Patterns of cervical lymph node involvement in mono-focal papillary thyroid carcinoma patients with different capsular status: A multi-center analysis.

OBJECTIVE: The characteristics of cervical lymph node involvement in papillary thyroid carcinoma (PTC) patients with different degree of capsular invasion remains unclear, especially for those with mono-focal lesion who have traditionally been considered as low neck metastasis risk subgroup. STUDY DESIGN: Retrospective cohort study. SETTING: Three academic teaching hospital. METHODS: A total of 1276 mono-focal PTC patients were retrospectively analyzed. RESULTS: Mono-focal PTC patients with extrathyroidal extension (ETE) showed significantly higher central lymph node metastasis (CLNM) rate than those without. For patients with no gross ETE (gETE), those with minimal ETE (mETE) also showed more commonly CLNM than those with encapsulated lesions. However, the lateral lymph node metastasis (LLNM) rates of patients with mETE and encapsulated tumors were comparable, both lower than that of patients with gETE. Age ≥40, male, and MTD ≥0.5 cm were identified as independent risk factors of CLNM for those with encapsulated tumors and were enrolled for creating a prediction model. In terms of LLNM, only MTD ≥1.0 cm was confirmed as independent risk factors of LLNM for patients with positive gETE. CONCLUSIONS: The presence and degree of ETE may have different effects on the risk of central and lateral lymph node metastasis. gETE demonstrates a strong correlation with both CLNM and LLNM while mETE is only associated with CLNM in mono-focal PTC patients. A comprehensive model is established in the aim of predicting neck involvement according to the capsular status and the corresponding stratified risk factors, which may aid clinical decision-making for the management of neck regions.

Erratum: [Corrigendum] Survival outcomes in patients with T3­4aN0M0 glottic laryngeal squamous cell carcinoma and evaluation of postoperative radiotherapy.

[This corrects the article DOI: 10.3892/ol.2022.13554.].

Impact of changes in collagen construction and molecular state on integrin - binding properties.

The interaction between the integrin and collagen is important in cell adhesion and signaling. Collagen, as the main component of extracellular matrix, is a base material for tissue engineering constructs. In tissue engineering, the collagen structure and molecule state may be altered to varying degrees in the process of processing and utilizing, thereby affecting its biological properties. In this work, the impact of changes in collagen structure and molecular state on the binding properties of collagen to integrin α2ß1 and integrin specific cell adhesion were explored. The results showed that the molecular structure of collagen is destroyed under the influence of heating, freeze-grinding and irradiation, the triple helix integrity is reduced and molecular breaking degree is increased. The binding ability of collagen to integrin α2ß1 is increased with the increase of triple helix integrity and decays exponentially with the increase of molecular breaking degree. The collagen molecular state can also influences the binding ability of collagen to cellular receptor. The collagen fibrils binding to integrin α2ß1 and HT1080 cells is stronger than to collagen monomolecule. Meanwhile, the hybrid fibril exhibits a different cellular receptor binding performance from corresponding single species collagen fibril. These findings provide ideas for the design and development of new collagen-based biomaterials and tissue engineering research.

Ultrahigh pressure field: A friendly pathway for regulating the cellular adhesion and migration capacity of collagen.

Customized control of the biological response between the material matrix and cells is a crucial aspect in the development of the next generation of collagen materials. This study aims to investigate the effects of ultrahigh pressure treatment on the interaction between collagen and cells by subjecting bovine tendon collagen to different intensities of ultrahigh pressure field. The results indicate that ultrahigh pressure treatment alters the spatial folding of collagen, causing distortion of its triple helical conformation and exposing more free amino groups and hydrophobic regions. As a result, collagen's cell adhesion capability and ability to promote cell migration are significantly enhanced. Optimal cell adhesion and migration capabilities are observed in collagen samples treated at 500 MPa for 15 min. However, further increasing the intensity of the ultrahigh pressure treatment leads to severe damage to the triple-helical structure of collagen, along with re-aggregation of free amino groups and hydrophobic moieties, thereby reducing collagen's cell adhesion capability and ability to promote cell migration. Therefore, ultrahigh pressure treatment offers a promising method to effectively regulate collagen-cell adhesion and promote cell migration without the need for external components. This provides a potential means for the customized enhancement of collagen-based material interfaces.

m6A­modified HOXC10 promotes HNSCC progression via co­activation of ADAM17/EGFR and Wnt/ß­catenin signaling.

