Descending necrotizing mediastinitis (DNM) is a severe complication of deep neck infection when the mediastinum is involved. Currently, the optimal surgical treatment for DNM, especially for Endo IIA DNM, has not been defined. We aimed to describe a standardized ETMD procedure emphasizing safe catheter placement into the main mediastinal abscess cavities and to evaluate its association outcomes compared with non-ETMD approaches in patients with DNM. This multicenter retrospective cohort study included adult patients (≥ 18 years) diagnosed with descending necrotizing mediastinitis (DNM) secondary to deep neck infection between 2008 and 2024. Patients who received incomplete treatment or were unable to undergo surgery were excluded. Clinical, laboratory, and imaging data were collected. Surgical management was classified as endoscopic transcervical mediastinal drainage (ETMD) or non-ETMD. The primary outcome was the requirement for secondary drainage. Secondary outcomes included hospital stay, drainage duration, and major complications. Statistical analyses were performed using t-tests, Mann–Whitney U tests, chi-square tests, and multivariable models where appropriate. Multivariable regression and supplementary inverse probability of treatment weighting (IPTW) analyses were performed to adjust for potential confounding. Among 95 patients enrolled, 49 received ETMD. The secondary drainage rate was significantly lower in patients who received ETMD (10.2

OBJECTIVE:To evaluate associations between environmental toxicant (ET) exposures and obstructive sleep apnea (OSA) using an exposome-wide approach. METHODS:This cross-sectional analysis included 13,161 participants from two NHANES cycles (2015-2016 and 2017-March 2020). Fifty-six toxicants across six classes (arsenic species, ethylene oxide, heavy metals, nicotine metabolites, VOC metabolites, and thyroid-disrupting compounds) were measured. OSA status was defined using a validated questionnaire based on self-reported symptoms. Exposome-wide association analysis (ExWAS) adjusted for sociodemographic, lifestyle, and clinical covariates, and restricted cubic spline (RCS) analysis characterized nonlinear exposure-response relationships. RESULTS:The overall prevalence of OSA was 49% (n = 6,443). Nine ETs showed significant associations with OSA, including blood and urinary cadmium, seven volatile organic compound metabolites (e.g., 2,5-dimethylfuran, ethylbenzene, furan, o-xylene), and three urinary cysteine-derived metabolites (N-acetylcysteine derivatives). Subgroup analyses revealed higher susceptibility among women and individuals aged <65 years. RCS analyses demonstrated nonlinear, nonmonotonic relationships for cadmium and cysteine-derived metabolites with OSA prevalence. CONCLUSIONS:Nine ETs were significantly associated with OSA prevalence, with evidence of differential susceptibility by sex and age. These findings highlight environmental factors associated with OSA, which may serve as potential targets for future mechanistic research and public health interventions.

Aim To identify novel substrates of USP14 and elucidate the molecular mechanisms by which USP14 promotes head and neck squamous cell carcinoma (HNSCC) progression.Materials and methods USP14 expression patterns were examined in HNSCC tissues and cell lines. Functional effects were assessed using genetic knockout and overexpression models in vitro and in vivo. USP14-CFL2 interactions were evaluated by co-immunoprecipitation and GST pull-down assays. Deubiquitination activity was measured in vitro. Transcriptomic analysis and bioinformatics were used to identify downstream pathways and clinical relevance.Results USP14 was significantly overexpressed in HNSCC and correlated with poor prognosis. Genetic knockout of USP14 markedly suppressed HNSCC cell proliferation, migration, and tumor growth, while USP14 overexpression exerted opposite effects. Mechanistically, we identified CFL2 as a novel substrate of USP14; USP14 directly interacted with and deubiquitinated CFL2, thereby enhancing its stability by preventing proteasomal degradation. Clinically, CFL2 was also overexpressed in HNSCC and its elevated levels correlated with reduced overall survival. Functionally, CFL2 overexpression significantly rescued the anti-tumor effects of USP14 knockout, including impaired cell proliferation and migration.Conclusion In summary, our findings identify a novel USP14-CFL2 regulatory axis and establish USP14 as a critical promoter of HNSCC progression, acting through CFL2 deubiquitination and stabilization.

