up was conducted for both groups of patients within 1 to 3 months postoperatively.In the monito-ring group,there were 7 ears classified as grade A,4 ears as grade B,4 ears as grade C,and 3 ears as grade D.Among them,3 patients experienced hearing loss after surgery,and the postoperative pure tone average was 52.20±38.35 dB HL.In the control group,there was 1 ear classified as grade A,1 ear as grade B,6 ears as grade C,and 10 ears as grade D.Among them,10 patients experienced hearing loss after surgery,and the postoperative pure tone average was 90.90±37.28 dB HL.Conclusion EABR monitoring during the resection of acoustic neuroma not only has positive significance for improving the hearing protection rate of acoustic neuroma surgery,but also assists the surgeons in identifying the cochlear nerve during surgery.The integrity of the auditory nerve pathway is protec-ted to the greatest extent for possible cochlear implanting.

Objective:To evaluate the safety of neoadjuvant therapy with pembrolizumab combined with 5-fluorouracil (5-FU) and cisplatin in patients with advanced temporal bone squamous cell carcinoma (TBSCC), and its impact on tumor response rate and disease-free survival (DFS).Methods:This prospective, single-arm, open-label clinical study enrolled patients with advanced (Stage Ⅲ/Ⅳ) TBSCC from Sun Yat-sen Memorial Hospital. Patients received 2-3 cycles of neoadjuvant therapy with pembrolizumab, 5-FU, and cisplatin, followed by definitive surgery. Postoperatively, patients received 6 cycles of pembrolizumab combined with radiotherapy. The primary endpoint was the 2-year disease-free survival (DFS) rate. Secondary endpoints included objective response rate (ORR) and safety indicators. Survival analysis was performed using the Kaplan-Meier method. Adverse events (AE) were assessed using the National Cancer Institute′s Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Statistical analyses were conducted using SPSS software, version 22.0.Results:From August 2021 to April 2024, 16 patients with advanced TBSCC were enrolled (13 males and 3 females), with a median age of 54 years and a median follow-up time of 2.32 years. Following neoadjuvant therapy, the objective response rate (ORR) was 64.3% (9/14), and the disease control rate (DCR) was 92.9% (13/14). The 2-year DFS rate was 86.6%. Common treatment-related adverse events (TRAE) included leukopenia (56.3%, 9/16), nausea and vomiting (50.0%, 8/16), diarrhea, oral mucositis, and elevated liver function tests (25.0%, 4/16). One patient (6.25%) experienced a grade 3 adverse event.Conclusion:Neoadjuvant pembrolizumab-chemotherapy significantly enhances objective response rate and disease-free survival in advanced TBSCC.

Objective:To investigate the prevalence of influenza, pneumococcal, hepatitis B virus (HBV), human papillomavirus (HPV), and varicella zoster virus (VZV) vaccination in patients with systemic lupus erythematosus (SLE), and to analyze the factors related to vaccination.Methods:Data were obtained from 1 203 patients with SLE, via a multi-center web-based survey using an online questionnaire. Data about their social conditions, clinical presentations, willingness for being vaccinated, vaccination within 5 years were collected. Demographic data were shown by descriptive analysis. Chi-square and logistic regression analysis were used to assess the power of related indexes as predictors of vaccination.Results:The vaccination rates of influenza, pneumococcal, HBV, HPV, and VZV were 5.49% (66/1 203), 0.66% (8/1 203), 2.08% (25/1 203), 3.82% (46/1 203), and 0.17% (2/1 203), respectively. Data analysis showed that higher education ( χ2=30.94, P<0.001) and higher income ( χ2=10.70, P=0.001) had greater effects on influenza vaccination. There was a relationship between HPV vaccination and higher education ( χ2=20.96, P<0.001), higher income ( χ2=20.56, P<0.001), younger age ( χ2=8.54, P=0.001), and single ( χ2=5.63, P=0.018). Male ( χ2=10.27, P=0.001) and higher education ( χ2=4.52, P=0.034) were associated with HBV vaccination. The multivariate logistic regression analysis revealed that higher education [ OR (95% CI)=2.14 (1.10, 4.18), P=0.026], having children under 18 years-old [ OR(95% CI)=1.802(1.02, 3.18), P=0.042], and hydroxychloroquine usage [ OR(95% CI)=2.55(1.06, 6.15), P=0.037], had a positive correlation with influenza vaccination. Male [ OR(95% CI)=4.24(1.37, 13.08), P=0.012], had an impact on HBV vaccination. The factors related to HPV vaccination included age <45 [ OR (95% CI)=0.93(0.89, 0.97), P=0.001], higher education [ OR(95% CI)=2.28(1.11, 4.65), P=0.024], higher income [ OR(95% CI)=2.68(1.32, 3.41), P=0.006] and the usage of immunosuppressive agents [ OR(95% CI)=1.92(1.03, 3.59), P=0.041]. Conclusion:The prevalence of vaccination in patients with SLE is low. Patients with higher education and income are more likely to being vaccinated.