The homeobox (HOX) gene family plays a fundamental role in carcinogenesis. However, the oncogenic mechanism of HOXC10 in head and neck squamous cell carcinoma (HNSCC) remains unclear. In the present study, it was revealed that HOXC10 expression was significantly higher in HNSCC tissues than in adjacent tissues, and a high level of HOXC10 was closely associated with worse clinical outcomes. HOXC10 overexpression promoted HNSCC cell proliferation, migration, and invasion, both in vitro and in vivo. Mechanistically, chromatin immunoprecipitation sequencing revealed that HOXC10 drove the transcriptional activation of a disintegrin and metalloproteinase 17 (ADAM17), and the ADAM17/epidermal growth factor receptor (EGFR)/ERK1/2 signaling pathway facilitating the proliferation of HNSCC. Furthermore, mass spectrometric analysis indicated that HOXC10 interacted with ribosomal protein S15A (RPS15A) and enhanced RPS15A protein expression, activating the Wnt/ß­catenin pathway and contributing to invasion and metastasis of HNSCC. Additionally, the methylated RNA immune precipitation and RNA antisense purification assays showed that N6­methyladenosine (m6A) writer, methyltransferase­like 3, catalyzed m6A modification of the HOXC10 transcript, m6A reader insulin like growth factor 2 mRNA binding protein (IGF2BP)1 and IGF2BP3 involved in recognizing and stabilizing m6A­tagged HOXC10 mRNA. In summary, the present study identified HOXC10 as a promising candidate oncogene in HNSCC. The m6A modification­mediated HOXC10 promoted proliferation, migration, and invasion of HNSCC through co­activation of ADAM17/EGFR and Wnt/ß­catenin signaling, providing a novel diagnostic and prognostic biomarker and a potential therapeutic target for HNSCC.

LSD-YOLOv5: A Steel Strip Surface Defect Detection Algorithm Based on Lightweight Network and Enhanced Feature Fusion Mode.

In the field of metallurgy, the timely and accurate detection of surface defects on metallic materials is a crucial quality control task. However, current defect detection approaches face challenges with large model parameters and low detection rates. To address these issues, this paper proposes a lightweight recognition model for surface damage on steel strips, named LSD-YOLOv5. First, we design a shallow feature enhancement module to replace the first Conv structure in the backbone network. Second, the Coordinate Attention mechanism is introduced into the MobileNetV2 bottleneck structure to maintain the lightweight nature of the model. Then, we propose a smaller bidirectional feature pyramid network (BiFPN-S) and combine it with Concat operation for efficient bidirectional cross-scale connectivity and weighted feature fusion. Finally, the Soft-DIoU-NMS algorithm is employed to enhance the recognition efficiency in scenarios where targets overlap. Compared with the original YOLOv5s, the LSD-YOLOv5 model achieves a reduction of 61.5% in model parameters and a 28.7% improvement in detection speed, while improving recognition accuracy by 2.4%. This demonstrates that the model achieves an optimal balance between detection accuracy and speed, while maintaining a lightweight structure.

Insight into the differences in carbon dots prepared from fish scales using conventional hydrothermal and microwave methods.

