VOice analysis with Iphones: a low Cost Experimental Solution

Background: Acoustic voice analysis requires a resource intensive setup, including a soundproof booth. This project evaluates smartphone microphone and recording environment impacts on voice sample collection for acoustic voice analysis. A proprietary analysis algorithm is presented for validation. Methods: Microphone and recording environment were evaluated using previously collected voice samples presented in four conditions to test two microphones and two recording environments. Prospective samples were used to test the proprietary algorithm, whereby samples were analyzed using this and Praat. Results: Microphone and recording environment had small, clinically unimportant impacts on most measurements. The proprietary algorithm reliably analyzed sustained vowels, with strong correlation to the Praat results. Continuous speech analysis was less reliable. Conclusion: Smartphone microphones are adequate for voice sample collection. Quiet, non-soundproof settings can be used for voice collection. The proprietary algorithm represents a reliable method to analyze sustained vowel samples. Some improvements are necessary before continuous speech analysis can be considered valid

Cervicofacial Actinomycosis in the Pediatric Population: Presentation and Management

Background: Infection caused by Actinomyces species is a rare cause of head and neck infection in children. This chronic cervicofacial infection can present with localized swelling, abscess formation, sinus drainage and can be complicated by osteomyelitis. Methods: Presented are 2 pediatric cases of secondary actinomycosis in the context of congenital lesions: 1 patient with a previously excised preauricular sinus and another with a persistent sublingual mass. A comprehensive literature search was conducted for reported cases of pediatric actinomycosis in the cervicofacial region. Results: Both cases presented were successfully treated with a combination of complete surgical excision of the lesions and prolonged antibiotic therapy. Thirty-four pediatric cases of cervicofacial actinomycosis are reviewed, 2 presented herein, and 32 from the published literature. There was equal gender distribution and the median age was 7.5 years. The most common site for infection was the submandibular area. Four (12%) of cases arose in pre-existing congenital lesions. Most patients were treated with penicillin-based antibiotics for a median duration of 6 months following surgical excision or debridement. Conclusions: Actinomycosis is a rare infection of the cervicofacial region; secondary infections arising from congenital lesions of the head and neck are even more rare. A previously excised pre-auricular sinus and a sublingual dermoid cyst are not previously reported sites of infection. Actinomycosis should be suspected in chronically draining sinuses of the head and neck region and confirmed through anaerobic culture. Osteomyelitis is a potential complication and magnetic resonance (MR) imaging is warranted. Long-term antibiotic therapy with a penicillin-based antibiotic and surgical excision should be considered

Functional outcomes in early (T1/T2) supraglottic cancer: a systematic review

ObjectivesOrgan preserving surgery (OPS) and radiotherapy (RT) are both accepted treatment options for early stage supraglottic cancer (SGC). Radiation has supplanted surgery in most cases, because of the perception that surgery results in poorer functional outcomes. However, evidence suggests that OPS with a neck dissection may be associated with improved survival. Our objective was to conduct a systematic review of the literature to compare functional outcomes of OPS and RT for early SGC.MethodsWe searched Medline, EMBASE and Cochrane Central Register of Controlled Trials to identify studies. Studies were included if they reported functional outcomes on 10 or more patients with early stage SGC treated with radiation or OPS, including open partial laryngectomy, transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Two reviewers independently screened articles for relevance using pre-determined criteria.ResultsFrom 7720 references, we included 10 articles (n=640 patients). 50% (n=320) of patients were treated with surgery. Three head-to-head RT versus OPS papers were included, however different outcome measures were used for each group. Intractable aspiration management (including total laryngectomy or permanent tracheostomy) following OPS was reported in five papers representing 186 patients; the definitive intractable aspiration management rate was 2.6% (95% CI 1.0-6.8%). Four papers reported permanent G-tube rate for the surgical group (n=198), calculating a rate of 5.3% (95% CI 2.6-10.5%), this was not reported for the RT group in any papers. One study reported quality of life. Two studies reported objective voice measures.ConclusionsThis systematic review revealed a paucity of objective measures and significant data heterogeneity, rendering the comparison of functional outcomes following OPS versus RT for early SGC limited. Future research should include objective measures of functional outcomes including laryngectomy rate, g-tube rate, tracheostomy dependence, quality of life, and voice quality measures

