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Nasal irrigation is a grade A recommendation treatment, which is essential in many pathological conditions. Very heterogeneous practices are observed in paediatrics as a result of poor instruction in this technique. We propose to describe the nasal irrigation technique developed by a team of respiratory physiotherapists in Lille for the management of cystic fibrosis and bronchiolitis. This technique is intended for children over the age of 6 months, as it requires an oral breathing reflex and cough reflex that are not systematically acquired before this age. Nasal irrigation is performed on a 30° upward inclined plane on a calm and cooperative child, away from meals. The child is maintained gently, without pressure, in the fencing position with the head turned away from the practitioner. Using a continuous flow spray, the practitioner grasps the top of the upper nostril and irrigates the nostril for an average of 3 s (6 mL per nostril). These steps are then repeated until satisfactory patency is achieved in both nostrils. This technique constitutes a practical tool to help healthcare professionals and parents perform nasal irrigation in young children over the age of 6 months.

International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

The influenza virus and SARS-CoV-2 cause trivial upper and severe lower respiratory infections (Influenza virus 290,000 to 650,000 deaths/year). These viruses come into contact with the airways either by direct projection, by secondary inhalation of airborne droplets, or by handling (fomites). The objective of this article is to clarify the mechanisms of production and penetration of droplets of secretions emitted during all expiratory phenomena likely to transport these viruses and come into contact with the respiratory mucosa. The droplets > 5 μm follow the laws of ballistics, those

Sinonasal carcinomas account for 3% of ENT cancers. They are subdivided into squamous cell carcinomas (50%), adenocarcinomas [20%, mostly of intestinal type (ITAC)], and more rarely, adenoid cystic carcinomas, olfactory neuroblastomas (=esthesioneuroblastomas), neuroendocrine carcinomas or undifferentiated sinonasal carcinomas (SNUC). The 5-year survival rates are, in descending order, 72% for neuroblastomas, 63% for adenocarcinomas, 50-60% for large-cell neuroendocrine carcinomas, 53% for squamous cell carcinomas, 25-50% for adenoid cystic, 35% for small-cell neuroendocrine carcinomas and 35% for SNUC and newly discovered histologies. Surgery is the main treatment; endoscopic approaches reduce the morbidity with equivalent tumour control. Intensity-modulated radiation therapy (IMRT) is almost systematic. Nodal involvement is rare in ethmoidal adenocarcinomas and adenoid cystic carcinomas; it is intermediate and may justify prophylactic radiotherapy for N0 necks in SNUC, neuroblastoma, squamous cell carcinomas and sinonasal neuroendocrine carcinomas. IMRT or proton therapy is the mainstay of treatment of unresectable disease. Radiotherapy optimization by carbon ion therapy for adenoid cystic carcinomas, or by chemotherapy for all carcinomas with IMRT or proton therapy, is investigated within clinical trials in France. Neoadjuvant chemotherapy is reserved for rapidly progressive disease or histologies with a high metastatic potential such as neuroendocrine carcinomas or SNUC. Given their histologic and molecular specificities and different relapse patterns, an expertise of the REFCOR network, with REFCORpath review, is likely to correct diagnoses, rectify treatments, with an impact on survival.

BACKGROUND: Knowledge of age-related DNA methylation changes in skeletal muscle is limited, yet this tissue is severely affected by ageing in humans. METHODS: We conducted a large-scale epigenome-wide association study meta-analysis of age in human skeletal muscle from 10 studies (total n = 908 muscle methylomes from men and women aged 18-89 years old). We explored the genomic context of age-related DNA methylation changes in chromatin states, CpG islands, and transcription factor binding sites and performed gene set enrichment analysis. We then integrated the DNA methylation data with known transcriptomic and proteomic age-related changes in skeletal muscle. Finally, we updated our recently developed muscle epigenetic clock (https://bioconductor.org/packages/release/bioc/html/MEAT.html). RESULTS: We identified 6710 differentially methylated regions at a stringent false discovery rate

Importance: A validated biomaterial would have several medical advantages in septorhinoplasties requiring a large-volume graft such as avoiding donor site morbidity, making ambulatory surgery possible, and reducing surgical costs. Objective: To assess the safety and efficacy of a ceramic to treat saddle and crooked noses. The main endpoint was the biocompatibility of the implant. The secondary endpoint was its functional and aesthetic efficacy. Design, Setting, and Participants: The nasal septum (NASEPT) study is a pilot multicenter noncomparative prospective phase IIa clinical trial. The biomaterial tested was a biphasic calcium phosphate implant composed of 75% hydroxyapatite and 25% beta tri calcium phosphate. This versatile material can be used to replace septal skeleton when it is absent or nonusable. We included 25 patients with a multifractured osseous and cartilaginous framework after several traumas or surgeries. The implant placement technique was identical to an extracorporeal septoplasty through the external approach. Main Outcomes and Measures: The primary endpoint was the occurrence of expected adverse and severe adverse events. The secondary endpoints were clinical functional and aesthetic results and histological microscopic modifications. Results: Any extrusion, infection, pain, and epistaxis were observed. All implants were placed in a sagittal, straight, and solid position without extralobular depression. Comparisons between pre- and postoperative symptoms showed that nasal comfort (p

