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.

Objective:To construct a remote screening network for breast cancer based on automated breast ultrasound (ABUS) and explore the value of ABUS with remote reading for breast cancer screening.Methods:We constructed a remote breast cancer screening network including one remote reading center and 48 image-acquisition centers. We recruited women to participate in breast cancer screening at one of these image-acquisition centers from January 2021 to January 2023. The technicians collected the whole breast images using the ABUS. The images were then sent to the reading center through the PVBUS System and interpreted independently by two radiologists using the Breast Imaging Reporting and Data System (BI-RADS). BI-RADS categories 1 and 2 indicate negative screening results, and women diagnosed with these categories were recommended for annual breast ultrasound screening. BI-RADS categories 3, 4, and 5 indicate positive results. Women with BI-RADS category 3 lesions were recommended for follow-up examinations every 6 months using ABUS or handheld ultrasound, while those with BI-RADS 4 and 5 lesions were suggested to undergo pathological examinations.Results:In our study, we enrolled 10 344 women who completed the ABUS screening and were followed up for more than 12 months. After remote reading, 6 164 women were diagnosed with BI-RADS category 1 and 2 626 woman were within BI-RADS category 2. In contrast, 1 404 women were within BI-RADS category 3, a total of 135 women were within BI-RADS category 4, and 15 women were within BI-RADS category 5. The positive screening rate of ABUS was 15.0% (1 554/10 344). The ABUS with remote reading had a detection rate of 3.7/1 000 (38/10 344) for breast cancer screening, with a sensitivity of 97.4% (38/39) and a specificity of 85.3% (8 789/10 305). Among the 38 breast cancer cases detected, 92.1% (35/38) were invasive carcinomas, and 63.2% (24/38) were stage 0 or Ⅰ breast cancers.Conclusions:Breast cancer screening based on ABUS with remote reading provided an efficient and feasible solution to the problem of unevenly distributed medical resources and medical staff levels in various regions of China, enabling the decentralization of high-quality medical resources and improving the accessibility of high-quality screening services. It has provided an alternative for breast cancer screening in China.

Objective:To construct a remote screening network for breast cancer based on automated breast ultrasound (ABUS) and explore the value of ABUS with remote reading for breast cancer screening.Methods:We constructed a remote breast cancer screening network including one remote reading center and 48 image-acquisition centers. We recruited women to participate in breast cancer screening at one of these image-acquisition centers from January 2021 to January 2023. The technicians collected the whole breast images using the ABUS. The images were then sent to the reading center through the PVBUS System and interpreted independently by two radiologists using the Breast Imaging Reporting and Data System (BI-RADS). BI-RADS categories 1 and 2 indicate negative screening results, and women diagnosed with these categories were recommended for annual breast ultrasound screening. BI-RADS categories 3, 4, and 5 indicate positive results. Women with BI-RADS category 3 lesions were recommended for follow-up examinations every 6 months using ABUS or handheld ultrasound, while those with BI-RADS 4 and 5 lesions were suggested to undergo pathological examinations.Results:In our study, we enrolled 10 344 women who completed the ABUS screening and were followed up for more than 12 months. After remote reading, 6 164 women were diagnosed with BI-RADS category 1 and 2 626 woman were within BI-RADS category 2. In contrast, 1 404 women were within BI-RADS category 3, a total of 135 women were within BI-RADS category 4, and 15 women were within BI-RADS category 5. The positive screening rate of ABUS was 15.0% (1 554/10 344). The ABUS with remote reading had a detection rate of 3.7/1 000 (38/10 344) for breast cancer screening, with a sensitivity of 97.4% (38/39) and a specificity of 85.3% (8 789/10 305). Among the 38 breast cancer cases detected, 92.1% (35/38) were invasive carcinomas, and 63.2% (24/38) were stage 0 or Ⅰ breast cancers.Conclusions:Breast cancer screening based on ABUS with remote reading provided an efficient and feasible solution to the problem of unevenly distributed medical resources and medical staff levels in various regions of China, enabling the decentralization of high-quality medical resources and improving the accessibility of high-quality screening services. It has provided an alternative for breast cancer screening in China.