The preparation of carbon dots (CDs) from waste fish scales is an attractive and high-value transformation. In this study, fish scales were used as a precursor to prepare CDs, and the effects of hydrothermal and microwave methods on their fluorescence properties and structures were evaluated. The microwave method was more conducive to the self-doping of nitrogen due to rapid and uniform heating. However, the low temperature associated with the microwave method resulted in insufficient dissolution of the organic matter in the fish scales, resulting in incomplete dehydration and condensation and the formation of nanosheet-like CDs, whose emission behavior had no significant correlation with excitation. Although the CDs prepared using the conventional hydrothermal method showed lower nitrogen doping, the relative pyrrolic nitrogen content was higher, which was beneficial in improving their quantum yield. Additionally, the controllable high temperature and sealed environment used in the conventional hydrothermal method promoted dehydration and condensation of the organic matter in the fish scales to form CDs with a higher degree of carbonization, uniform size, and higher C = O/COOH content. CDs prepared using the conventional hydrothermal method exhibited higher quantum yields and excitation wavelength-dependent emission behavior.

Uncommon Insidious Dumbbell-shaped Double Thyroglossal Duct Cyst.

As one of the most common congenital neck masses, thyroglossal duct cyst (TGDC) developed from the residual ductal epithelial cells in any remnants of thyroglossal duct. However, the reports of double TGDCs were rare. A 60-year-old male was referred to our department because of the presentation of an anterior neck mass. Only a hypodense oval mass inferior to hyoid bone was shown by computed tomography. During the Sistrunk operation, the dumbbell-shaped double TGDCs with the hyoid bone as the pivot were excised. No recurrence was observed. Before surgery, ultrasonography and computed tomography or magnetic resonance imaging should be conducted to verify the locations and sizes of TGDCs. During Sistrunk procedure, the rims of hyoid bone should be checked to avoid possible duct remnants.

Predictive value of pathological carcinoma size in patients with T2 glottic laryngeal squamous cell carcinoma.

BACKGROUND: T2N0M0 glottic laryngeal squamous cell carcinoma (LSCC) is a common type of laryngeal cancer. OBJECTIVES: The objective of this research was to assess the predictive value of tumor size for the rates of overall survival (OS) and disease-free survival (DFS) as determined by postoperative pathological examination in patients with T2 LSCC. METHODS: A retrospective study was conducted on 535 successive patients with T2 glottic LSCC who underwent operation from 2005 to 2010. The effect of tumor size on OS and DFS results was evaluated by the affected area. RESULTS: Of the cohort, 528 (98.7%) were male, and 7 (1.3%) were female, with an average age of 60.1 ± 9.4 years. The 10-year DFS and OS rates were 72.1% and 76.3%, respectively. The tumor diameter and area cut-off values that best discriminated OS and DFS rates were 1.35 cm and 1 cm2, respectively. Patients with glottis carcinoma with a longer tumor diameter and larger tumor area had inferior OS and DFS rates. Tumor diameter and tumor area were independent predictive factors for the rates of OS and DFS in patients with T2 glottic LSCC. CONCLUSION AND SIGNIFICANCE: This research showed that patients with T2 glottic LSCC with a carcinoma diameter >1.35 cm or a tumor area >1 cm2 have worse survival outcomes. These factors independently predict survival outcomes in patients.

A fluorescent sensing platform based on collagen peptides-protected Au/Ag nanoclusters and WS2 for determining collagen triple helix integrity.

The unique triple helix structure of collagen plays an important role in its biological properties, and the triple helix integrity is closely correlated with its molecular behavior and biological functions. Nevertheless, there is still a lack of convenient, accurate and practical methods for quantitatively determining collagen triple helix integrity. Herein, we first prepared bovine skin collagen peptide (BSCP)-protected Au/Ag nanoclusters (Au/AgNCs@BSCP) with excellent optical properties, high stability and good biocompatibility, which could adsorb on WS2 surface leading to fluorescence quenching. Upon the addition of collagen, the interaction of collagen and Au/AgNCs@BSCP led to the detachment of Au/AgNCs@BSCP from the WS2 surface, causing an increase in the fluorescence signal. Using the difference in the fluorescence recovery of the different samples, we achieved the quantitative determination of collagen triple helix integrity. This developed strategy exhibited excellent accuracy, selectivity, and practicality, thus showing promising potentials in biomedical applications.

