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Background and Objectives This study analyzed data from patients who were diagnosed with human papilloma virus (HPV)-associated oropharyngeal (OPC) and treated surgically to construct a machine learning survival prediction model.Subjects and Method We retrospectively analyzed the clinico-pathological data of 203 patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) from 2007 to 2015.Results In the Cox proportional hazard (CPH) model, the c-index values for the training set and the test set were 0.81 and 0.59, respectively. The univariate analysis showed that contralateral lymph nodes (LNs) metastasis, lymphovascular invasion, pN, stage, surgical margin status, histologic grade, pT, and the number of metastatic LNs had significant correlations with survival. Contrastively, the multivariate analysis showed pT and histologic grade to have significant correlation with survival. In the random survival forest model, the c-index values for the training set and the test set were 0.83 and 0.87, respectively. In the DeepSurv model, the cindex values for the training set and the test set were 0.75 and 0.83. Among the three models mentioned above, Random Survival Forest and DeepSurv showed the best performance for predicting the survival of HPV-associated OPSCC patients.Conclusion We confirmed that a survival prediction model using machine learning and deep learning algorithms showed reasonable survival estimates for HPV-associated OPSCC patients.

Background and Objectives We analyzed surgical outcomes, perioperative complications, and mortality in head and neck squamous cell carcinoma (HNSCC) in patients who underwent curative surgery following neoadjuvant immunotherapy.Subjects and Method The records of 36 HNSCC patients who underwent curative surgery with neoadjuvant immunotherapy and 69 HNSCC patients who received neoadjuvant chemotherapy were analyzed.Results The average operation time was 315 minutes, and the average bleeding volume was 167 cc. The average length of hospital stay was 21 days. When evaluating surgical margin status, we found 24 patients (66.6%) who exhibited a negative margin. We found no case where surgery was impossible due to progression of the lesion during neoadjuvant immunotherapy. Compared to the neoadjuvant chemotherapy group, neoadjuvant immunotherapy group showed acceptable perioperative safety and complication profile. The postoperative complication rate was 19.4% in the neoadjuvant immunotherapy group and 13.0% in the neoadjuvant chemotherapy group (p=0.386). There were no serious complications during the recovery period after surgery or instances of death due to complications.Conclusion In HNSCC patients, there was no increase in the incidence of complications or mortality related to curative surgery after neoadjuvant immunotherapy.

Background and Objectives The purpose of this study was to analyze the survival data of salivary gland cancer (SGCs) patients to construct machine learning and deep learning models that can predict survival and use them to stratify SGC patients according to risk estimate.Subjects and Method We retrospectively analyzed the clinicopathologic data from 460 patients with SGCs from 2006 to 2018.Results In Cox proportional hazard (CPH) model, pM, stage, lymphovascular invasion, lymph node ratio, and age exhibited significant correlation with patient’s survival. In the CPH model, the c-index value for the training set was 0.85, and that for the test set was 0.81. In the Random Survival Forest model, the c-index value for the training set was 0.86, and that for the test set was 0.82. Stage and age exhibited high importance in both the Random Survival Forest and CPH models. In the deep learning-based model, the c-index value was 0.72 for the training set and 0.72 for the test set. Among the three models mentioned above, the Random Survival Forest model exhibited the highest performance in predicting the survival of SGC patients.Conclusion A survival prediction model using machine learning techniques showed acceptable performance in predicting the survival of SGC patients. Although large-scale clinical and multicenter studies should be conducted to establish more powerful predictive model, we expect that individualized treatment can be realized according to risk stratification made by the machine learning model.

