Wenbin Lei

Objectives Clinical evidence supporting ultrasound-guided percutaneous catheter drainage (US-PCD) as a first-line treatment for deep neck space abscesses (DNSAs) remains limited. This study aimed to evaluate the outcomes of US-PCD as initial management for DNSAs and to identify factors associated with treatment efficacy. Materials and methods This multicenter retrospective cohort study included patients with DNSAs who underwent US-PCD as a first-line treatment at four tertiary hospitals in China between 2015 and 2022. All patients were hemodynamically stable and had a stable airway, with preprocedural contrast-enhanced CT/MRI confirming no extensive mediastinal involvement beyond the anterosuperior compartment. Univariable and multivariable logistic regression analyses were used to identify preprocedural predictors of US-PCD efficacy. Results US-PCD was performed in 117 patients. The procedure was technically accessible in 116 (98%) patients, among whom 12 (10%) had descending mediastinitis confined to the anterosuperior mediastinum. No procedure-related major complications occurred. Drainage success was achieved in 98 patients (84%). Among the 18 patients (16%) in whom US-PCD failed, three (3%) died and the remaining 15 (13%) required open surgical drainage. Multiple septations and leukocyte count were significant in univariate but not multivariable analysis. The only independent predictor of drainage failure was the presence of serious associated events—a composite variable including descending mediastinitis, sepsis, airway compromise, and vascular thrombosis (OR = 5.7, 95% CI: 1.9–17.4, p = 0.002). Conclusion Ultrasound-guided percutaneous catheter drainage represents an effective minimally invasive first-line option for selected patients with deep neck space abscesses; however, open surgery should be prioritized when serious associated events are present. Key Points Question For deep neck space abscesses (DNSAs), ultrasound-guided percutaneous drainage (US-PCD) is a common surgical alternative, but its outcomes and predictors as a first-line treatment remain unclear. Findings US-PCD was effective as a first-line treatment for selected DNSAs. Only serious associated events—mediastinitis, sepsis, airway compromise, and thrombosis—independently predicted drainage failure. Clinical relevance US-PCD may be considered a first-line minimally invasive option for hemodynamically and airway-stable DNSA patients, even with anterosuperior mediastinal extension. Surgical drainage remains prioritized for cases with serious associated events to achieve rapid infection control. Graphical Abstract

Hypopharyngeal squamous cell carcinoma (HPSCC) is a rare, highly aggressive malignancy, with recurrence playing a pivotal role in treatment failure and cancer-related mortality. The tumor microenvironment (TME) characteristics and molecular mechanisms driving recurrence in HPSCC remain poorly defined. Primary HPSCC (P-HPSCC) samples (n = 6) and recurrent HPSCC (R-HPSCC) samples (n = 3) were analyzed. Single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics were employed to dissect the cellular composition and molecular characteristics of the TME. Key regulatory networks were identified through gene expression analysis, pathway enrichment, and intercellular communication profiling. Functional validation experiments were performed to confirm the biological relevance of the pathways identified. ScRNA-seq analysis revealed that malignant epithelial cells (maEpCs) in recurrent tumors exhibited increased stemness, epithelial-mesenchymal transition (EMT), and immune evasion programs. Mechanistically, IGF2BP2 was selectively upregulated in R-HPSCC and functioned as an m⁶A reader to stabilize SMAD3 mRNA, thereby activating transforming growth factor beta (TGF-β) signaling and facilitating malignant progression. Integrated spatial transcriptomics and functional assays demonstrated that cancer-associated fibroblasts in recurrent tumors promote progression via FN1-mediated signaling. Concurrently, the recurrent TME underwent myeloid remodeling toward an immunosuppressive state, characterized by increased infiltration of SPP1⁺ tumor-associated macrophages and further enrichment of LAMP3⁺ dendritic cells with impaired antigen-presenting capacity, alongside aggravated CD8⁺ T-cell exhaustion, marked by upregulation of CTLA4 as a potential immune escape driver. This study identifies recurrence-associated cellular and molecular features in HPSCC. Recurrent tumors exhibited maEpC reprogramming via IGF2BP2-mediated activation of TGF-β signaling, coupled with FN1-dependent stromal activation and immune evasion marked by myeloid immunosuppressive remodeling and CD8⁺ T-cell exhaustion, characterized by CTLA4 upregulation. Collectively, these findings reveal a pro-recurrent TME and suggest potential therapeutic targets in R-HPSCC.

