Plasma nanoDSF Denaturation Profile at Baseline Is Predictive of Glioblastoma EGFR Status.

Glioblastoma (GBM) is the most frequent and aggressive primary brain tumor in adults. Recently, we demonstrated that plasma denaturation profiles of glioblastoma patients obtained using Differential Scanning Fluorimetry can be automatically distinguished from healthy controls with the help of Artificial Intelligence (AI). Here, we used a set of machine-learning algorithms to automatically classify plasma denaturation profiles of glioblastoma patients according to their EGFR status. We found that Adaboost AI is able to discriminate EGFR alterations in GBM with an 81.5% accuracy. Our study shows that the use of these plasma denaturation profiles could answer the unmet neuro-oncology need for diagnostic predictive biomarker in combination with brain MRI and clinical data, in order to allow for a rapid orientation of patients for a definitive pathological diagnosis and then treatment. We complete this study by showing that discriminating another mutation, MGMT, seems harder, and that post-surgery monitoring using our approach is not conclusive in the 48 h that follow the surgery.

An AI-Powered Blood Test to Detect Cancer Using NanoDSF.

Glioblastoma is the most frequent and aggressive primary brain tumor. Its diagnosis is based on resection or biopsy that could be especially difficult and dangerous in the case of deep location or patient comorbidities. Monitoring disease evolution and progression also requires repeated biopsies that are often not feasible. Therefore, there is an urgent need to develop biomarkers to diagnose and follow glioblastoma evolution in a minimally invasive way. In the present study, we described a novel cancer detection method based on plasma denaturation profiles obtained by a non-conventional use of differential scanning fluorimetry. Using blood samples from 84 glioma patients and 63 healthy controls, we showed that their denaturation profiles can be automatically distinguished with the help of machine learning algorithms with 92% accuracy. Proposed high throughput workflow can be applied to any type of cancer and could become a powerful pan-cancer diagnostic and monitoring tool requiring only a simple blood test.

COVID-19 and ear endoscopy in otologic practices.

PURPOSE: Otolaryngologists have had to postpone the majority of surgical procedures in the current COVID-19 pandemic. Airborne transmission, beyond the projection of droplets from upper airways, expose healthcare workers to a risk of viral infection. Aerosol generating procedures (AGP) increase the risk of viral transmission to staff within the operating room. METHODS: Surgery of middle ear and mastoid is also considered an AGP, particularly mastoidectomy performed using a high-speed drill. The authors report their experience in endoscopic ear surgery as an alternative technique to reduce AGP in otologic procedures. RESULTS: Transcanal endoscopic ear surgery is a reliable technique used to manage many otologic conditions. CONCLUSION: The endoscopic approach may reduce the risk of viral transmission to operating room staff by reducing the need for mastoidectomy.

Covid-19 and Otologic/Neurotologic Practices: Suggestions to Improve the Safety of Surgery and Consultations.

: Since the beginning of 2020, the world has been confronted by the Covid-19 pandemic. The lock-down aims to limit the circulation of the virus and thus avoid overwhelming healthcare systems. Healthcare workers have had to adapt by postponing consultation and surgical activities. Otolaryngologists are particularly exposed to infection from the upper airway where the virus is highly concentrated. Literature has previously reported other human coronaviruses in the middle ear and mastoid, suggesting a risk of infection to staff during ear surgery where aerosolizing procedures are usually used. The aim of this article is to propose a strategy for planning consultations and surgeries for ear and lateral skull base diseases, in the context of the current active evolution of the pandemic and of the future gradual recovery to normal practice.

Transcanal endoscopic management of cholesteatoma.

A detailed and comprehensive discussion of transcanal endoscopic management of cholesteatoma is presented. After a presentation of the anatomy of the area, the rationale, advantages and limitations, technique, and long-term results of each technique are presented. A case presentation follows each technique. Techniques presented are: endoscopic transcanal management of limited cholesteatoma, endoscopic open cavity management of cholesteatoma, and expanded transcanal access to middle ear and petrous apex.

Endoscopic management of chronic otitis media and tympanoplasty.

The endoscope allows for better inspection for cholesteatoma in cases with chronic otitis media, better access to selective epitympanic poor ventilation and secondary selective chronic otitis media, better visualization of anterior poor ventilation of the mesotympanum (reestablishing adequate ventilation to the mesotympanum), better visualization and reconstruction of anterior tympanic membrane perforations, allows use of Sheehy's lateral graft tympanoplasty through a transcanal approach, and increases the odds of preoperative detection of ossicular chain disruption associated with perforations.