OBJECTIVE Aim to explore the value and the selection of observation target of P1 component in children with cochlear implant(CI). METHODS 13 children(4.37±0.73 years old) with right side CI and one year of regular post-CI rehabilitation were recruited as CI group. 15 gender and age (4.25±0.84)years matched children with left side external and middle ear malformation were selected as control group. We collected their AEP which showed their reaction to 1000 Hz pure tone and analyzed the P1 component. RESULTS The cut off value between CI group and control groupwas 10.4mV for P1 Amplitude(P1A) and 110.5 mV for P1 Latency(P1L). More precisely, the values of CI group were above the cut off value while the values of control group were below it. Whether choosing P1A or P1L as dividing standard, the AUC were between 0.5 and 0.9(AUC: P1A0.733, P1L0.800), which showed medium distinguishing significance. P1L component showed greater You-den index(0.590>0.471) and sensitivity(0.923> 0.538) while P1A showed greater specificity(0.933>0.667). CONCLUSION P1L shows greater ability in distinguishing the difference between CI group and control group while P1A has advantage in determining their common feature. Generally, P1L shows higher value in studying CI children. We need to make choice between P1A and P1L in different situation and use P1A and P1L standard in series or parallel.

Objective To summary the risk factors,clinical characteristics and treatment of acute colonic pseudo-obstruction (ACPO) after cesarean section(CS).Methods The case group enrolled 11 patients who were diagnosed with ACPO after cesarean section in the First Affiliated Hospital of University of Science and Technology of China from January 2006 to January 2018.Another 55 patients without ACPO after CS,performed within two weeks' difference from the case group,were randomly selected as the control group.Clinical data of all subjects were analyzed retrospectively.Potential clinical risk factors were statistically analyzed.T test,Chi-square test and logistic regression analysis were used for statistical analysis.Results In the case group,the abdominal distension presented on 2 d (n=1),3 d (n=7),4 d (n=2) and 17 d (n=1) respectively after CS,and all cases experienced abdominal pain and nausea.Vomiting was reported in some cases.Plain abdominal X-ray images revealed pneumocolon with colon pouch.The maximum diameter of cecum was 6 to 12 cm.Air-liquid levels were observed in two patients.All patients underwent fasting,gastrointestinal decompression,intravenous fluid infusion,correction of electrolyte imbalance,hypertonic saline enema and prophylactic antibiotic treatment.The disease condition lasted two to six days in these patients.Conservative treatment was successful in eight patients and failed in the other three who later went for operations.The maximum cecal diameters in the three patients who underwent surgery were all ≥ 9 cm,among whom one case progressed quickly and laparotomy was tempted to rule out mechanical intestinal obstruction.In this case,the pressure was successfully reduced by placing a thoracic catheter through the anus after the failure of intestinal puncture trying to release the gases.One patient underwent colostomy due to positive signs of peritoneal irritation after a failure of four-day conservative treatment.One patient suffered a relapse after having been treated conservatively for five days,and then underwent surgeries of resection of ileocecum,distal closure of the colon ascendens plus terminal ileostomy due to intestinal perforation.Multivariate logistic regression analysis showed that higher postoperative leukocyte count (OR=1.38,95％CI:1.12-1.71,P=0.003) and postoperative body temperature ＞38 ℃ (OR=6.47,95％CI:1.06-39.61,P=0.044) were the risk factors for ACPO after CS.Conclusions Elevated leukocyte count and body temperature ＞38 ℃ were two high-risk factors for ACPO after CS.ACPO is characterized by acute onset,and the first choice is conservative management.Active surgical treatment would be required if conservative treatment fails,especially when the maximum diameter of the cecum is ≥ 9 cm,which may increase the incidence of intestinal necrosis or perforation.