Mesenchymal Stem Cell Derived Extracellular Vesicles: Promising Nanomedicine for Cutaneous Wound Treatment.

A skin wound represents a rupture caused by external damage or the existence of underlying pathological conditions. Sometimes, skin wound healing processes may place a heavy burden on patients, families, and society. Wound healing processes mainly consist of several continuous, dynamic, but overlapping stages, namely, the coagulation stage, inflammation stage, proliferation stage, and remodeling stage. Bacterial infection, excessive inflammation, impaired angiogenesis, and scar formation constitute the four significant factors impeding the recovery efficacy of skin wounds. This encourages scientists to develop multifunctional nanomedicines to meet challenging needs. As we know, mesenchymal stem cells (MSCs) have been widely explored for wound repair owing to their unique capability for self-renewal and multipotency. However, problems including immune concerns and legal restrictions should be properly resolved before MSC-based therapeutics are safely and widely used in clinics. Besides, maintaining the high viability/proliferation capability of MSCs during administration processes and therapy procedures is also one of the biggest technical bottlenecks. Extracellular vesicles (EVs) are cell-derived nanovesicles, that not only possess the basic characteristics and functions of their corresponding maternal cells but also contain several outstanding advantages including abundant sources, excellent biocompatibility, and convenient administration routes. Furthermore, the membrane surface and cavity are easy to flexibly modify to meet versatile application needs. Recently, MSC-derived EVs have emerged as promising therapeutics for skin wound repair. However, current reviews are too broad and rarely focused on the specific roles of EVs in the different stages of wound recovery. Therefore, it is quite necessary to demonstrate the significance of stem cell-derived EVs in promoting wound healing from several specific aspects. Here, this review primarily tries to provide critical comments on current advances in EVs derived from MSCs for wound repair, particularly elaborating on their impressive roles in effectively eliminating infections, inhibiting inflammation, promoting angiogenesis, and reducing scar formation. Last but not least, current limitations and future prospects of EVs derived from MSCs in the areas of wound repair are also objectively analyzed.

Transnasal drainage prevents surgical cavity related complications in transoral robotic surgery resected parapharyngeal space tumors.

BACKGROUND: There is no evidence about the relationship between surgical cavity drainage and related postoperative complications in transoral robotic surgery (TORS) resected parapharyngeal space (PPS) tumors. OBJECTIVES: To investigate the clinical efficacy and advantage of transnasal PPS drainage to prevent surgical cavity related complications (SCRC) in TORS resected PPS tumors. MATERIAL AND METHODS: Twenty-three patients undergoing TORS for PPS tumors were identified. In the experimental group (EG, 8 patients), the surgical incision was sutured directly and the transnasal drainage tube was placed. In the control group (CG, 15 patients), the surgical incision was partially sutured without drainage. The healing grade of surgical incision (HGSI), healing grade of surgical cavity (HGSC), SCRC, and other complications were compared. RESULTS: There were significant statistical differences in postoperative clinical rehabilitation indexes (HGSI/HGSC/SCRC) between the two groups. The comparison results of HGSI and HGSC in the two groups (EG vs CG) were (100% vs 66.7%) and (100% vs 46.7%) respectively. Compared with the EG, eight cases (53.3%) in the CG had postoperative SCRC such as hemorrhage, effusion, and swollen. CONCLUSIONS AND SIGNIFICANCE: For TORS resected PPS tumors, transnasal PPS drainage is an effective and comfortable method to improve postoperative HGSI and HGSC and prevent SCRC.

Stem cell-derived exosomes for chronic wound repair.