Circular RNAs (circRNAs) have emerged as key players in tumor progression, yet their role in head and neck squamous cell carcinoma (HNSCC) remains largely unexplored. The AURKA gene is frequently amplified and activated in HNSCC. This study investigates the expression patterns and functions of circ_0008777, which is derived from AURKA exons 3-6, in HNSCC. The biological functions of circ_0008777 were evaluated in vitro and in vivo, along with its interactions with positive cofactor 4 (PC4) and miR-185-3p. Our data indicated that circ_0008777 expression levels are upregulated in HNSCC tissues and cell lines, and linked to aggressive clinical features. Knocking down circ_0008777 significantly inhibited HNSCC cell proliferation and migration in vitro, as well as restrained tumor growth in vivo, while overexpressing circ_0008777 had the opposite effects. Mechanistically, circ_0008777 can bind to PC4 to increase c-Myc transcription. Bioinformatics analysis showed that PC4 is highly expressed in HNSCC patients, with survival analysis revealing a negative correlation between PC4 expression and overall survival rates. PC4 knockout could hinder HNSCC cell proliferation and migration in vitro. Additionally, circ_0008777 can bind to miR-185-3p through a microRNA sponge mechanism, relieving miR-185-3p-mediated repression of c-Myc mRNA. Furthermore, the inhibitory effects of circ_0008777 knockdown on the cell migration and proliferation rates were rescued by c-Myc overexpression. In conclusion, circ_0008777 can promote HNSCC progression by upregulating c-Myc expression through both PC4- and miR-185-3p-related mechanisms, showing potential as a candidate therapeutic target in this cancer.

Background : Non-invasive quantitative assessment of intrinsic upper airway tissue alterations in patients with obstructive sleep apnea (OSA) is vital for mechanistic research. This study aims to evaluate the application of synthetic MRI (SyMRI) in this field. Methods : This was a cross-sectional study that prospectively collected data from a single centre. Participants, both with and without OSA, underwent SyMRI of the upper airway to measure quantitative changes in the intrinsic properties (T1, T2, and PD values) of the soft palate and tongue.These changes were annotated using the IDEAL-IQ MRI sequence and histopathology methods, including Masson, H&E and Oil Red O staining. Results : 125 (82 OSA and 43 non-OSA) participants were enrolled. Patients with OSA exhibited higher T2 value in the soft palate and higher T2 and PD values in the tongue compared to non-OSA participants. SyMRI parameters were correlated with the fat fraction derived from IDEAL-IQsequence. A positive correlation was observed between the T2 value and the area of fat, mucous gland and fibrosis in the soft palate. T2 and PD values of tongue showed independent relationship with AHI. The area under curve (AUC) values of T2 and PD of tongue were 0.756. Conclusion : SyMRI could act as an effective noninvasive method to quantify inherent alterations of upper airway tissues in OSA, such as fat infiltration, fibrosis, and mucous gland hypertrophy. SyMRI parameters hold promise as the image biomarker, providing valuable information for differentiating various OSA subtypes and thereby promoting personalized treatment.

Prophylactic low-molecular-weight heparin (LMWH) treatment helps reduce the incidence of postoperative venous thromboembolism (VTE) and pulmonary embolism (PE), while also carrying a risk of bleeding. Currently, there are little specific recommendations for postoperative prophylactic anticoagulation in laryngopharyngeal cancer (LPC) patients. In this multicenter retrospective study, we identified potential risk factors for PE following open surgery of LPC by logistic regression. An applicable scoring system for risk stratification of postoperative PE was developed based on the risk factors and compared with other PE risk scores. The efficacy and safety of prophylactic LMWH treatment among different risk patients were compared. Among 2033 included patients (551 with LMWH and 1482 without), 97 (4.8