Objective To investigate the clinical and immunological features of primary Sj(o)gren's syndrome (pSS) in both sexs,and to find out the pathophysiology of pSS.Methods Clinical data of 110 pSS cases were analyzed retrospectively,and cytokine levels of interleukin (IL)-2,IL-4,IL-6,IL-10,IL-17A,Tumour necrosis factor (TNF)-α,interferon (IFN)-α were measured (male=20,female=90) in patients and healthy controls (n=30) using enzyme linked immunosorbent assay (ELISA).Results Compared with female patients,no significant difference was found in male patientsin symptoms of dry mouth and dry eye (90.0％ vs 98.9％,x2=4.874,P＞0.05);the frequency of parotid gland enlargement and lymphadenectasis were higher in male (40.0％ vs 5.6％,x2=18.629,P＜0.01;25.0％ vs 6.7％,x3=6.111,P＜0.05);and the level of immunoglobu lin (Ig)A and C4 [2.2(1.5,3.0) g/L vs 3.3(2.5,5.0) g/L,Z=-3.119,P＜0.01;(0.15±0.05) g/L vs (0.19±0.08) g/L,t=-2.659,P＜0.05] were lower in male,as well as the incidence of positive anti SSA/SSB antibodies (55.0％ vs 78.8％,x2=4.921,P＜0.05).Cytokine levels of IL-2,IL-6,TNF-α (t=-3.783,-6.193,-2.065,P＜0.05) were higher in pSS than HC.Compared with female patients,cytokine levels of IL-10,IFN-γ (t=-1.075,6.286,P＜0.05) were higher in male,however,the levels of IL-2,TNF-o (t=-3.472,-5.867,P＜0.01) were lower in male.Conclusion There are differences in the cytokine levels secreted from Thl and Th2 cell between male and female patients of pSS,which may relate to the clinical and immunological characteristics and can help to reveal the pathophysiology of pSS.

Objective To compare the value of computed tomography(CT)and magnetic resonance im-aging(MRI)in assessing the curative effect of primary liver cancer after transcatheter arterial chemoembolization (TACE). Methods 45 patients with primary hepatocellular carcinoma treated with TACE for 3 ～ 5 times were included in the research. CT ,MRI and digital subtraction angiography (DSA) were performed after treatment. DSA was used as a standard to analyze the lesions ,residual or lesion recurrence and the detection of tumor cap-sule in CT and MRI DSA. Results The scanning accuracy and sensitivity of residual lesions or lesion recurrence after TACE in CT was much lower than MRI ,and there is a significant difference between the two groups (P <0.05). In terms of tumor capsule detection accuracy after TACE ,CT was much lower than MRI(P < 0.05). In detection rate of residual or lesion recurrence in different types of lipiodol deposition after TACE ,CT was much lower than MRI (P < 0.05). Conclusions Compared with the CT test ,MRI detection has a higher accuracy and sensitivity of residual lesions or recurrence after TACE. MRI can not only effectively show the tumor cap-sule ,but also detect residual lesion or lesion recurrence of different types of lipiodol deposition. MRI is superior to CT in the evaluating the curative effect of primary liver cancer after TACE.

Objective To study the change of toll-like receptor 3 (TLR3) and tumor necrosis factoralpha (TNF-α) both at the levels of protein and mRNA in human lung epithelial cells (A549) infected with respiratory syncytial virus (RSV) and the effects of peroxisome proliferator-activated receptor γ (PPARγ) agonists Rosiglitazone and 15-deoxy-delta12,14 prostaglandin J2 (15d-PGJ2).Methods RSV inoculation after A549 cells subcultured,then A549 cells were randomly divided into six groups:15d-PGJ2 + RSV group (group A),Rosiglitazone + RSV group (group B),RSV group (group C),PDTC + RSV group (group D),GW9662 + Rosiglitazone + RSV group (group E) and cell control group (group F).Cells were harvested after incubated for 12 h,24 h and 48 h respectively.The expression of TLR3 and TNF-α at mRNA was determined by real-time RT-PCR,and the protein level of TLR3 and TNF-α was determined by Western Blot and ELISA respectively.Results The expression of TLR3 and TNF-α at mRNA and protein at virous time in group C were significantly higher than those of group F (all P ＜ 0.01).While,the expression of TLR3 and TNF-α mRNA and protein in group A,B and D were significantly lower than than those of group C (all P ＜ 0.01).15d-PGJ2 and Rosiglitazone had the strongest effect to inhibit the expression of TLR3 and TNF-αmRNA and protein at 12 h and the expression of TLR3 and TNF-α mRNA and protein decreased as the increasing dose of 15d-PGJ2 and Rosiglitazone.Conclusion RSV infection induces increased expression of TLR3 and TNF-α mRNA and protein,which can be inhibited by Rosiglitazone and 15d-PGJ2 in a dose-dependent manner.