Descending necrotizing mediastinitis (DNM) is a severe complication of deep neck infection when the mediastinum is involved. Currently, the optimal surgica

Background: To compare outcomes of the combined transcervical–submandibular and transoral endoscopic approach versus the open transcervical parotid approach and transoral endoscopic surgery alone, and to clarify the indications and advantages of the combined technique. Methods: This retrospective observational study was conducted at a tertiary academic hospital in China between January 2013 and December 2024. A total of 114 consecutive patients with histologically confirmed benign parapharyngeal space tumors underwent the open transcervical parotid approach ( n = 48), transoral endoscopic surgery alone ( n = 42), or the combined transcervical‐submandibular and transoral endoscopic approach ( n = 24). Tumor size, intraoperative blood loss, hospitalization duration, tracheotomy rates, en‐bloc resection rates, and surgery‐related complications were compared among the three groups. Results: The combined surgery group had significantly larger tumors and a lower incidence of surgery‐related complications. No statistically significant differences were observed among the three approaches in tracheostomy rates, intraoperative blood loss, operative duration, or hospitalization duration. Conclusions: The combined approach appears effective in reducing complications associated with resection of large, anatomically complex benign parapharyngeal tumors, particularly those involving critical neurovascular structures. This technique shows clinical value and warrants broader application.

Importance: Tinnitus, affecting 10% to 15% of the global population, is a debilitating condition often linked to hearing loss and neurological disorders. While air pollution is a known risk factor for respiratory and cardiovascular diseases, its association with tinnitus remains underexplored. Objective: This study investigates the association between air pollution, polygenic risk score (PRS), and tinnitus prevalence. Design: Cross-sectional analysis. Setting: UK Biobank (UKB) population-based cohort. Participants: Seventy-nine thousand two hundred seventy-seven individuals from the UKB with available tinnitus, air pollution, and genetic data. Exposures: Air pollution measures (PM _2.5 , PM _2.5–10 , PM ₁₀ , NO ₂ , and NO _x ). A composite air pollution score was calculated, and PRS was derived from 6 tinnitus-associated single-nucleotide polymorphisms. Main outcome measures: Prevalence, frequency, and severity of tinnitus. Logistic regression models were used, adjusting for sociodemographic, health, and hearing-related covariates. Results: Each interquartile range increase in air pollution score was associated with higher odds of current tinnitus (OR = 1.06, 95% CI: 1.03-1.08, P < .001), particularly transient tinnitus (OR = 1.04, P = .008). PRS was independently associated with prevalent tinnitus ( P < .001), and higher OR were observed among individuals with both high air pollution exposure and high PRS (OR = 1.34, 95% CI: 1.18-1.52, P < .001). Individual pollutants showed weaker associations. Conclusion: A joint association of air pollution exposure and genetic susceptibility with tinnitus prevalence was observed in this cross-sectional analysis, highlighting the importance of integrated environmental and genetic assessments in auditory health. Relevance: Our findings emphasize the potential value of integrating environmental and genetic factors for risk stratification of tinnitus in populations.