INTRODUCTION:Observational epidemiological studies have revealed that multiple risk factors may be associated with the risk of obstructive sleep apnea (OSA). However, the causal relationship between them remains largely unknown. We aimed to investigate the causal relationship between potential risk factors and OSA risk. METHODS:A two-sample Mendelian randomization approach was used to evaluate the causal association of 42 risk factors with OSA risk. Summary data on OSA were obtained from a recently published genome-wide association study including 16,761 patients with OSA. RESULTS:Suggestive associations with increased risk were observed for body mass index (OR = 2.19, 95% CI 1.99-2.42, P < 0.01), childhood body mass index (OR = 1.46, 95% CI 1.15-1.83, P < 0.01), overweight (OR = 1.43, 95% CI 1.17-1.74, P < 0.01), smoking initiation (OR = 1.27, 95% CI 1.09-1.49, P < 0.01), gastroesophageal reflux disease (OR = 1.60, 95% CI 1.40-1.82, P < 0.01), and depression (OR = 1.28, 95% CI 1.06-1.53, P = 0.01). Age at first birth (OR = 0.88, 95% CI 0.82-0.94, P < 0.01) and education (OR = 0.76, 95% CI 0.66-0.87, P < 0.01) were significantly associated with decreased risk of OSA. CONCLUSIONS:We found a causal effect for several potential risk factors on OSA risk, including obesity, smoking, education, age at first birth, gastroesophageal reflux disease, and depression.

Backgrounds A deep neck space abscess (DNSA) is a critical condition resulting from infection of deep neck fascia and soft issue, leading to high morbidity and mortality. Therefore, intensive care can be very significant for patients with DNSA. This study aimed to develop models to predict the need for postoperative intensive care in patients with DNSA. Methods We retrospectively analyzed the records of 332 patients with DNSA who received drainage operation between 2015 and 2020. Multivariate logistic regression analysis and the eXtrem Gradient Boosting (XGBoost) algorithm were used to develop predictive models. Results We developed two predictive models, the nomogram and the XGBoost model. The area under the curve (AUC) of the nomogram was 0.911 and of the XGBoost model was 0.935. Conclusion We developed two predictive models for guiding clinical decision making for postoperative ICU admission for DNSA patients, which may help improve prognosis and optimize intensive care resource allocation.

Thepatient presentedwith dyspnoea.He reported ahistory of a painlessmass on theneck that had increased over 10 years and an alcohol intake of 80 units/week for more than 30 years. Computed tomography showed characteristic non-encapsulated adipose tissue causing compressionof theupper airway, clinically consistent with benign symmetrical lipomatosis. Although this condition is benign, surgical intervention is indicated when the trachea or vena cava become compressedandcausedyspnoeaor impaired venous return, respectively. The causativemechanism is thought to be mutation in the mitochrondrial DNA secondary to alcohol intake.3 -5

There have been few reports of mature cystic teratoma, also known as a dermoid cyst, in the head and neck. Cervical neck teratoma extending into the mediastinum is also relatively rare. Here, we report a mature teratoma found in a cervical tumor in a 21-year-old man. This is the first reported case of a mature cervical teratoma extending into the anterior mediastinum. A combination of frontal X-ray, ultrasonography, computed tomography, and magnetic resonance imaging indicated a large oval heterogeneous mass surrounding the thyroid gland and trachea, underneath the sternocleidomastoid and sternohyoid, which pressed on the left lobar thyroid and trachea and extended into the anterior mediastinum. Based on preoperative observation, a diagnosis of an embryonal benign tumor was made. Although rare, this case demonstrates that these tumors should be completely removed during workup of cervical tumors.