Objective:To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia (COVID-19), bacterial pneumonia and other viral pneumonia.Methods:Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed, including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020, 16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020, and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020. Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease.Results:Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia, and the incidence was significantly higher than that of bacterial pneumonia (91.6%, 75.0% vs. 26.0%, P < 0.05). Compared with other viral pneumonia and COVID-19, bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion (62.0% vs. 18.8%, 5.6%, P < 0.05), accompanied by pleural effusion and lymph node enlargement. The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%, that of patients with other viral pneumonia was 56.2%, and that of patients with bacterial pneumonia was only 2.0% ( P < 0.05). The incidence rate of lung tissue consolidation (25.0%, 12.5%), air bronchial sign (13.9%, 6.2%) and pleural effusion (16.7%, 37.5%) in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia (62.0%, 32.0%, 60.0%, all P < 0.05), paving stone sign (22.2%, 37.5%), fine mesh sign (38.9%, 31.2%), halo sign(11.1%, 25.0%), ground-glass opacity with interlobular septal thickening (30.6%, 37.5%), bilateral patchy pattern/rope shadow (80.6%, 50.0%) etc. were significantly higher than those of bacterial pneumonia (2.0%, 4.0%, 2.0%, 0%, 22.0%, all P < 0.05). The incidence of local patchy shadow in patients with COVID-19 was only 8.3%, significantly lower than that in patients with other viral pneumonia and bacterial pneumonia (8.3% vs. 68.8%, 50.0%, P < 0.05). There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19, other viral pneumonia and bacterial pneumonia (27.8%, 12.5%, 30.0%, P > 0.05). Conclusions:The probability of ground-glass opacity, paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia, and it was more common in the lower lungs and lateral dorsal segment. In other patients with viral pneumonia, ground-glass opacity was distributed in both upper and lower lungs. Bacterial pneumonia is usually characterized by single lung consolidation, distributed in lobules or large lobes and accompanied by pleural effusion.

Objective:To summarize the clinical manifestations, diagnosis and surgical treatment of abdominal unicentric Castleman's disease.Methods:The clinical data of abdominal unicentric Castleman's disease cases admitted to the General Surgery Department of the First Affiliated Hospital,Nanjing Medical University from Jan 2009 to Dec 2019 was retrospectively analyzed.Results:A total of 18 patients were included with definite pathological diagnosis. The main complaint was abdominal pain and discomfort (50%, 6/12), dizziness and fatigue (25%, 3/12), multiple rash with oral ulcer (16.7%, 2/12) and weight loss (8.3%, 1/12). All patients received surgical resection. Postoperative pathology showed clear vascular type in 15 patients and plasma cell type in 3 patients. There were no major complications nor mortality.Conclusion:Abdominal unicentric Castleman's disease has diverse clinical manifestations, which was difficult for preoperative diagnosis, postoperative prognosis is satisfactory.

【Objective】 To analyze the influence of different Inc parameters in the Monaco planning system on the left breast cancer volumetric modulated arc therapy (VMAT) planning, in the hope of providing some reference for plan design. 【Methods】 Seventeen left-breast cancer patients who were receiving radical radiotherapy were selected. The plans were enrolled in the design of VMAT with the same optimization conditions but different Inc parameters in the Monaco planning system. All plans used different Inc parameters like 10°, 20°, 30°, and 40°. The results of the plan were compared. The dosimetric parameters of the PTV and the organs at risk inquired by the plan were analyzed. The SPSS software was used for calculating the differences between the VMAT plans and evaluating the quality of the plans. 【Results】 The different Inc parameters affected the dosimetric parameters D98%, D2%, D50%, V55 Gy of PTV and CI, HI (F=10.528, F=15.154, F=15.513, F=16.979, F=4.632, F=14.277, all P<0.05). The MU of the four groups significantly differed (F=4.632, P<0.05), and the difference of V10 on the ipsilateral lung was significant (F= 3.324, P<0.05), the remaining parameters in the four groups had no statistically significant difference. 【Conclusion】 For the left-breast cancer volumetric modulated arc therapy, the smaller of Inc parameter on the plan had better dose distribution and conformity index while the monitor units increased. 40° was not suitable for the breast cancer VMAT plan, and the high amount beyond the range would increase the toxic and side effects on the skin.

Breast imaging techniques are used to assess the tumor response to neoadjuvant treatment (NAT), which is increasingly one of the preferred therapeutic options and increases the rate of breast conservation for breast cancer. Herein, we report a case in which a woman was diagnosed with invasive ductal carcinoma in the left breast and received NAT before surgery.Automated breast ultrasound (AB US) was regularly performed before and during the NAT to evaluate the tumor response to NAT by measuring diameter changes and volume reductions of the tumor. Images showed that the tumor size was significantly reduced and disappeared after 7 cycles of NAT, except for macrocalcification. Postoperative histopathological examination confirmed that there were no residual tumor cells. We found that AB US overcame the limitations of handheld US, such as operator dependence, poor reproducibility and limited field of view, and can be an alternative modality to assess the tumor response of NAT in the absence of magnetic resonance imaging (MRI) instruments.