Cartilaginous myringoplasty: the endoscopic transcanal procedure.

The objectives of the study are to evaluate the feasibility, results and complications of the endoscopic transcanal cartilaginous myringoplasty. Thirty patients with a tympanic membrane perforation underwent a transcanal endoscopic cartilaginous myringoplasty, between June 2008 and January 2010. Three patients had a residual perforation at 2 months after surgery. At 1 year, the perforation was closed for 29 patients (96 %). There was no case of blunting, lateralization of the tympanic membrane or ossicular injury. Two patients had an iatrogenic superficial cholesteatoma in the tympanic membrane. There was no significant postoperative worsening of sensorineural hearing loss. The preoperative Air Bone Gap (ABG) was not correlated with the size or site of TMP. The evolution of ABG postoperatively was not significant. The statistical analysis was performed by the Student's t test. The endoscopic transcanal cartilaginous myringoplasty is a minimally invasive, effective and reliable procedure in the management of the tympanic membrane perforations.

[Endoscopy of the middle ear]. / Endoscopie de l'oreille moyenne.

The otoscopy is a major point in a daily practice. The otoscope is usually used. In an ENT practice, the microscope is the main instrument but presents limits. The use of rigid endoscopes allows to refine considerably this otoscopy. In ear surgery, the endoscopy of the middle ear for ear chronic diseases has evolved, from an additional tool to the microscope towards an exclusive surgical procedure with its own indications, advantages and limits.

Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected?

OBJECTIVE: This study was conducted with the aim of determining the contribution of otoendoscopy in the surgical management of cholesteatoma of the middle ear. BACKGROUND: The anterior epitympanum and the retrotympanum are anatomic sites that are difficult to access under otomicroscopy. Otoendoscopy offers a large field of vision using direct vision and lateral vision endoscopes, particularly in the supratubal recess and sinus tympani, for which visualization is excellent with reduced surgical approaches.The objectives of the study were to evaluate otoendoscopy as a means of identifying residues of lesions after excision of the disease under otomicroscopy in the same stage of surgery and its impact on the frequency of residual cholesteatomas at the time of surgical revision. STUDY DESIGN: Retrospective case review. SETTING: Private hospital center. PATIENTS: Patients operated on a tympanoplasty under otomicroscopy with or without an otoendoscopic exploration for a cholesteatoma or an uncontrollable tympanic retraction pocket. INTERVENTIONS: Between 1994 and 2005, 350 patients underwent tympanoplasty for a cholesteatoma or an uncontrollable tympanic retraction pocket.The surgical procedures were divided into closed tympanoplasty via the transmeatal approach, closed tympanoplasty with antroatticomastoidectomy and open tympanoplasty. Tympanoplasty was initially performed systematically under otomicroscopy.After excision of the disease, the cavities of the middle ear were examined by otovideoendoscopy, with the aim of identifying any peroperative residue of the lesion, to determine its location, especially in the epitympanum and retrotympanum, and the quality of its excision under otovideoendoscopy.During surgical revision, the frequency and location of any residual cholesteatoma were systematically recorded to determine the prognostic value of the quality of excision under otovideoendoscopy. MAIN OUTCOME MEASURES: The repartition of the canal wall down, canal wall up, and transmeatic tympanoplasties was compared between the population operated with or without the otoendoscopy as a complementary exploration of the otomicroscopy in the same surgical time. The frequency and the location of a residual disease identified by the otoendoscopy and the frequency of a residual disease in a second surgical stage were evaluated. RESULTS: Eighty patients (34%) who presented with an initial location of the disease at the epitympanum underwent complementary exploration by otovideoendoscopy. In this population, the frequency of open tympanoplasty was significantly lower.In 35 cases (44%), otoendoscopy revealed a residual lesion after an apparently total excision by otomicroscopy during closed tympanoplasty.The use of otoendoscopy did not produce a significant reduction in the number of residual cholesteatomas at the second stage of surgery compared to the population that underwent surgery under otomicroscopy alone. Nevertheless, the 35 residual lesions identified under otoendoscopy, as a complement to the microscope, during the first stage of surgery would have led systematically to a residual cholesteatoma at the second stage of surgery.Complementary exploration by otoendoscopy was performed on 85 patients (34%) who presented with a lesion of the retrotympanum. In this population, the frequency of open tympanoplasty was significantly reduced, while the techniques by the transmeatal approach were used in the majority of cases.In 65 cases (76%), a residual lesion was identified by otoendoscopy during the first stage of surgery in the sinus tympani or on the footplate of the stapes, between the crura of the stapes. Otoendoscopy did not produce a reduction in the frequency of residual cholesteatomas during surgical revision. Nevertheless, as for the epitympanum, the 65 residual lesions discovered under otoendoscopy would have led systematically to a residual cholesteatoma at the second stage of surgery if otoendoscopy had not been performed during the first stage. CONCLUSION: This study confirms the real value of otoendoscopy in the surgical management of cholesteatomas of the middle ear. It belongs entirely to the minimally invasive surgical procedures, while significantly reducing the frequency of open tympanoplasty and recourse to posterior tympanotomy and offering excellent access to numerous lesions by the transmeatal approach. Analysis using otoendoscopy reduces the incidence of residual cholesteatomas by identifying lesion extensions that are overlooked under otomicroscopy. Nevertheless, some residual cholesteatomas persist at the second stage of surgery. The quality of excision under otoendoscopy constitutes an important parameter in the decision regarding revision surgery. By targeting the at-risk regions where a residual lesion was discovered, it allows the control scanner to be read with greater accuracy, thus facilitating the decision on whether to perform surgical exploration.