BACKGROUND:The Mre11-Rad50-Nbs1 (MRN) complex is well known for its crucial role in initiating DNA double strand breaks (DSBs) repair pathways to resistant irradiation (IR) injury and thus facilitating radioresistance which severely reduces radiocurability of nasopharyngeal cancer (NPC). Targeting native cellular MRN function would sensitize NPC cells to IR.METHODS:A recombinant adenovirus containing a mutant Rad50 gene (Ad-RAD50) expressing Rad50 zinc hook domain but lacking the ATPase domain and the Mre11 interaction domain was constructed to disrupt native cellular MRN functions. The effects of Ad-RAD50 on the MRN functions were assessed in NPC cells lines using western blot, co-immunoprecipitation and confocal microscopy analyses. The increased radiosensitivity of transient Ad-RAD50 to IR was examined in NPC cells, including MTT assay, colony formation. The molecular mechanisms of radiosensitization were confirmed by neutral comet assay and western bolts. Nude mice subcutaneous injection, tumor growth curve and TUNEL assay were used to evaluate tumor regression and apoptosis in vivo.RESULTS:Rad50 is remarkably upregulated in NPC cells after IR, implying the critical role of Rad50 in MRN functions. The transient expression of this mutant Rad50 decreased the levels of native cellular Rad50, Mre11 and Nbs1, weakened the interactions among these proteins, abrogated the G2/M arrest induced by DSBs and reduced the DNA repair ability in NPC cells. A combination of IR and mutant RAD50 therapy produced significant tumor cytotoxicity in vitro, with a corresponding increase in DNA damage, prevented proliferation and cell viability. Furthermore, Ad-RAD50 sensitized NPC cells to IR by causing dramatic tumor regression and inducing apoptosis in vivo.CONCLUSION:Our findings define a novel therapeutic approach to NPC radiosensitization via targeted native cellular Rad50 disruption.

OBJECTIVE To explore the application of enhanced CT in the differential diagnosis and treatment of peritonsillar abscess (PTA) and intratonsillar abscess (ITA). METHODS Thirty-eight in-patients with clinically suspected PTA from June 2011 to June 2013 were included in this study. All these patients underwent enhanced CT scan for the throat region. According to CT results, the location of abscess was determined, and the thickness of the posterior wall of abscess as well as its distance with the internal carotid artery was calculated.Incision and drainage were then guided with this information. RESULTS Twenty-six of the 38 patients (68.4%) met the diagnosis of PTA, demonstrating a hypodense collection with rim enhancement in the peritonsillar space, including 4 cases with multilocular abscess. Ten cases (26.3%) should actually be diagnosed as ITA, with a abscess collection located in the palatine tonsil tissue. Two cases(5.3%) were diagnosed as peritonsillar cellulitis (PTC), showing diffuse isodense lesion around the peritonsillar space. The 26 cases of PTA and 10 cases of ITA patients were all cured using incision and drainage under the precise guidance of CT, while the 2 cases of PTC only treated with medicine. The mean distance between the posterior wall of abscess and the carotid artery (X(-) ± s) were (0.76 ± 0.34) cm and (0.90 ± 0.37) cm for the two entities respectively, with no significant difference (P > 0.05). CONCLUSIONS Enhanced CT scan can clearly demonstrate the characters of PTA and ITA, and make identification. Moreover, it is helpful for the determination of therapy, improving the success rate of drainage and reducing the potential risk of large artery injury.

OBJECTIVE:To introduce the outcomes of tracheal resection with primary end to end anastomosis for benign cervical tracheal stenosis, and to discuss the strategy for prevention of surgical complications.METHODS:A retrospective analysis was performed in 12 patients diagnosed as benign cervical tracheal stenosis from October 2009 to June 2012. Laryngo-tracheal endoscopic examination and computed tomography (CT) were used to assess the degree of stenosis, the grade of inflammation and edema of the subglottis and trachea, and the extent of stenosis and the remaining linear amount of normal airway. The Meyer and Cotton grading system was used to categorise the clinical severity of the stenoses. All patients underwent tracheal resection with primary end to end anastomosis.RESULTS:The length of cervical tracheal stenosis ranged from 2.3 to 4.1 cm. Grade II stenosis was present in three patients, Grade III stenosis was present in seven patients and grade IV stenosis in two patients. Successful extubation was achieved in all 12 cases. After surgery, temporary hoarseness occurred in 1 patient (8.3%); unilateral pulmonary atelectasis with pleural effusion occurred in 1 patient (8.3%); subcutaneous emphysema with infection occurred in 1 patient (8.3%); mild dysphagia occurred in 3 patients (25.0%); a slight deepening of the tone of voice occurred in 5 patients (41.7%), granulation tissue growth near the suture occurred in 3 patients (25.0%), and suture dehiscence did not occur in any patient. The follow-up period ranged from 6 months to 38 months, no patient developed restenosis.CONCLUSIONS:It presents a high success rate and good functional result of tracheal resection with primary end-to-end anastomosis. Therefore, it is an effective and reliable approach for the management of benign cervical tracheal stenosis. To avoid complications, the preoperative assessment, patients selection and postoperative management should be emphasized.