Stem cells possess the capability of self-renewal and multipotency, which endows them with great application potential in wound repair fields. Yet, several problems including immune concerns, ethical debates, and oncogenicity impede the broad and deep advance of stem cell-based products. Recently, owing to their abundant resources, excellent biocompatibility, and ease of being engineered, stem cell-derived exosomes were proved to be promising nanomedicine for curing chronic wounds. What is more, stem cell-derived exosomes are almost the mini record of their maternal cells, which even equipped them with the unique characteristics of stem cells. Chronic wound healing efficacy is dominated by several complicated factors, especially the excessive inflammation conditions and impaired vessels. Therefore, this review tries to concentrate on the current advances of stem cell-derived exosomes for reducing inflammation and promoting angiogenesis in chronic wound healing processes. Last but not least, the existing limitations and future perspectives of stem cell-derived exosomes for chronic wound treatment are also outlined.

Site-specific modification of N-terminal α-amino groups of succinylated collagen.

Polymer based protein engineering provides an attractive strategy to endow novel properties to protein and overcome the inherent limitations of both counterparts. The exquisite control of site and density of attached polymers on the proteins is crucial for the bioactivities and properties of the protein-polymer bioconjugates, but is still a challenge. Collagen is the major structural protein in extracellular matrix of animals. Based on the advancements of polymer-based protein engineering, collagen bioconjugates has been widely fabricated and applied as biomaterials. However, the site-specific synthesis of well-defined collagen-polymer bioconjugates is still not achieved. Herein, a versatile strategy for the specific modification of N-terminal α-amino groups in collagen was developed. Firstly, all reactive amino groups of tropocollagen (collagen with telopeptides) were protected by succinic anhydride. Then, the telopeptides were digested to give the active N-terminal α-amino groups, which were subsequently attached with poly(N-isopropylacrylamide) (PNIPAAm) via "grafting from" method based on the atom transfer radical polymerization (ATRP). The site-specific N-terminal PNIPAAm modified succinylated collagen was prepared and its structure, thermal responsive behaviour, and properties was explored.

Trends in the surgical management of parapharyngeal space tumors: A single-center retrospective analysis.

PURPOSE: Surgery remains the mainstay treatment for parapharyngeal space (PPS) tumors. Given the rapid advance and increasing usage of endoscopic and robotic techniques, we aimed to investigate the surgical trends of PPS tumors in our institution and analyze their impact on patients' treatment outcomes. MATERIALS AND METHODS: All patients who underwent surgical resection of PPS tumors from 2014 to 2021 at the Eye, Ear, Nose, and Throat Hospital of Fudan University were retrospectively reviewed. Student's t-test, Chi-square test, and multinomial logistic regression analyses were used to compare the surgical outcomes between groups. RESULT: Of the included 389 patients, the recipients of endoscopic surgery have largely increased in our center, with 17 of 134 cases (12.7%) in the group 2014-2017 and 187 of 255 cases (73.3%) in the group 2018-2021. The use of transoral and trans-nasal approaches increased in recent years (5.2% in 2014-2017 vs. 26.0% in 2018-2021), while that of trans-mandibular and lateral skull base approaches decreased (5.9% in 2014-2017 vs. 0.8% in 2018-2021). Decreased blood loss of operation and decreased risks of postoperative neurovascular complications were observed in the group 2018-2021. Similar findings were observed among patients receiving endoscopic surgery when compared with those receiving conventional surgery. CONCLUSION: In our institution, the overall trends in the surgical management of PPS tumors moved towards minimally invasive approaches with the assistance of endoscopy or surgical robots. The two surgical techniques were feasible and safe, and to a great extent, contributed to the improved surgical outcomes we observed in recent years.

Survival outcomes in patients with T3-4aN0M0 glottic laryngeal squamous cell carcinoma and evaluation of postoperative radiotherapy.