Background/Objectives: This study analyzed the prognostic significance of clinico-pathologic factors including comprehensive nodal factors in parotid gland cancers (PGCs) patients and constructed a survival prediction model for PGCs patients using machine learning techniques.Materials & Methods: A total of 131 PGCs patients were enrolled in the study.Results: There were 19 cases (14.5%) of lymph nodes (LNs) at the lower neck level and 43 cases (32.8%) involved multiple level LNs metastases. There were 2 cases (1.5%) of metastases to the contralateral LNs. Intraparotid LNs metastasis was observed in 6 cases (4.6%) and extranodal extension (ENE) findings were observed in 35 cases (26.7%). Lymphovascular invasion (LVI) and perineural invasion findings were observed in 42 cases (32.1%) and 49 cases (37.4%), respectively. Machine learning prediction models were constructed using clinico-pathologic factors including comprehensive nodal factors and Decision Tree and Stacking model showed the highest accuracy at 74% and 70% for predicting patient’s survival.Conclusion: Lower level LNs metastasis and LNR have important prognostic significance for predicting disease recurrence and survival in PGCs patients. These two factors were used as important features for constructing machine learning prediction model. Our machine learning model could predict PGCs patient’s survival with a considerable level of accuracy.

Penetrating brain injury caused by a nail gun is an uncommon clinical scenario reported in the literature. A 36-year-old male presented with a nail that had penetrated through the occipital bone. He was alert and neurologically intact except for visual disturbance. Computed tomography (CT) of the brain showed the nail lodged at the occipital lobe and the parietal lobe, with minimal intracerebral hemorrhage. The nail was placed in the occipital lobe close to the superior sagittal sinus. We removed the nail with craniotomy since the entrance of the nail was close to the superior sagittal sinus. There were no newly developed neurological deficits postoperatively. Immediate postoperative CT showed no newly developed lesions. The patient recovered well without any significant complications. Two weeks postoperatively, magnetic resonance imaging showed no remarkable lesions. The visual disturbance was followed up at the outpatient department. To summarize, we report a rare case of penetrating head injury by a nail gun and discuss relevant aspects of the clinical management.

To develop machine learning (ML) models for predicting positive margins in patients undergoing transoral robotic surgery (TORS).Data from 453 patients with laryngeal, hypopharyngeal, and oropharyngeal squamous cell carcinoma were retrospectively collected at a tertiary referral center to train (n = 316) and validate (n = 137) six two-class supervised ML models employing 14 variables available pre-operatively.The accuracy of the six ML models ranged between 0.67 and 0.75, while the measured AUC between 0.68 and 0.75. The ML algorithms showed high specificity (range: 0.75-0.89) and low sensitivity (range: 0.26-0.64) in detecting patients with positive margins after TORS. NPV was higher (range: 0.73-0.83) compared to PPV (range: 0.45-0.63). T classification and tumor site were the most important predictors of positive surgical margins.ML algorithms can identify patients with low risk of positive margins and therefore amenable to TORS.

BACKGROUND We aimed to identify the optimal indications of neoadjuvant chemotherapy (NACT) and transoral robotic surgery (TORS) in patients with locoregionally advanced (T3-4 or N2-3) head and neck cancer (HNC). METHODS A total of 50 patients were included in the study. RESULTS T1 was identified in seven cases, T2 in 19, T3 in 22, and T4 in 2. N0 was identified in nine cases, N1 in 18, N2 in 22, and N3 in 1. There were 25 patients (50%) with complete remission of the primary lesion and 25 patients (50%) with partial remission. On pathologic examination of surgical specimens after neoadjuvant chemotherapy and TORS, 2 patients (4%) had a positive surgical margin, and 48 patients (96%) had a negative margin. Pathologic metastatic lymph nodes (LNs) were not observed in 39 cases (78%), and one metastatic LN was observed in 11 cases (22%). The 3-year recurrence-free survival (RFS) of all patients was 85.4%. On multivariate analysis, lymphovascular invasion showed a significant correlation with RFS. CONCLUSIONS In patients with locoregionally advanced HNC, NACT and TORS achieved favorable oncologic and functional outcomes.