Objective: The aim of this study was to describe our experience with intratympanic (IT) steroid treatment of sudden sensorineural hearing loss (SSNHL) after the failure of intravenous (IV) steroid treatment and to examine the efficacy of this treatment. Methods: We recruited 65 patients with SSNHL who did not respond to IV treatment with prednisolone. These patients were randomized into 3 groups: treatment with IT steroid, treatment with steroid in ear drops, and blank control. The 24 patients in the IT group received an IT injection of methylprednisolone and the 21 patients in the ear drop group received methylprednisolone that was directly dropped onto the tympanic membrane through the ear canal. The 20 patients in the blank control group did not receive any treatment after the completion of the IV prednisolone injection. Audiograms were performed at the beginning of the study and 2 months after the end of the study. Results: In the IT treatment group, audiogram results showed that the average of the pure tone speech frequencies (500–4000 Hz) was 64.8 (range 40–101 dB) at baseline, 60.7 (range 35–92 dB) at the end of systemic treatment, and 52.9 (range 35–73 dB) at the end of IT treatment. The improvement in the IT group was significantly better than that in the other two groups, with 37% of the IT patients having significant improvement in their hearing (baseline to after systemic treatment). During IT treatment, only 1 patient developed a persistent tympanic membrane perforation, and no serious complications such as chronic otitis media, disequilibrium, and dysgeusia developed. Conclusions: IT steroid therapy can improve hearing function in patients with SSNHL after the failure of systemic steroid treatment.

Objective: The purpose of the study is to examine the optimal surgical strategies and their treatment efficacy for sinonasal inverted papilloma resection in relation to lesion stage. Methods: A retrospective analysis was performed on the medical records of 91 patients who underwent endoscopic resection of sinonasal inverted papilloma between August 1996 and Feburary 2008. Results : Based on tumor stage and the surgical procedure performed, 91 patients were divided into three groups. A group, purely endoscopic sinus surgery group, consisted of 18 patients at Krouse stage I, 33 patients at stage II and 13 patients at stage III. B group, nasal endoscopy combined with modified Caldwell - Luc surgery group, consisted of 12 patients at stage II and 12 patients at stage III. C group, combined external and nasal endoscopic surgery group, consisted of 3 patients at stage IV. Patients were followed up for a period ranging from 18 to 90 months, 37 months on average. The overall reoccurrence rate was 15.4% (14/91). Reoccurrence rates for A group are, stage I 5.6% (1 / 18), stage II 6.1% (2 / 33) and stage III 53.8% (7 / 13); B group, stage II  16.7% (2 / 12) and stage III 8.3% (1 / 12); C group, stage IV 33.3% (1 / 3). Statistical analysis suggested that for patients at stage II, there was no significant difference in the reoccurrence rate between A and B groups. However, for patients at stage III, A group had a significantly higher recurrence rate than B group. Patients with relapse underwent a second resection and no recurrence was observed within 24 months of follow up. Conclusion : Our findings suggest that endoscopic sinus surgery is a safe and effective treatment for sinonasal inverted papilloma, with most lesions entirely resectable through endoscopic surgery. Importantly, surgical strategies need to be thoughtfully chosen based on tumor stage to achieve maximal removal of the lesion and minimize recurrence rate.