【Objective】 To investigate setup and respiratory movement residual error with the guidance of online four-dimensional cone beam computed tomography (4DCBCT) and the impact on margins required to internal target volume (ITV) margin during stereotactic body radiotherapy (SBRT) of lung tumor in the middle or lower lobe. 【Methods】 Twenty SBRT treatment patients with lung tumor in the middle or lower lobe were enrolled for treatment residual error retrospective analysis. Thermoplastic masks were used as immobilization devices during SBRT treatment. ITV was determined by 4DCBCT simulation. A total of 76 4DCBCT scans before the treatment were recorded to determine the setup and respiratory residual error for ITV margins. 【Results】 The setup and respiratory movement error were significantly reduced with the guidance of online 4DCBCT during radiotherapy. The setup residual errors were respectively (0.07±0.12)cm, (0.03±0.29)cm and (0.04±0.14)cm in right-left (RL), superior-inferior (SI) directions and anterior-posterior (AP) directions. The respiratory movement residual errors were respectively (-0.06±0.07)cm, (0.02±0.26)cm and (0.02±0.11)cm in RL, AP, and SI directions. Based on setup and respiratory movement residual errors, the PTV margins of NSCLC were reduced from 1.13 cm, 2.15 cm and 0.90 cm to 0.50 cm, 0.59 cm and 0.56 cm in RL, AP and SI directions, respectively, calculated with recipe by VanHerk. 【Conclusion】 With the guidance of online 4DCBCT, the setup and respiratory movement residual error cannot be ignored during SBRT of lung tumor in the middle or lower lobe. The ITV margin required after online 4DCBCT correction for the patients enrolled in the study would be approximatively 0.6 cm around to ensure an accurate dose to the target tumor and reduce the dose to normal tissues.

Objective The aim of this study was to investigate the anti-tumor effect on sequential injection of heterogeneic lymphocyte(HL)and autogeneic lymphocyte(AL). Methods The HL was prepared by using CC3HF1 mice as feeders. CB6F1 mice were used as recipients,and Hepa1-6 cells were inoculated into the recepients′groin subcutis. A cryoprecipitate was extracted from mouse plasma by freeze-thaw method to prepare fibrin Glue(FG);FG was combined with HL or AL to be FG-HL or FG-AL. The experimental treatment consisted of two stages. At first stage(15 d),FG-HL were injected on the surface of the tumor-bearing tissue of the recipients as the experimental group,and FG-phosphate buffer saline(FG-PBS)were injected on the surface of the tumor-bearing tissue of the rest recipients as the control group. The immunological factors such as tumor cell killing rate of the spleen lym-phocytes and numbers of lymphocytes,CD8 +T and NK in the two groups were detected,respectively. At later stage(10 d),a part of mice were randomly selected from the experimental and control groups,and the lymphocytes( AL) were used to form FG-AL,which were injected on the surface of tumor-bearing tissues in the rest of mice. Tumors in mice of the two groups were compared for tumor volume and tumor inhibition rate. Results The tumor cell killing rate of AL in the experimental group(26. 70 ± 7. 22) was signifi-cantly higher than that in the control group(5. 70 ± 2. 68)(P<0. 01). Numbers of mouse spleen lymphocytes,CD8 +T cells and NK cells were significantly higher than the corresponding values of the control group(P<0. 05). After the two-stage treatment,the aver-age tumor volume of the experimental group[(1.20 ±0.33)cm3]was significantly smaller than that of control group[(2.05 ±0.37) cm3](P<0. 01). The tumor inhibition rate in the experiment group was 41. 5% when compared to the control group. Conclusion Local injections of FG-HL followed by FG-AL can significantly inhibit the growth of transplanted tumor in mice;it is expected to become an anti-tumor biological therapy.

Objective To investigate the time efficiency and accuracy of atlas-based auto-segmentation ( ABAS ) software with different atlas template numbers and layers of computed tomography ( CT ) scans in delineation of the target tissues of cervical cancer patients receiving radiotherapy . Methods The CT images from 20, 40, 60, 80, 100, and 120 patients with cervical cancer were separately selected as atlas templates for MIM auto-segmentation software, and the CT-based tumor volumes of another 20 patients with cervical cancer were manually contoured by physicians. The quality of contours obtained automatically from the software and manual contouring was compared by one-way analysis of variance ( ANOVA ) , randomized block ANOVA, and least significant difference t test. The impact of atlas template numbers and layers of CT scans on the accuracy and time efficiency of MIM software was analyzed based on the time spent in delineation, dice similarity coefficient, and overlap index. Results Taking manual contouring as the reference, no significant differences were observed in the accuracy and time efficiency of auto-contouring when atlas template numbers ranged from 20 to 120(all P>005). The ABAS auto-contouring significantly shortened the time for target contours when the layers of CT scans were less than 65 ( all P>005 ) , but reduced the accuracy of rectal contours (P=0000), while CT scans with 67 layers achieved the highest accuracy of rectal contours ( P= 0037 ) . Conclusions The ABAS software shows an advantage in delineation of the target tissues of cervical cancer patients receiving radiotherapy, and 20 templates are suggested to construct this atlas. The CT scans with 65 layers are recommended for patients when target tissues include the bladder, femur, and spinal cord, and CT scans with 67 layers are recommended for patients when target tissues include the rectum.