No consensus exists regarding the most effective reconstruction after total laryngectomy with partial pharyngectomy (TLwPP). This study aims to compare different reconstructive techniques (pectoralis major myo-cutaneous flap, PMMCF; anterolateral thigh flap, ALTF; radial forearm free flap, RFFF) after TLwPP in terms of pharyngocutaneous fistula (PCF), stenosis and feeding tube dependence (FTD) incidence.The Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar databases were searched. A single-arm meta-analysis was performed for PCF incidence, stenosis incidence, and FTD incidence on the entire cohort. An arm-based network analysis was conducted to compare three different surgical interventions (PMMCF, ALTF, RFFF).A total of 13 studies and 232 patients were included in the network meta-analysis. The lowest PCF absolute risk was measured for the RFFF (11.7%, 95% CI: 2.8%-33.4%), compared to the ALTF (13.4%, 95% CI: 4.5%-32.1%) and the PMMC (49.0%, 95% CI: 19.2%-79.3%). The RFFF showed a stenosis absolute risk of 0.0% (95% CI: 0.0%-1.1%), while a higher stenosis incidence was measured for the ALTF (5.7%, 95% CI: 0.8%-25.2%) and the PMMCF (11.6%, 95% CI: 0.8%-55.1%). The RFFF showed the lowest absolute risk of FTD incidence (6.8%, 95% CI: 0.5%-28.1%) compared to the other reconstructive techniques (PMMCF: 12.4%, 95% CI: 2.4%-42.1%; ALTF: 17.5%, 95% CI: 6.4%-38.9%).The RFFF seems the best choice for reconstruction of partial pharyngeal defects after TLwPP due to the lower incidence of PCF, stenosis and FTD compared to the ALTF and the PMMCF.

The five-dimensional process-oriented model of identity development delineates the formation and evaluation cycles of identity and includes ruminative exploration. In South Korea, individualistic and collectivistic cultures coexist, and such culture may influence the identity development process of young adults. However, identity development in Korean young adults has not been studied abundantly. In particular, the five-dimensional model of identity has never been used to study a Korean sample. In the present study, we tested the applicability of the five-dimensional model of identity with South Korean young adults between ages 19 and 25 (N = 548; Mage = 22.72; SDage = 1.93; 44.2% men). Specifically, we examined the measurement model of the Dimensions of Identity Development Scale (DIDS) and nomological net of the identity dimensions. Further, we conducted a cluster analysis to derive identity statuses. Results indicated that the five-factor model of the DIDS could be applied in our sample. The identity dimensions were related to each other and with external variables in ways that were mostly consistent with previous studies. Exploration in breadth and exploration in depth’s relations with commitment making, identification with commitment, and psychosocial functioning, which have not been consistent in previous studies, were positive. Finally, we identified five identity status clusters that resembled statuses identified in previous studies, but further research would be needed to ensure comparability.

We performed robotic neck surgery through a transoral or retroauricular approach (RA) using the DaVinci SP and analyzed our experiences to evaluate the feasibility and safety of this system for performing RA neck surgeries. A total of 63 patients were enrolled in this study, consisting of 37 males and 26 females. All operations were successfully completed without significant complication in 63 patients with head and neck tumor. Using DaVinci SP, it is easy to insert three robotic arms into a long and narrow working space because all robotic arms and an endoscope are inserted through a single arm. Using the navigation function of the DaVinci SP, the endoscopic arm could be made into the shape of a "cobra" to secure proper visualization of the surgical site, which helps surgeons identify specific anatomic structures such as cranial nerve or vessels. We did not have any cases where robotic surgery was converted to open surgery due to severe bleeding or technical issues during surgery. The mean operative time was 207 min and the average hospital stay was 6.9 days. The time required for docking the surgical robot was within 10 min on average for DaVinci SP, which was much simpler and faster than that of the previous Si/Xi system. Based on our early experiences performing robotic head and neck surgery using the DaVinci SP, we confirmed that the system provided advanced technical advantages over the previous Si/Xi system in performing robotic surgery.

