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.

To explore the correlation between MTHFR C677T gene polymorphism and hypertension, hyperhomocysteinemia(Hcy), and hyperlipidemia in the Tibetan population of Tibet.

AIM:To evaluate the optimal timing of preoperative intravitreal anti vascular endothelial growth factor(VEGF)therapy in proliferative diabetic retinopathy(PDR)using intraoperative fluorescein angiography(IOFA).METHODS:A retrospective case series study was conducted on patients who underwent vitrectomy for PDR with vitreous hemorrhage(VH)at Sichuan Provincial People's Hospital from January 2023 to February 2025. Patients were divided into three groups according to the interval between intravitreal conbercept injection and surgery: Group A(3 d before surgery), Group B(7 d before surgery), and Group C(14 d before surgery). IOFA was used to assess the number and size of retinal neovascularization(NV). Additional data were collected including preoperative best corrected visual acuity(BCVA), vitreous hemorrhage grading, operative time, frequency of intraoperative endodiathermy, duration of high perfusion pressure, vitreoretinal adhesion grade, postoperative BCVA, and central macular thickness(CMT). Multidimensional analyses were performed.RESULTS:This study enrolled a total of 91 patients(94 eyes)with PDR accompanied by vitreous hemorrhage. Among them, Group A consisted of 31 patients(31 eyes; 18 males, 13 females; mean age 53.26±12.38 y), Group B consisted of 34 patients(37 eyes; 21 males, 13 females; mean age 51.61±14.16 y), and Group C consisted of 26 patients(26 eyes; 18 males, 8 females; mean age 51.00±12.02 y), with baseline characteristics comparable among the three groups(all P>0.05). Comparative analysis of NV visualized via IOFA revealed that both the number and size of NVs were significantly lower in Groups B and C than in Group A(all P<0.0167), while no statistically significant differences were observed between Groups B and C(both P>0.05). No significant differences were found among the three groups regarding other intraoperative parameters, including operation time, frequency of electrocoagulation application, duration of high perfusion pressure, or grading of vitreoretinal adhesion(all P>0.05).CONCLUSION:IOFA confirms that preoperative anti-VEGF therapy administered 7 or 14 d before surgery is more effective than a 3 d interval in suppressing retinal NV activity in PDR patients.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective To evaluate the efficacy,safety and cost-effectiveness of avatrombopag for treating primary immune thrombocytopenia(ITP)by rapid health technology assessment(rHTA),to provide evidence-based basis for clinical decision-making.Methods PubMed,Cochrane Library,Web of Science,Embase,CNKI,WanFang Data and the official website of health technology assessment(HTA)agency were electronically searched to collect systematic reviews/Meta-analyses,pharmacoeconomic literature,and HTA reports of avatrombopag for the treatment of ITP from inception to May 31,2025.Two reviewers independently screened studies,extracted data,assessed the quality of included studies,and qualitatively analyzed the result.Results A total of 12 studies were included,including 10 systematic reviews/Meta-analyses,1 pharmacoeconomic study and 1 HTA report.In terms of effectiveness,compared with placebo,treatment with avatrombopag significantly elevated platelet response,durable platelet response,early platelet response,and platelet count,reduction in use of concomitant ITP medication(P<0.05),and there was no significant difference in the need for remedial measures during the treatment period(P>0.05).Avatrombopag was also superior to eltrombopag,romiplostim,rituximab alone or in combination with recombinant human thrombopoietin(rhTPO)for platelet response(P<0.05).In terms of safety,there was no significant difference in the incidence of adverse events,serious adverse events,bleeding events and thrombotic events when comparing avatrombopag to placebo,eltrombopag,romiplostim and rituximab for the treatment of ITP(P>0.05).Economic study showed that avatrombopag has an economic advantage compared to eltrombopag and romiplostim,but it does not have economic advantages compared with observation and rescue.Conclusion Compared with placebo or other second-line treatments for ITP,avatrombopag has good efficacy and no significant differences in safety.Regarding economics,avatrombopag demonstrates greater cost-effectiveness than eltrombopag and romiplostim.However,due to its higher price,it does not have economic advantages compared to observation and rescue.Future economic research should be conducted domestically.