Objective: To develop and validate a modular, low‐cost, and anatomically realistic microsurgical simulator for endolaryngeal training, including CO ₂ laser procedures and microsuturing. Methods: We developed a dual‐module simulator consisting of a laryngeal specimen fixation unit and a flexible laryngoscope holder. The device accommodates porcine larynges and enables adjustable exposure and instrument manipulation under microscopic or exoscopic visualization. Junior and senior otolaryngologists performed standardized tasks, including subepithelial vocal fold dissection, microsuturing, and CO ₂ laser cordectomy. Participants completed a post‐session Likert‐scale survey assessing realism, usability, and perceived educational value. Results: Twenty one otolaryngologists evaluated the simulator. Across survey items, mean scores ranged from 4.29 to 4.95 (SD: 0.22–0.78), with 81.0%–100% agreement (Likert ≥ 4). Perceived training benefit was highest for hand–eye coordination (4.95 ± 0.22, 100%), basic instrumentation for microscopic laser surgery (4.95 ± 0.22, 100%), and bimanual dexterity (4.90 ± 0.30, 100%). Overall satisfaction with the model was high (4.71 ± 0.46, 100%). Conclusion: This novel modular porcine‐larynx simulator provides a practical platform for microlaryngeal skills training with high user‐rated realism and educational utility. Its simple design, affordability, and adaptability may facilitate broader implementation in surgical education. Level of Evidence: 4.

Nasopharyngolaryngoscopy (NPL) is widely used to examine the nasopharyngolaryngeal anatomical sites. The quality of NPL depends on the endoscopist's performance, and incomplete examinations may contribute to missed findings in practice. Here, we developed ENDOVISTA-ENT, an intelligent quality control system trained on NPL videos from 3,630 patients. The system can monitor anatomical coverage in real time during NPL procedures. It is not designed to detect lesions. By integrating into the existing NPL workflow, it provides endoscopists with real-time feedback on anatomical coverage, examination progress, and procedure duration. To evaluate its effect, we conducted a prospective, double-centre, randomized controlled trial registered in the Chinese Clinical Trial Registry (ChiCTR2400091245). A total of 318 patients were randomly assigned to undergo ENDOVISTA-ENT-assisted or conventional NPL examination. The primary outcome was coverage of predefined anatomical sites. Results showed that ENDOVISTA-ENT-assisted NPL examinations achieved signi6cantly higher mean anatomical coverage than conventional examinations (93.08% vs. 83.50%, P < 0.0001). Importantly, this improvement occurred without significantly increasing examination time. Subgroup analyses revealed benefits across all experience levels, particularly among junior endoscopists. These findings suggest that a real-time AI-assisted quality control system can support a more standardized NPL workflow and improve endoscopists' procedural completeness during NPL.

Laryngeal squamous cell carcinoma (LSCC) is typically diagnosed at advanced stages, highlighting the critical need for early intervention. By integrating single-cell and bulk RNA-seq data from LSCC, vocal cord leukoplakia (VCL), and LSCC precursors, we characterized dynamic remodeling of the tumor microenvironment during LSCC pathogenesis. We identified transcriptional program gene modules that reflect malignant epithelial cells (maEpCs). The infiltration of POSTN⁺ fibroblasts progressively increases from normal tissue to VCL and further to LSCC, accompanied by enhanced intercellular communication. These fibroblasts interact with maEpCs and endothelial cells via ligands such as MIF, promoting epithelial-mesenchymal transition, cancer stemness, and angiogenesis. Blocking MIF reversed cancer-associated fibroblast-driven invasion and angiogenesis. Here, we further revealed that an immunosuppressive microenvironment arises as early as the precancerous stage, with VCL exhibiting CD8⁺ T cell exhaustion and abundant LAMP3⁺ dendritic cells that correlate positively with Tregs and exhausted CD8⁺ T cells, promoting early immune escape. Additionally, LSCC was uniquely enriched for a pro-tumor SPP1⁺ macrophage subset with low phagocytic activity and high angiogenic potential, linked to poor prognosis. Our findings uncover key mechanisms driving LSCC malignant progression, offer insights for early diagnosis and prognosis assessment, and highlight MIF as a promising therapeutic target.