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.

The parahippocampal gyrus-orbitofrontal cortex (PHG-OFC) circuit in humans is homologous to the postrhinal cortex (POR)-ventral lateral orbitofrontal cortex (vlOFC) circuit in rodents. Both are associated with visuospatial malfunctions in Alzheimer's disease (AD). However, the underlying mechanisms remain to be elucidated. In this study, we explored the relationship between an impaired POR-vlOFC circuit and visuospatial memory deficits through retrograde tracing and in vivo local field potential recordings in 5XFAD mice, and investigated alterations of the PHG-OFC circuit by multi-domain magnetic resonance imaging (MRI) in patients on the AD spectrum. We demonstrated that an impaired glutamatergic POR-vlOFC circuit resulted in deficient visuospatial memory in 5XFAD mice. Moreover, MRI measurements of the PHG-OFC circuit had an accuracy of 77.33% for the classification of amnestic mild cognitive impairment converters versus non-converters. Thus, the PHG-OFC circuit explains the neuroanatomical basis of visuospatial memory deficits in AD, thereby providing a potential predictor for AD progression and a promising interventional approach for AD.

OBJECTIVETo investigate the current supply and use of personal protective equipment (PPE) among rural-to-urban migrant workers in small and medium enterprises (SMEs) in Zhongshan and Shenzhen, China and the influential factors for the use of PPE, and to provide a basis for better occupational health services and ensuring the health of migrant workers.

METHODSMulti-stage sampling was used to select 856 migrant workers from 27 SMEs in Zhongshan and Shenzhen, and face-to-face questionnaire survey was conducted in these subjects. Statistical analysis was performed by one-way analysis of variance, chi-square test, and logistic regression.

RESULTSOf all migrant workers, 38.67%were supplied with free PPE by the factory, and this rate varied across industries (furniture industry: 45.81%; electronic industry: 31.46%) and SMEs (medium enterprises: 42.13%; small enterprises: 39.20%; micro enterprises: 22.16%); 22.43% insisted on the use of PPE. The logistic regression analysis showed that factors associated with the use of PPE included sex, age, awareness of occupational health knowledge, and the size of enterprise.

CONCLUSIONThe rates of supply and use of PPE among migrant workers are low. The larger the enterprise, the better the supply of PPE. Male gender, being elder, and high occupational health knowledge score were favorable factors for the use of PPE, while small enterprise size was the unfavorable factor for the use of PPE.

Adult ; China ; Female ; Humans ; Male ; Occupational Health Services ; statistics & numerical data ; Protective Devices ; statistics & numerical data ; Rural Population ; statistics & numerical data ; Transients and Migrants ; statistics & numerical data

Objective To identify the main etiologies of emergency room (ER) patients with chest pain or equivalent syndrome.Methods This was a prospective and cross-sectinal survey of ER patinets with chest pain or equivalent syndrome in 17 medical centre in Beijing,China from July to August 2009.Data was collected by structured interviews and medical record reviews.The mean follow up period was 30 days.Results A total of 5666 patients were enrolled in the study (2663 males and 3303 females) and the mean age was 58.1 ± 18.4years.Their final diagnoses were:coronary heart disease 1506 ( 27.4％ ),acute heart failure 149 ( 2.6％ ),pericarditis 4 ( 0.1％ ),pulmonary embolism 11 ( 0.2％ ),aortic dissection 8 ( 0.1％ ),acute cerebrovascular disease 431 ( 7.6％ ) and non-cardic chest pain 2538 ( 44.9％ ).Thirty-seven cased died and 275 cases hospitalized again 30 days later,4.9％ patients with cornary heart disease had symptoms at their presentation.Conclusion Special vigilance and thorough coronary artery evaluation are needed for all patients with chest discomfort or respiratory distress in the ER,even for patients without chest pain.

Objective To evaluate the prevalence of depression and anxiety in the middle and elderly patients with chest pain from department of emergency.Methods Totally 1200 patients suffering from chest pain were enrolled from July 2009 to August 2009.All patients were scored by self-rating depression scale (SDS) and self evaluation anxious scale (SAS).Results 383 cases of 912 patients(42.0％) with coronary heart disease (CAD) and 58 of 288 patients (20.1％) without CAD had depression,with a statistically significant difference (x2 =44.98,P=0.002).Odds ratio (OR) for CAD in patients with depression was 2.5,with 95 ％ confidence interval (CI) of 1.0-5.0 (P ＜0.05).Conclusions There is high prevalence of depression and anxiety as independent risk factors for CAD.