Objective:To evaluate the design and application of the superior thyroid artery perforator flap (STAPF) for reconstruction after head and neck oncological resection.Methods:A retrospective analysis was performed on 24 consecutive patients (22 men, 2 women; age 40-72 years) treated at Hunan Cancer Hospital between June 2018 and December 2023. Their primary tumors included buccal carcinoma ( n=7), tongue carcinoma ( n=8), oropharyngeal carcinoma ( n=2), floor-of-mouth carcinoma ( n=3), laryngeal carcinoma ( n=3), and hypopharyngeal carcinoma ( n=1). Flap design, venous drainage strategy, and postoperative outcomes were assessed. SPSS 19.0 software was used for statistical analysis. Results:Flap dimensions were length of 9.4±0.5 cm, width of 3.3±0.6 cm, thickness of 0.5±0.2 cm, and pedicle length of 7.3±0.6 cm. Fifteen flaps were based on a single perforator (diameter ≥0.5 mm), whereas, nine fascial flaps incorporated multiple perforators (capillary diameter ≤0.5 mm). Venous drainage routes were as follows: superior thyroid vein ( n=12, retrograde in 3), facial vein ( n=5, all retrograde), anterior jugular vein ( n=4, retrograde in 1), and external jugular vein ( n=3, retrograde in 2). All 24 flaps survived completely. Donor sites were closed primarily and all cervical wounds healed. No flap-related complications, inculding orocutaneous, pharyngocutaneous, laryngocutaneous fistula and wound infection, were observed. Final pathologic stages were T1N0M0 ( n=2), T2N0M0 ( n=16), T2N1M0 ( n=3), and T3N0M0 ( n=3). With follow-up of 12-46 months, aside from one patient with tongue cancer died of contralateral cervical and parapharyngeal lymph-node metastases at 6 months, others remained disease-free. Patients with laryngeal or hypopharyngeal carcinoma had their tracheostomy tubes removed within 4 weeks postoperatively. Conclusion:STAPF offers flexible design, with minimal donor-site morbidity and low functional impairment. It is particularly advantageous for reconstruction of small-to-moderate defects following head and neck tumor ablation.

Aim To investigate the effects of sodium lactate(NALA)on right heart failure induced by monocrotaline(MCT)-induced pulmonary arterial hy-pertension in rats and to reveal the underlying mecha-nisms.Methods Forty male Sprague-Dawley(SD)rats were randomly allocated into four groups,with ten rats in each group,namely,MCT group,NALA group,and NALA+MCT group;the MCT and NALA+MCT groups were administered a single intraperito-neal injection of MCT at 60 mg·kg-1 to induce pul-monary hypertension,and one week later,the NALA and NALA+MCT groups received intraperitoneal in-jections of NALA at 0.1 g·kg-1(once a day,for 5 weeks),while the CON and MCT groups received e-qual volumes of physiological saline(once a day,for 5 weeks);right heart function was assessed using echo-cardiography,right ventricular and pulmonary artery remodeling were evaluated via histopathological sec-tions,and the expression levels of ANP,BNP,and in-flammatory factors were measured by ELISA,along with assessments of oxidative stress levels,Western blot detection of the expression levels of proteins in the TLR4/NF-κB signaling pathway.Results Compared to the CON group,the MCT group exhibited increased RVSP and RVHI,decreased right heart function,in-creased collagen fiber deposition,and elevated oxida-tive stress and inflammatory factor expression,and the expression levels of proteins in the TLR4/NF-κB signa-ling pathway increased(P＜0.05);compared to the MCT group,the NALA+MCT group showed reduced RVSP and RVHI,improved right heart function,atten-uated pulmonary vascular remodeling,decreased ex-pression of ANP,BNP,inflammatory factors,and H2O2,along with increased antioxidant enzyme expres-sion,and the expression levels of proteins in the TLR4/NF-κB signaling pathway decreased(P＜0.05).Conclusion NALA can inhibit right ventric-ular remodeling in rats with pulmonary hypertension,and the underlying mechanism may involve the allevia-tion of inflammatory responses and oxidative stress through the inhibition of the TLR4/NF-κB signaling pathway.