This study aimed to evaluate the clinical outcomes of patients with T3-4aN0M0 glottic laryngeal squamous cell carcinoma (LSCC) treated with laryngectomy, and to assess the postoperative radiotherapy (PORT) results in terms of the survival of T3-T4aN0M0 patients with negative margins. This was a retrospective review of 369 T3-4aN0M0 glottic LSCC cases. The 5-year cancer-specific survival (CSS) and overall survival (OS) rates were 67.5 and 66.7%, respectively. Patients who received total laryngectomy had worse survival [5-year CSS, 62.5%; disease-free survival (DFS), 56.2%] than those who underwent partial laryngectomy (5-year CSS, 79.3%; DFS, 65.4%). More advanced-stage cancer is a predictor of poor survival. There was no significant difference in CSS or DFS between patients with positive margins following rescue therapy and those with negative margins. Furthermore, no difference in the survival rates was observed between patients with negative margins who received PORT and those who did not (5-year DFS: 59.1 vs. 63.8%, P=0.057 and CSS: 62.5 vs. 69.5%, P=0.074). For T3-4aN0M0 glottic LSCC patients, surgical treatment remained a good option, as it can achieve satisfactory oncological outcomes. However, PORT did not increase survival in surgically managed pT3-4aN0M0 LSCC patients with negative margins.

Recurrence risk stratification and treatment strategies of patients with stage IVa-b hypopharyngeal squamous cell carcinoma.

BACKGROUND: Optimal treatment strategies for patients with stage IVa-b hypopharyngeal squamous cell carcinoma (HSCC) remain controversial. This study aimed to examine the high-risk factors of postoperative tumor recurrence after surgical resection of HSCC and devise individualized postoperative adjuvant treatment (POAT). METHODS: Overall, 218 patients with stage IVa-b HSCC who received surgery as initial treatment and with negative surgical margins were evaluated. Independent risk factors of recurrence were identified, and survival outcomes were compared according to recurrence risk and POAT use. RESULTS: POAT significantly improved recurrence-free survival (RFS) and overall survival (OS) only in the high-risk patients (p = 0.003 and 0.018, respectively). Compared with postoperative radiotherapy alone, postoperative chemoradiotherapy (pCRT) achieved significantly better RFS (p = 0.035) and OS (p = 0.048). CONCLUSIONS: POATs are recommended for high-risk patients with stage Iva-b HSCC, with pCRT achieving superior outcomes. Regular re-examination after tumor resection is sufficient for low-risk patients.

Immune Escape Adaptive Mutations in Hemagglutinin Are Responsible for the Antigenic Drift of Eurasian Avian-Like H1N1 Swine Influenza Viruses.

The continuous antigenic variation of influenza A viruses remains a major hurdle for vaccine selection; however, the molecular determinants and mechanisms of antigenic change remain largely unknown. In this study, two escape mutants were generated by serial passages of the Eurasian avian-like H1N1 swine influenza virus (EA H1N1 SIV) A/swine/Henan/11/2005 (HeN11) in the presence of two neutralizing monoclonal antibodies (mAbs) against the hemagglutinin (HA) protein, which were designated HeN11-2B6-P5 and HeN11-4C7-P8, respectively. The HeN11-2B6-P5 mutant simultaneously harbored the N190D and I230M substitutions in HA, whereas HeN11-4C7-P8 harbored the M269R substitution in HA (H3 numbering). The effects of each of these substitutions on viral antigenicity were determined by measuring the neutralization and hemagglutination inhibition (HI) titers with mAbs and polyclonal sera raised against the representative viruses. The results indicate that residues 190 and 269 are key determinants of viral antigenic variation. In particular, the N190D mutation had the greatest antigenic impact, as determined by the HI assay. Further studies showed that both HeN11-2B6-P5 and HeN11-4C7-P8 maintained the receptor-binding specificity of the parent virus, although the single mutation N190D decreased the binding affinity for the human-type receptor. The replicative ability in vitro of HeN11-2B6-P5 was increased, whereas that of HeN11-4C7-P8 was decreased. These findings extend our understanding of the antigenic evolution of influenza viruses under immune pressure and provide insights into the functional effects of amino acid substitutions near the receptor-binding site and the interplay among receptor binding, viral replication, and antigenic drift. IMPORTANCE The antigenic changes that occur continually in the evolution of influenza A viruses remain a great challenge for the effective control of disease outbreaks. Here, we identified three amino acid substitutions (at positions 190, 230, and 269) in the HA of EA H1N1 SIVs that determine viral antigenicity and result in escape from neutralizing monoclonal antibodies. All three of these substitutions have emerged in nature. Of note, residues 190 and 230 have synergistic effects on receptor binding and antigenicity. Our findings provide a better understanding of the functional effects of amino acid substitutions in HA and their consequences for the antigenic drift of influenza viruses.