Objectives. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group).Methods. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016.Results. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780).Conclusion. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

We aimed to investigate the prognostic value of multiple immune cell markers including programmed death-ligand 1 (PD-L1) and poliovirus receptor (PVR) in head and neck squamous cell carcinoma (HNSCC) using archival tumor tissues METHODS: Patients diagnosed with HNSCC who have undergone surgical resection in 2005-2012 were included. Correlations between PVR and PD-L1 expression and patient characteristics were analyzed by analysis of variance. The Kaplan-Meier method and log-rank test were used to estimate survival. P values 0.05 were considered statistically significant.In total, 375 primary tumor tissues were analyzed using immunohistochemistry. High PVR expression was associated with a poor prognosis in terms of overall survival (OS) and recurrence-free survival (RFS), and tumors with high PVR expression were associated with a short OS. PD-L1 tumor expression did not have a prognostic impact on survival. Univariate analysis revealed that OS and RFS were affected by age and p16 and PVR expression; multivariate analysis revealed that age and p16 and PVR expression were the most important determinants of RFS.PVR overexpression is a poor prognostic factor in patients with HNSCC and co-targeting PVR and PD-L1 may be a promising therapeutic option that needs further investigation.

Objectives. In subset of patients, acinic cell carcinoma (AcCC) exhibits aggressive features such as recurrence, distant metastasis, and mortality. This study aimed to investigate clinicopathologic factors influencing patients’ prognosis and to identify adverse features predictive of an unfavorable prognosis.Methods. Between January 2000 and December 2016, 59 patients with AcCC were enrolled in this study.Results. The patients’ 5-year overall survival rate was 93.3%, and their 5-year recurrence-free survival rate was 80.5%. During the study period, recurrence occurred in 10 patients. The mean time to recurrence after surgery was 26 months (range, 5–60 months). During the study period, three patients died from the disease. Univariate analysis showed that sex, surgical extent, extranodal extension, T classification, and TNM stage were significantly associated with disease recurrence. Multivariate analysis showed that, among the clinicopathologic factors included in the analysis, only TNM stage displayed a statistically significant correlation with disease recurrence.Conclusion. Surgical treatment alone yielded good results for AcCC, and additional treatment did not affect the recurrence-free survival rate or the overall survival rate, even when the resection margin was less than 1 mm. Other pathologic factors did not show prognostic significance for disease recurrence or death.

Introduction: With increased life expectancy, the proportion of elderly trauma admissions has increased. Elderly patients frequently have underlying diseases necessitating anticoagulant/antiplatelet medication, which worsens coagulopathy. We ascertained the relationship between preinjury anticoagulants/antiplatelet medication use and transfusion requirements in patients older than 65 years. Methods: This retrospective study enrolled patients admitted to the trauma intensive care unit of Chungbuk National University Hospital during January 2016 to June 2019. Data on medication history, clinical features, and component transfusions were analyzed with the chi-square test, independent t-test, one-way analysis of variance, and analysis of covariance. Results: Overall, 142 and 324 (overall 466) patients did and did not receive anticoagulant/antiplatelet medication, respectively. Falls were more frequent ( p Conclusion: Preinjury anticoagulant/antiplatelet medication use was not significantly associated with transfusion amounts in patients older than 65 years.

Background Recurrent and/or metastatic squamous cell carcinoma of head and neck (R/M SCCHN) is a common cancer with high recurrence and mortality. Current treatments have low response rates (RRs). Methods Fifty-three patients with R/M SCCHN received continuous oral buparlisib. In parallel, patient-derived xenografts (PDXs) were established in mice to evaluate resistance mechanisms and efficacy of buparlisib/cetuximab combination. Baseline and on-treatment tumour genomes and transcriptomes were sequenced. Based on the integrated clinical and PDX data, 11 patients with progression under buparlisib monotherapy were treated with a combination of buparlisib and cetuximab. Results For buparlisib monotherapy, disease control rate (DCR) was 49%, RR was 3% and median progression-free survival (PFS) and overall survival (OS) were 63 and 143 days, respectively. For combination therapy, DCR was 91%, RR was 18% and median PFS and OS were 111 and 206 days, respectively. Four PDX models were originated from patients enrolled in the current clinical trial. While buparlisib alone did not inhibit tumour growth, combination therapy achieved tumour inhibition in three of seven PDXs. Genes associated with apoptosis and cell-cycle arrest were expressed at higher levels with combination treatment than with buparlisib or cetuximab alone. Conclusions The buparlisib/cetuximab combination has significant promise as a treatment strategy for R/M SCCHN. Clinical Trial Registration NCT01527877.