Objectives To draw up guidelines for ENT management associated with dental implant surgery with or without sinus lift. Materials and methods The methodology followed the rules of laid down by the French Health Authority (HAS): “Methodological bases for drawing up professional recommendations by formalized consensus”. The chosen method was the RAND/UCLA “RAND appropriateness method” (short version). Results In the pre-implantation check-up, it is recommended to systematically screen for sinonasal pathology on medical interview and to favor 3D CT or cone-beam imaging. It is recommended that imaging include the entire maxillary sinus when the patient does not have sinonasal history or functional signs on interview. Otherwise, examination of all sinonasal cavities is recommended. This attitude enables simultaneous analysis of maxillary infrastructure for pre-implantation work-up and assessment of sinonasal cavity status. Sinus mucosal incidentalomas are very common in the healthy population and must be assessed with reference to the clinical, endoscopic and radiological context. Conclusion This formalized expert consensus establishes a common base of knowledge, to clarify the issues and clinical situations and to standardize practices.

Simple Summary Sinonasal cancers are rare and heterogeneous tumors, mainly carcinomas, with essentially local evolution and a severe vital and functional prognosis. These tumors are more and more being treated in first intent by a mini-morbid endoscopic approach rather than open surgery as the cornerstone of curative treatment. Adjuvant radiotherapy remains necessary owing to non-optimal local control. This article describes the requirements of radiotherapy to ensure adequate delays, the potential of postoperative radiotherapy to increase local and distant disease control and to decrease morbidity further after mini morbid surgery and dose painting techniques, and reviews the criteria that lead to the choice of one technique over another. Abstract Radiotherapy plays an important role in the treatment of sinonasal cancer, mainly in the adjuvant setting after surgical resection. Many technological approaches have been described, including intensity-modulated radiotherapy, concomitant chemoradiotherapy, charged particle therapy or combined approaches. The choice is based on general criteria related to the oncological results and morbidity of each technique and their availability, as well as specific criteria related to the tumor (tumor extensions, pathology and quality of margins). The aims of this review are: (i) to provide an overview of the radiotherapy techniques available for the management of sinonasal malignant tumors and (ii) to describe the constraints and opportunities of radiotherapy owing to the recent developments of endonasal endoscopic surgery. The indication and morbidity of the different techniques will be discussed based on a critical literature review.

International audience

The purpose of this article is to give rhinologists advice on how to adapt their standard practice during the COVID-19 pandemic. The main goal of these recommendations is to protect healthcare workers against COVID-19 while continuing to provide emergency care so as to prevent loss of chance for patients. We reviewed our recommendations concerning consultations, medical prescriptions and surgical activity in rhinology.

To assess and compare the safety and quality of the management of sinonasal surgery (all procedures) between day-case and traditional admission.A 2-year retrospective study included all patients undergoing functional septonasal surgery, ethmoidectomy, middle antrostomy, frontal sinusotomy or endoscopic sphenoidotomy, as day-surgery on inpatient admission. Demographic, operative, pre- and post-operative anesthetic data, complications, and rates of emergency consultation and readmission within 30 days were collected and compared between out- and in-patients.Nine hundred and nine patients were included: 569 functional septonasal surgeries, 180 ethmoidectomies, 101 middle meatotomies, 40 Draf procedures and 19 sphenoidotomies; respectively 60%, 21%, 54%, 20% and 37% were performed in the day-surgery unit. There were no significant differences in number of emergency consultations or readmissions between the out- and in-patient groups. There were more complications in in-patients (P0.0001) (4.9% anticoagulant and 12% antiplatelet treatments, 18% obstructive sleep apnea-hypopnea syndromes). The conversion rate to conventional admission was 4.6%. Antiplatelet treatment or postoperative nasal packing were not significant risk factors for complications or readmission.Outpatient sinonasal surgery does not seem to incur extra risk for the patient or surgeon when eligibility criteria are met.

For C band application, the optical amplification efficiency of cladding pumped multicore EDFA is still problematic as a major part of the pump light is not absorbed in the short doped fiber. In this paper, we study the pump recycling technology. The operation principle is introduced and verified experimentally. Also, fundamental optical amplification performance is characterized. Moreover, feasibility of the application to multicore optical transmission systems is researched.