[Indications for resection of parapharyngeal space tumors by transoral robotic surgery and prevention and treatment of complications].

Objective:This study investigated the clinical indications, prevention and management of common complications of TORS resection of parapharyngeal space tumors. Methods:The clinical data of 23 patients with parapharyngeal space tumors treated with TORS in the Eye & ENT Hospital of Fudan University from July 2020 to February 2022 were retrospectively analyzed. The surgical methods were divided into simple TORS surgery and TORS combined endoscopic or cervical surgery. The surgical incision can be directly sutured or partially sutured. If the surgical cavity is below the oropharyngeal plane and there is a risk of airway compression, preventive tracheotomy would be performed. No drainage（15 cases） or transnasal negative pressure drainage tube（8 cases） was placed in the operation cavity. In 17 cases, tumors were located between the top of nasopharynx and the lower boundary of oropharynx and these patients underwent simple TORS surgery; one case received combined cervical and endoscopic surgery, as the tumor was located near the skull base with unclear boundary with the deep lobe of parotid gland; five cases underwent combined endoscopic surgery, as the tumor reached the upper part of the nasopharynx or the outer part of the parapharyngeal space. Results:One case underwent emergency hemostasis for postoperative bleeding, and three cases underwent puncture and drainage for postoperative effusion. No complication occurred such as postoperative infection and airway obstruction. The healing grade of surgical incision and surgical cavity in transnasal drainage group was significantly better than that in non-drainage group. Conclusion:TORS operation is a safe and minimally invasive method in treating parapharyngeal space tumors with appropriate size and location. Postoperative effusion is a common complication after TORS. In case that surgical cavity extends to the deep parapharyngeal space or the lower part of the surgical cavity is beneath the surgical incision, the placement of transnasal negative pressure drainage tube after operation can improve postoperative recovery and reduce the incidence of complications such as effusion and infection.

Management of clinically node-negative glottic squamous cell carcinoma patients according to risk-scoring model for occult lymph node metastases.

Background: Glottic squamous cell carcinoma (GSCC) is the most prevalent type of laryngeal carcinoma. The value of prophylactic lymph node dissection (LND) in resected GSCC remains controversial. This study aims to quantitatively assess the probability of occult lymph node metastasis (LNM) for GSCC patients and devise individualized postoperative radiotherapy strategies. Methods: A total of 1319 patients with GSCC were retrospectively analyzed. Results: GSCC patients with T1-T2 stages showed significantly lower LNM rate than those with T3-T4 stages. For patients with T3-T4 GSCC, multivariate logistic analyses indicated that three factors-maximum tumor diameter (MTD) of more than 2.0 cm, relatively low differentiation, and tumor invasive depth of no less than 1.0 cm-were independent risk factors for the existence of LNM. A predictive nomogram was established based on these factors. The accuracy and validity of our model were verified by 0.716 and remained at 0.717 after 1000 bootstrapping. The calibration curve was also plotted and showed a favorable agreement. The patients were stratified into two groups based on their individual LNM risk points. Possible LNM rates for low-risk and high-risk subgroups were 4.7% and 25.2%, respectively. Conclusions: A new post-operative strategy selection flow chart was established based on our newly created nomogram which can effectively predict the individualized possibility of occult LNM for GSCC patients. For clinical T3-4N0 patients in the high-risk subgroup, prophylactic dose post-operative radiation therapy is recommended. However, for all those clinically diagnosed as T1-2N0 stage, regular follow-up is sufficient in view of the low occult LNM rate.Level of Evidence: 2a.