Objectives/hypothesis In this study, we retrospectively reviewed medical records of patients who underwent surgery for p16+ oropharyngeal cancer and analyzed the prognostic implications of pathologic lymph node (LN) status, including number of metastatic LNs, LN ratio, and location of metastatic LNs. Study design Retrospective case series. Methods We retrospectively reviewed data on patients diagnosed with p16+ oropharyngeal cancer. Results The study population consisted of 159 males and 29 females with a mean age of 57.2 years. The primary tumor sites were tonsils (n = 160), base of the tongue (n = 24), and soft palate (n = 4). Only recurrence-free survival (RFS) showed a significant correlation with contralateral LN metastasis on multivariate analysis. On Kaplan-Meier analysis, 5-year RFS was 92.4% in patients without contralateral LN metastasis and 68.8% in patients with contralateral LN metastasis. Conclusions Among pathologic LN status in p16+ oropharyngeal cancer, only contralateral LN metastasis showed prognostic significance in disease recurrence of p16+ oropharyngeal squamous cell carcinoma patients. Level of evidence 4 Laryngoscope, 130: 1973-1979, 2020.

Background Transoral robotic surgery (TORS) has recently emerged as a surgical technique for oropharyngeal cancer. We performed a systematic review to investigate the clinical safety and effectiveness of robotic surgery compared with conventional open surgery in primary oropharyngeal cancer. Methods A literature search was conducted using the English-language databases Ovid-MEDLINE, Ovid-Embase, and the Cochrane Library, as well as local databases containing publications through July 2018. The outcomes included demographic characteristics, adverse events, and complications, as well as oncologic, functional, and surgical outcomes. Results Nine papers (n = 574 patients) met the inclusion criteria. Disease-free survival rate was significantly higher in the TORS group than open surgery group (n = 5 studies, RR: 1.13, 95% CI: 1.03, 1.24, I2 = 0%). Primary TORS compared with open surgery was associated with lower risks of free flap reconstruction (relative risk [RR]: 0.33, 95% confidence interval [CI]: 0.12.0.88, I2 = 6%). In subgroup analyses, the time to decannulation reconstruction (N = 2 concurrent studies, mean difference [MD]: −6.71, 95% CI: −8.40, −5.03, I2 = 78%) in the TORS group shortened by 6.7 days than open surgery group. The length of hospital stay showed significant shorter by 1.09 days in three concurrent studies (95% CI -3.49, 1.30, I2 = 72%). Conclusions From current non-randomized studies, TORS could have advantage for disease-free survival and lowering the risk of free flap reconstruction compared to open surgery. However, due to lack of relevant studies, oncologic, functional, surgical outcomes including complications of TORS versus open surgery for oropharyngeal cancer are need to be verified with long-term follow-up comparative studies.