Therapeutic management of laryngeal cancer. Results of a study of 356 patients from the Cancer Registry of the Somme, France.

CONCLUSIONS: The global survival rate was low compared to those reported in the literature, in which the analyzed populations were selected according to the tumor stage or treatment. This study should be prolonged and should also involve other cancer registries in France in order to increase the number of patients and to analyze tumors of comparable stage and therapeutic management. OBJECTIVE: To analyze the survival rate of a non-selected laryngeal cancer population from the Cancer Registry of the Somme, a French region. MATERIAL AND METHODS: A total of 356 patients were included in a retrospective study covering the period 1987-1997. Survival and prognostic factors were analyzed. Statistical analysis was performed using the Kaplan-Meier method, the Cox model and the chi2 test. RESULTS: The 5-year global survival rate was 42% for males and 55% for females. Tumor localization, T, N and M stages and surgery were found to be significant prognostic factors. Sex and age were not statistically significant factors. For stage I tumors, surgery alone gave better results than radiotherapy alone in terms of global survival. No difference occurred in terms of local recurrence. A similar comparison was not possible for stage II-IV tumors owing to the small number of cases.

Experimental study of the effects of surface mucus viscosity on the glottic cycle.

Numerous clinical findings indicate that viscosity of laryngeal mucosa is a crucial factor in glottal perfomance. Experience using experimental test benches has shown the importance of humidifying air stream used to induce vibration in excised larynges. Nevertheless, there is a lack of knowledge particularly regarding the physicochemical properties of laryngeal mucus. The purpose of this study was to research vocal fold vibration in excised larynges using artificial mucus of precisely known viscosity. Eight freshly harvested porcine larynges were examined. Parameters measured were Fo and vocal fold contact time. Measurements were performed under three conditions: basal (no fluid application on vocal cord surface), after application of a fluid of 60cP viscosity (Visc60), and after application of a fluid of 100cP viscosity (Visc100). Electroglottographic measurements were performed at two different times for each condition: 1 s after airflow onset (T1) and 6 seconds after airflow onset (T2). Statistical analysis consisted of comparing data obtained under each condition at T1 and T2. The results showed a significant decrease in Fo after application of Visc60 and Visc100 fluids and a decrease in Fo at T2. Closure time was significantly higher under Visc60 conditions and under Visc100 conditions than under basal conditions. Application of artificial mucus to the mucosa of the vocal folds lowered vibratory frequency and prolonged the contact phase. Our interpretation of this data is that the presence of mucus on the surface of the vocal folds generated superficial tension and caused adhesion, which is a source of nonlinearity in vocal vibration.

Adenoma of the middle ear: a rare and misleading lesion.

PURPOSE: To discuss features of the adenoma of the middle ear according to the literature. BACKGROUND: Adenoma of the middle ear is a rare tumor, which is developed from the tympanic cavity. Its histopathologic appearance is benign and is characterized by a glandular and neuroendocrine component. METHODS: The authors report their experience with two cases, treated surgically by tympanoplasty. RESULTS AND CONCLUSION: The treatment is exclusively surgical and must be complete to prevent recurrence.