OBJECTIVE:To explore the quality of life (QOL) outcome in patients with allergic rhinitis (AR). METHODS:A prospective trial was conducted to survey the QOL status of 101 AR patients, in contrast to that of 121 healthy individuals and 97 chronic pharyngitis (CP) patients by generic questionnaire medical outcomes study short-form 36-items health survey (SF-36), and to survey the most troublesome problems of AR patients by disease-specific questionnaire rhinoconjunctivitis quality of life questionnaire (RQLQ). The correlation between SF-36 and RQLQ had also been analyzed. All the results were analyzed statistically. RESULTS:By the assessment of SF-36, the scores of 3 domains (x ± s, the same as follow, the scores were 78.02 ± 18.37, 56.13 ± 17.49, 78.81 ± 16.47, respectively) of AR patients were less than those (84.00 ± 18.36, 74.69 ± 14.13, 83.78 ± 14.31) of healthy individuals (P < 0.05), and the scores of 7 domains (the scores were: 91.78 ± 11.78, 79.16 ± 30.23, 78.02 ± 18.37, 56.13 ± 17.49, 78.81 ± 16.47, 67.66 ± 39.57, 68.78 ± 13.65, respectively) of AR patients were similar with those (94.12 ± 6.88, 80.67 ± 32.38, 73.57 ± 17.96, 59.73 ± 16.58, 80.41 ± 17.01, 63.58 ± 39.99, 66.43 ± 13.71) of CP patients (P > 0.05). By the assessment of RQLQ, in AR patients, both the nasal symptoms and the practical problems got the highest scores (the scores were 2.70 ± 1.29, 2.53 ± 1.37 respectively). According to the assessment of the correlation between SF-36 and RQLQ, the correlation was weak (r = -0.199 ∼ -0.526, P < 0.05). CONCLUSIONS:The QOL of AR patients decreased compared with that of healthy individuals, but similar with that of CP patients. The most troublesome problems in AR patients were nasal symptoms and the practical problems. Both SF-36 and RQLQ were suitable for assessing the health status of AR patients. SF-36 and RQLQ each covered a different part of the QOL of AR patients, and the combination of the two questionnaires could improve the QOL measurement.

<正>阻塞性睡眠呼吸暂停综合征(OSAS)是一种常见疾病,发病率为2～4%,被认为是各种心血管紊乱的危险因素。OSAS患者心血管并发症的发病机理并不清楚,现有多种机制,包括交感神经兴奋、炎症和氧化应激介导的内皮功能紊乱、凝血异常以及

<正>睡眠呼吸紊乱(sleep disordered breathing,SDB)指包括单纯鼾症、阻塞性睡眠呼吸暂停综合征(OSAS)在内的阻断夜间呼吸与睡眠结构呼吸紊乱。儿童OSAS发病率为2～3%。该病与神经行为、认知行为以及心血管疾病发病率密

OBJECTIVE:To summarize the clinical experience of treatment of frontal sinus diseases via combined transfrontal and intranasal endoscopic approaches, and to explore its indications.METHODS:A retrospective study of 24 patients was conducted. All patients were underwent combined transfrontal and intranasal double approaches because of different kinds of frontal sinus diseases, including 16 cases with frontal sinus cerebrospinal fluid rhinorrhea caused by traumatic comminuted fractures located in posterior wall of frontal sinus, 5 cases with osteoma, 3 cases with inverted papilloma (cancer was confirmed in one case).RESULTS:All sixteen cases with frontal sinus cerebrospinal fluid rhinorrhea were cured after the first attempt. All cases with osteoma and inverted papilloma (including the patient with canceration) were resected completely after the first attempt. Postoperative follow-up lasted from 3 to 132 months in frontal sinus cerebrospinal fluid rhinorrhea, 8-38 months in osteoma, 7-42 months in inverted papilloma and canceration, the median follow-up period was 36 months. No recurrence was found. Operations were successful in all the patients and frontal sinus outflow tracts were unobstructed. No intraoperative or postoperative complications occurred and no disfigurement was found.CONCLUSIONS:The potential indications for the combined transfrontal and intranasal endoscopic approaches are listed as follows, (1) frontal sinus lesions mainly located on the posterior wall, (2) propensity to recur or malignant neoplasms, (3) the lesions of frontal sinus with their lateral boundaries or operative site beyond the plane of the lamina papyracea.