Genotype-phenotype relationships of truncating mutations, p.E297G and p.D482G in bile salt export pump deficiency

Background &amp; Aims: Bile salt export pump (BSEP) deficiency frequently necessitates liver transplantation in childhood. In contrast to two predicted protein truncating mutations (PPTMs), homozygous p.D482G or p.E297G mutations are associated with relatively mild phenotypes, responsive to surgical interruption of the enterohepatic circulation (siEHC). The phenotype of patients with a compound heterozygous genotype of one p.D482G or p.E297G mutation and one PPTM has remained unclear. We aimed to assess their genotype-phenotype relationship. Methods: From the NAPPED database, we selected patients with homozygous p.D482G or p.E297G mutations (BSEP1/1; n = 31), with one p.D482G or p.E297G, and one PPTM (BSEP1/3; n = 30), and with two PPTMs (BSEP3/3; n = 77). We compared clinical presentation, native liver survival (NLS), and the effect of siEHC on NLS. Results: The groups had a similar median age at presentation (0.7-1.3 years). Overall NLS at age 10 years was 21% in BSEP1/3 vs. 75% in BSEP1/1 and 23% in BSEP3/3 (p &lt;0.001). Without siEHC, NLS in the BSEP1/3 group was similar to that in BSEP3/3, but considerably lower than in BSEP1/1 (at age 10 years: 38%, 30%, and 71%, respectively; p = 0.003). After siEHC, BSEP1/3 and BSEP3/3 were associated with similarly low NLS, while NLS was much higher in BSEP1/1 (10 years after siEHC, 27%, 14%, and 92%, respectively; p &lt;0.001). Conclusions: Individuals with BSEP deficiency with one p.E297G or p.D482G mutation and one PPTM have a similarly severe disease course and low responsiveness to siEHC as those with two PPTMs. This identifies a considerable subgroup of patients who are unlikely to benefit from interruption of the enterohepatic circulation by either surgical or ileal bile acid transporter inhibitor treatment. Impact and implications: This manuscript defines the clinical features and prognosis of individuals with BSEP deficiency involving the combination of one relatively mild and one very severe BSEP deficiency mutation. Until now, it had always been assumed that the mild mutation would be enough to ensure a relatively good prognosis. However, our manuscript shows that the prognosis of these patients is just as poor as that of patients with two severe mutations. They do not respond to biliary diversion surgery and will likely not respond to the new IBAT (ileal bile acid transporter) inhibitors, which have recently been approved for use in BSEP deficiency.</p

Genotype-phenotype relationships of truncating mutations, p.E297G and p.D482G in bile salt export pump deficiency

Background & Aims: Bile salt export pump (BSEP) deficiency frequently necessitates liver transplantation in childhood. Homozygous p.D482G or p.E297G mutations are associated with relatively mild phenotypes, responsive to surgical interruption of the enterohepatic circulation (siEHC), in contrast to patients with two predicted protein truncating mutations (PPTM). The phenotype of patients with a compound heterozygous genotype of one p.D482G or p.E297G mutation and one PPTM has remained unclear. We aimed to assess their genotype-phenotype relationship. Methods: From the NAPPED database, we selected patients with homozygous p.D482G or p.E297G mutations (BSEP1/1; n=31), with one p.D482G or p.E297G, and one PPTM (BSEP1/3; n=30), and with two PPTMs (BSEP3/3; n=77). We compared presentation, native liver survival (NLS), and effect of siEHC on NLS. Results: The groups had a similar median age at presentation (0.7-1.3 years). Overall NLS at age 10 years was 21% in BSEP1/3 vs. 75% in BSEP1/1 and 23% in BSEP3/3 (P<0.001). Without siEHC in their follow-up, NLS of BSEP1/3 was similar to BSEP3/3 patients, but considerably lower than BSEP1/1 patients (at age 10 years: 38%, 30%, and 71%, resp; P=0.003). After siEHC, BSEP1/3 and BSEP3/3 patients had similarly low NLS, while this was much higher in BSEP1/1 patients (10 years after siEHC, 27%, 14%, and 92%, resp.; P<0.001). Conclusions: BSEP deficiency patients with one p.E297G or p.D482G mutation and one PPTM have a similarly severe disease course and low responsiveness to siEHC as patients with two PPTMs. This identifies a considerable subgroup of patients who are unlikely to benefit from interruption of the enterohepatic circulation by either surgical or ileal bile acid transporter inhibitor treatment