Artificial intelligence(AI)has emerged as a cutting-edge technology leading the future and is a key engine for China's development.In the innovation and research of medical devices,AI has provided critical support in the areas of intelligent diagnostic assistance,intelligent therapeutic assis-tance,intelligent monitoring,life support,et al.Ma-chine learning-enabled device software functions(ML-DSFs)have become an essential component of many medical devices.Recently,the United States Food and Drug Administration(FDA)released a draft guidance titled"Marketing Submission Rec-ommendations for a Predetermined Change Con-trol Plan for Artificial Intelligence/Machine Learn-ing(AI/ML)-Enabled Device Software Functions(Draft)."that aimed to provide a forward-looking approach to foster the development of ML medical devices.By supporting iterative updates through modifications,this approach ensures the continu-ous safety and effectiveness of the devices.This guidance represents the latest in regulatory direc-tion and is especially beneficial for enhancing the quality and efficiency of clinical trials for AI prod-ucts.Therefore,we plan to provide a detailed intro-duction and interpretation of the guidance,with the aim of learning from international advanced regulatory concepts and experiences to promote the development of ML-DSFs with more profound international influence.

[Purpose]To analyze the trends of cancer incidence and mortality in cancer registration areas of Guizhou Province in 2019 and change trend from 2015 to 2019.[Methods]The incidence and mortality data of malignant tumors in 54 cancer registries in Guizhou Province that met the quality standards in 2019 were included.The incidence and mortality rate,age-standardized in-cidence/mortality rates by Chinese standard population(ASIRC,ASMRC)and world standard pop-ulation(ASIRW,ASMRW)as well as cumulative rates(0～74 years old)were calculated for urban and rural areas,as well as for men and women.Joinpoint software was used to calculate the an-nual percentage change(APC)and 95％confidence interval for trend anaylsis.[Results]In 2019,the crude incidence of cancers in Guizhou cancer registration areas was 246.72/105,ASIRC was 189.45/105,ASMRC was 181.85/105 and the cumulative incidence rate(0～74 years old)was 19.43％.Among the rankings of cancer incidence,lung cancer ranked the first,followed by liver cancer,female breast cancer,cervical cancer and colorectal cancer.In the same year,the crude mortality rate of cancers was 158.57/105,the ASMRC was 114.08/105,ASMRW was 111.94/105,with the cumulative mortality rate(0～74 years old)of 11.99％.Among the rankings of cancer mor-tality,lung cancer ranked the first,followed by liver cancer,colorectal cancer,stomach cancer and cervical cancer.In 2019,the incidence and mortality of cancers in the cancer registration areas of Guizhou Province showed an increasing trend with age.From 2015 to 2019,the ASIRC in Guizhou showed a decreased trend(APC=-1.13％)and the ASMRC showed an increasing trend(APC=2.48％),but they were not statistically significant(both P＞0.05).[Conclusion]From 2015 to 2019,the mortality rate of malignant tumors in the cancer registered areas of Guizhou Province increased and was higher than the national average level,and the disease burden was heavy.Lung cancer,malignant tumors of the digestive system,female breast cancer,and cervical cancer were malignant tumors with high incidence and mortality rates,and should be given priority for preven-tion and control.

Objective:To quantitatively evaluate the level of the three medical linkage in China from 2009 to 2022,explore the influencing factors and driving paths of the three medical linkage in China,and provide a new perspective for promoting the development of the three medical linkage.Methods:An optimized coupling coordination degree model was used to calculate the coupling coordination degree between the trinity healthcare systems and different binary systems within the systems in 31 provinces of China(excluding Hong Kong,Macao and Taiwan),and the Fuzzy-set Qualitative Comparative Analysis method was used to explore the condition configurations of multi-factor-driven three medical linkage.Results:From 2009 to 2022,the coupling coordination degree between the trinity healthcare systems in each province of China generally showed an increasing trend year by year.Among the binary systems,the overall coordinated development situation between the medical and medical insurance systems was the best and the regional development was the most balanced.The coupling coordination degree gap between the trinity healthcare system and the internal binary systems among provinces gradually widened,and the multi-polarization trend intensified.The paths to promote high-level three medical linkage can be summarized into two types:internal and external balanced development type(H1)and government-led type(H2,H3),among which the H1 path with per capita GDP and health expenditure as core conditions was the most common.Conclusion:It is suggested to enhance institutional and technological innovation,and integrate resources through a cross-departmental collaboration mechanism and digital technology.Provinces should select high-level optimization paths by leveraging regional endowments to narrow the regional development gap.Meanwhile,under the impetus of high-level policies,the protection and supervision system continues to improve,thereby promoting the three medical linkage.