Background Oropharyngeal cancer (OPC) exhibits diverse immunological properties; however, their implications for immunotherapy are unknown. Methods We analysed 37 surgically resected and nine recurrent or metastatic anti-programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1)-treated OPC tumours. OPCs were classified into immune-rich (IR), mesenchymal (MS) and xenobiotic (XB) subtypes based on RNA-sequencing data. Results All IR type tumours were human papillomavirus (HPV) positive, most XB types were HPV negative, and MS types showed mixed HPV status. The IR type showed an enriched T cell exhaustion signature with PD-1+ CD8+ T cells and type I macrophages infiltrating the tumour nest on multiplex immunohistochemistry. The MS type showed an exclusion of CD8+ T cells from the tumour nest and high MS and tumour growth factor-β signatures. The XB type showed scant CD8+ T cell infiltration and focal CD73 expression. The IR type was associated with a favourable response signature during anti-PD-1/PD-L1 therapy and showed a high APOBEC mutation signature, whereas the MS and XB types showed resistance signature upregulation. Among anti-PD-1/PD-L1-treated OPC patients, the IR type showed a favourable clinical response (3/4 patients), whereas the XB type showed early progression (3/3 patients). Conclusion Our analysis classified OPCs into three subtypes with distinct immune microenvironments that are potentially related to the response to anti-PD-1/PD-L1 therapy.

Background We performed robotic parotidectomy with or without robotic neck dissection via a retroauricular approach in patients with parotid benign and malignant tumors and analyzed treatment outcomes of the patients to evaluate the safety and feasibility of robotic parotidectomy. Methods Between January 2017 and July 2018, 53 patients received robotic parotidectomy with/without robotic neck dissection through a remote access retroauricular incision without a preauricular incision. Results All operations were successfully performed in all patients without significant perioperative complications or tumor spillage. Tumors were located in the superficial lobe of the parotid gland in 40 patients, and the remaining 13 tumors were located in the deep lobe of the parotid gland. Postoperative pathologic examination revealed benign tumor in 32 patients and malignant tumors in 18 patients. The mean operation time was 226 minutes in patients who underwent only parotidectomy and 375 minutes in patients who underwent parotidectomy with robotic neck dissection. The average amount of bleeding was 23 mL, and the amount of drainage after operation averaged 171 mL. The average length of hospital stay was 6 days. Postoperative complications were limited to transient facial paralysis in three patients, all of which resolved within 1 month. All patients were satisfied with their cosmetic results at 6 months after operation. Conclusions Robotic parotidectomy with/without robotic neck dissection through a retroauricular approach was a feasible and safe technique in patients with parotid benign and malignant tumor. Specifically, we found it to be helpful in young patients with malignant parotid tumors who should receive cervical lymphadenectomy and parotidectomy, because it does not leave a visible scar on the face or neck. In the future, long-term follow-up will be necessary to validate its oncologic safety and functional outcomes.

We suggested operative techniques and indications of robotic neck surgery. To determine operative techniques and the indications for robotic neck surgery, we analyzed treatment outcomes of patients who received robotic neck surgery. Between May 2010 and July 2018, a total of 945 patients with various neck diseases visited Severance Hospital and underwent robotic neck surgery. A variety of approaches, including the retroauricular approach (RA), modified facelift approach (MFLA), transaxillary approach (TA), and transaxillary retroauricular approach (TARA), was used to remove various tumors in the neck. A total of 235 patients underwent a robotic neck dissection (elective or therapeutic) in the treatment of head and neck cancer with metastatic cervical lymph nodes. Five hundred-seventeen patients underwent robotic thyroidectomy or parathyroidectomy for thyroid or parathyroid disease, respectively. The remaining 193 patients underwent robotic neck surgery in the treatment of other neck diseases. Various neck lesions were successfully excised using RA or MFLA (including salivary gland tumors, thyroid tumors, vascular tumors, neurogenic tumors, lipomas, lymphangiomas, venous malformations, dermoid cysts, and others). Robotic neck surgery is a feasible and safe technique for the resection of various head and neck tumors. This method could be particularly useful in young patients with thyroid tumors, salivary gland tumors, and vascular tumors, among others, because it does not leave a visible scar on the face or neck. The superior visualization and articulate robotic arm that moves freely at various angles allows surgeons to perform delicate and precise surgeries.