Parapharyngeal abscess following use of a laryngeal mask airway during open revision septorhinoplasty

AbstractIntroductionA laryngeal mask airway (LMA) is an established safe tool to support the airway during surgery under general anesthetic. It is commonly used both in North America and abroad. Complications with this device are rare.Presentation of caseA 50-year old female developed a parapharyngeal neck abscess following an uneventful septorhinoplasty during use of an LMA Classic. The patient had symptoms of pain and difficulty swallowing. CT revealed extensive soft tissue edema and swelling in the right and posterior neck involving the right parapharyngeal space, right parotid space, minimal involvement of the right submandibular space, and extending across the retropharyngeal space. The abscess was incised and drained with an open approach, combined with laryngoscopy to evaluate the site of the infection at the right pyriform fossa. The patient fully recovered following discharge.DiscussionDespite the rare incidence of LMA injuries, early recognition of parapharyngeal neck abscesses can initiate early treatment and prevention of spread to retropharyngeal space where airway obstruction and emergent complications may occur.ConclusionLaryngeal mask airways have a high rate of success and low rate of complications. In this reported case, pressure necrosis from over-inflation of the LMA is thought to have perforated the right pyriform fossa. The perforation created a communication into the parapharyngeal space causing infection. We report this case to highlight the importance of identifying possible complications associated with a routine method of airway management during shared airway surgeries

Robot-Automated Cartilage Contouring for Complex Ear Reconstruction: A Cadaveric Study

© 2020 American Laryngological, Rhinological and Otological Society Inc, The Triological Society and American Laryngological Association (ALA) Objectives/Hypothesis: Auricular reconstruction requiring manual contouring of costal cartilage is complex and time consuming, which could be facilitated by a robot in a fast and precise manner. This feasibility study evaluates the accuracy and speed of robotic contouring of cadaver costal cartilage. Methods: An augmented robot with a spherical burr was used on cadaveric rib cartilage. Using a laser scanner, each rib section was converted to a three-dimensional model for preoperative planning. A model ear was also scanned to define a carving path for each piece of cartilage. After being contoured, each specimen was compared against the preoperative plan utilizing deviation maps to analyze topographic accuracy. Contouring times of the robot were compared with 13 retrospectively reviewed cases (2006–2017) by an experienced surgeon. Results: Scanning the cartilage sections took 24.8 ± 6.8 seconds. Preoperative processing took an additional 29.9 ± 8.9 seconds for the preparation of the contouring path. Once the path was prepared, the robot contoured the specimens with a root mean square error of 0.54 mm and a mean absolute deviation of 0.40 mm. The average time to contour the specimens with the robot was 13 ± 2 minutes compared to 71 ± 6 minutes for the manual contouring in the reviewed cases. Conclusions: The accuracy of the robotic system was high, with submillimeter deviations from the preoperative plan. The robot required \u3c20% of the contouring time compared to the experienced surgeon. This represents a fast and accurate alternative to hand-contouring costal cartilage grafts for auricular reconstruction. Laryngoscope, 2020

Volcanisme et tectonique le long de l'archipel des Comores (Canal Nord Mozambique) : état d'avancement du projet ANR COYOTES