In this study, we sought to evaluate the clinical feasibility of indocyanine green (ICG)-guided sentinel lymph node (SLN) sampling during robotic retroauricular neck dissection (RAND) in patients with cN0 oral cancer. Nine adult patients diagnosed with T1 to T2 oral squamous cell carcinoma were consecutively recruited. All of them underwent transoral partial glossectomy and robotic RAND (levels I-III) simultaneously. Twelve hours prior to surgery, ICG was injected into the 4 quadrants around primary tongue tumors. During robotic RAND, intraoperative and ex vivo ICG-stained LNs were identified using the Firefly system and examined for the presence of fluorescence. ICG-stained LNs were identified in all patients. Thirty-one ICG-stained LNs were detected in 313 retrieved LNs (9.9%). Occult metastases were detected among the ICG-stained LNs in 2 patients (22.2%). There was no metastasis identified in the ICG-unstained LNs. Upstaging rates, sensitivity, specificity, and negative predictive value of ICG-guided SLN sampling were 22.2%, 100%, 91.5%, and 100%, respectively.

A 74-year-old woman presented with multiple rib fractures, hemothorax, spleen rupture, and right shoulder dislocation. Shoulder joint reduction was performed using the traction-countertraction method. An injury to the descending aorta, caused by the seventh rib, was confirmed.The authors encountered an aortic injury, a rare complication of shoulder joint reduction, in a patient with a posterior rib fracture. When managing patients with posterior fractures of the fourth to ninth ribs on the left side, the reduction method should be carefully selected depending on the status of the patient to avoid aortic injuries.

Traumatic intrapulmonary glass foreign bodies that are missed on an initial examination can migrate and lead to severe complications. Here, we present a rare case of a traumatic intrapulmonary glass foreign body surgically removed by a direct pulmonary incision, which preserved the pulmonary parenchyma and avoided severe complications caused by migration.

We attempted to predict pathological factors and treatment outcomes using machine learning and radiomic features extracted from preoperative magnetic resonance imaging (MRI) of oropharyngeal squamous cell carcinoma (OPSCC) patients.The medical records and imaging data of 155 patients who were diagnosed with OPSCC were analyzed retrospectively.The logistic regression model showed that the area under the receiver operating characteristic curve (AUC) of the model was 0.792 in predicting human papilloma virus (HPV) status. The LightGBM model showed an AUC of 0.8333 in predicting HPV status. The performance of the logistic model in predicting lymphovascular invasion, extracapsular nodal spread, and metastatic lymph nodes showed AUC values of 0.7871, 0.6713, and 0.6638, respectively. In predicting disease recurrence, the LightGBM model showed an AUC of 0.8571. In predicting patient death, the logistic model showed an AUC of 0.8175.A machine learning model using MRI radiomics showed satisfactory performance in predicting pathologic factors and treatment outcomes of OPSCC patients.

Objective We aimed to identify the risk factors for ventilator-associated pneumonia in patients admitted to critical care after a torso injury. Methods We retrospectively evaluated 178 patients with torso injury aged >15 years who were intubated in the emergency room and placed on a mechanical ventilator after intensive care unit (ICU) admission, survived for >48 hours, had thoracic and/or abdominal injuries, and had no end-stage renal disease. We compared clinico-laboratory variables between ventilator-associated pneumonia (n = 54, 30.3%) and non-ventilator-associated pneumonia (n = 124, 69.7%) groups. Risk factors for ventilator-associated pneumonia were assessed using multivariable logistic regression analysis. Results Ventilator-associated pneumonia was associated with a significantly longer stay in the ICU (11.3 vs. 6.8 days) and longer duration of mechanical ventilation (7 vs. 3 days). Injury Severity Score (adjusted odds ratio [AOR]: 1.048; 95% confidence interval [CI]: 1.008–1.090), use of vasopressors (AOR: 2.541; 95% CI: 1.121–5.758), and insertion of a nasogastric tube (AOR: 6.749; 95% CI: 2.397–18.999) were identified as independent risk factors of ventilator-associated pneumonia. Conclusion Ventilator-associated pneumonia in patients with torso injury who were admitted to the ICU was highly correlated with Injury Severity Score, use of vasopressors, and insertion of a nasogastric tube.