International audienceSuite à l’initiation en mai 2018 de la crise sismo-volcanique de Mayotte qui a donné lieu, entre autre, à une intense sismicité et à la mise en place d’un nouvel édifice volcanique sous-marin, Fani-Maoré, à 50km à l’Est de Mayotte, la communauté scientifique s’est fortement impliquée. Un effort conséquent a été réalisé pour améliorer les connaissances géologiques de ce territoire grâce à des projets de recherches, en parallèle de la surveillance de l’activité tellurique menée par le REVOSIMA (campagnes MAYOBS, DOI :10.18142/291).Le projet COYOTES (Comoros & maYotte: vOlcanism, TEctonics and Seismicity, 2020-2024), s’appuyant sur des données des campagnes océanographiques de recherche SISMAORE (10.17600/18001331) et SCRATCH (DOI :10.17600/18002274), vise à mieux comprendre le contexte géologique et géodynamique du Canal nord Mozambique. Cela intègre à la fois l'évolution et la répartition de l’activité volcanique, tectonique et sismologique ainsi que la cinématique et la caractérisation des dépôts sédimentaires et des structures crustales, à court et à long terme et aux échelles locale et régionale. Nous proposons de présenter l’état d’avancement des travaux menés dans le cadre de cet ANR-COYOTES, spécifiquement sur la distribution spatiale des déformations actives et récentes le long de l'archipel des Comores (Thinon et al., 2022 ; Boymond et al., 2022 ; Mercury et al., 2022), sur les nouveaux âges et la géochimie des édifices volcaniques et des iles (Rusquet et al., 2023), sur la caractérisation des dépôts volcano-détritiques et des déstabilisations identifiées dans la plaine abyssale (Paquet et al., 2019). L’architecture du substratum sous le volcan Fani-Maoré et la structuration crustale seront également exposées (Canva et al., RST 2023; Masquelet et al., 2022; Rolandone et al., 2022 ; Watremez et al., RST 2023). Ce résumé est une contribution des équipes du projet COYOTES (ANR-19-CE31-0018), financé par l’ANR et le BRGM (http://www.geocean.net/coyotes/doku.php?id=start)

Volcanisme et tectonique le long de l'archipel des Comores (Canal Nord Mozambique) : état d'avancement du projet ANR COYOTES

International audienceSuite à l’initiation en mai 2018 de la crise sismo-volcanique de Mayotte qui a donné lieu, entre autre, à une intense sismicité et à la mise en place d’un nouvel édifice volcanique sous-marin, Fani-Maoré, à 50km à l’Est de Mayotte, la communauté scientifique s’est fortement impliquée. Un effort conséquent a été réalisé pour améliorer les connaissances géologiques de ce territoire grâce à des projets de recherches, en parallèle de la surveillance de l’activité tellurique menée par le REVOSIMA (campagnes MAYOBS, DOI :10.18142/291).Le projet COYOTES (Comoros & maYotte: vOlcanism, TEctonics and Seismicity, 2020-2024), s’appuyant sur des données des campagnes océanographiques de recherche SISMAORE (10.17600/18001331) et SCRATCH (DOI :10.17600/18002274), vise à mieux comprendre le contexte géologique et géodynamique du Canal nord Mozambique. Cela intègre à la fois l'évolution et la répartition de l’activité volcanique, tectonique et sismologique ainsi que la cinématique et la caractérisation des dépôts sédimentaires et des structures crustales, à court et à long terme et aux échelles locale et régionale. Nous proposons de présenter l’état d’avancement des travaux menés dans le cadre de cet ANR-COYOTES, spécifiquement sur la distribution spatiale des déformations actives et récentes le long de l'archipel des Comores (Thinon et al., 2022 ; Boymond et al., 2022 ; Mercury et al., 2022), sur les nouveaux âges et la géochimie des édifices volcaniques et des iles (Rusquet et al., 2023), sur la caractérisation des dépôts volcano-détritiques et des déstabilisations identifiées dans la plaine abyssale (Paquet et al., 2019). L’architecture du substratum sous le volcan Fani-Maoré et la structuration crustale seront également exposées (Canva et al., RST 2023; Masquelet et al., 2022; Rolandone et al., 2022 ; Watremez et al., RST 2023). Ce résumé est une contribution des équipes du projet COYOTES (ANR-19-CE31-0018), financé par l’ANR et le BRGM (http://www.geocean.net/coyotes/doku.php?id=start)