OBJECTIVES To assess the feasibility of bilateral radical ethmoidectomy in ambulatory surgery by risk analysis, and to calculate possible medico-economic savings. METHODS This study was performed retrospectively over a 2-year period and prospectively for 1 year. It included all patients undergoing bilateral ethmoidectomy, associated to sphenoidotomy and/or septoplasty or not, in a university hospital department. Data were collected on demographics, disease etiology, previous surgery, operative details, postoperative course, complications and satisfaction assessed by questionnaire at days 1 and 30. Ambulatory surgery eligibility criteria were applied to this population, and an economic analysis compared savings between inpatient and outpatient management. RESULTS Hundred and sixty-five patients were included. Surgical indications comprised nasal polyposis (87%), chronic sinusitis without nasal polyps (6%) or cystic fibrosis (7%). Seventy-five septoplasties were associated (45.5%). Operating time depended on associated septoplasty (P=0.005), surgeon experience (P

Renal cell carcinoma (RCC) metastatic in the sinonasal cavity is rare. In many cases, it represents the initial presentation of RCC. We conducted a retrospective chart review to report the clinical presentation, imaging, and treatment of RCC metastases in the sinonasal cavity at two tertiary care referral centers. Our population was made up of 8 patients—6 men and 2 women, aged 55 to 86 years (mean: 66.9; median: 63.5)—who had been diagnosed with cancer in the sinonasal cavity. The most common complaints were epistaxis, nasal obstruction, and diplopia. Cancers were located in the ethmoid sinus (n = 3), nasal cavity (n = 2), sphenoid sinus (n = 2), and maxillary sinus (n = 1). Local treatment involved resection and adjuvant radiotherapy in 4 patients, surgery alone in 2 patients, and radiotherapy alone in the other 2. The lesion was embolized before surgery in 4 cases. We also performed a critical review of similar published cases. Our literature review covered 53 cases of RCC metastatic to the sinonasal cavity, including ours. Metastases were the first presentation of RCC in 24 of these cases (45.3%); in our series, the metastases led to the diagnosis of the primary RCC in 3 cases (37.5%). In the 53 reported cases, metastatic resection was performed on 35 patients (66.0%). Survival data were available for 22 of these operated patients, and 17 of them achieved a complete local response. Adjunctive radiotherapy was not associated with a better local response. Overall survival was significantly better in patients who had an isolated metastasis rather than multiple metastases (p = 0.013). There was no difference in overall survival between patients whose metastasis represented the initial presentation of RCC and those whose metastasis did not (p = 0.95). We recommend that sinonasal metastasis be suspected in the event of unilateral nasal bleeding or nasal obstruction in patients diagnosed with RCC. Embolization may prevent abundant bleeding during removal. Surgery may improve the quality of life of these patients while decreasing nasal obstruction and bleeding.

Background Sinonasal undifferentiated carcinoma (SNUC) is a very rare entity with a poor prognosis. Due to the lack of studies on the subject, evidence is lacking concerning its management. Methods A multicenter collaborative study was conducted to assess treatment strategy, oncological outcome, and prognostic factors. Results Definitive analyses focused on 54 patients with a majority of advanced stage; the 3-year overall survival (OS) and 3-year recurrence-free survival (RFS) rates were, respectively, 62.4% and 47.8%. During the follow-up, 18 patients (33.3%) died, 10 (18.5%) developed metastases, 7 had lymph-node involvement (13%), and 12 (22.2%) showed recurrence or local progression. In univariate analyses, treatment modalities associated with improved RFS were induction chemotherapy (p = 0.02) and intensity-modulated radiotherapy (p = 0.007). In the multivariate analyses, only induction chemotherapy (p = 0.047, hazard ratio [HR] = 0.39) was significantly associated with improved RFS. Conclusion Multimodal therapies including induction chemotherapy and intensity-modulated radiotherapy may improve the prognosis of SNUC; surgery might improve local control. Further multicenter studies are required.

BACKGROUND The purpose of this study was to assess the relevancy of flexible nasoendoscopy as a routine screening procedure of sinonasal adenocarcinoma among people occupationally exposed to wood dust. METHODS This study included woodworkers, occupationally exposed to wood dust. Evaluations were scheduled at the time of inclusion (T0) and after a 2-year period (T1). A questionnaire was used for standardized data collection. The score was based on anatomic landmarks on each side that are parts of the olfactory clefts: the area of middle turbinate, the anterior part of the olfactory cleft, the top of the choanal arch, the spheno-ethmoidal recess, the posterior part of the olfactory cleft, and the middle part of the olfactory cleft. RESULTS A total of 965 nasoendoscopies (T0+T1) were performed. Olfactory clefts were visualized in 72% of the cases. Nasoendoscopies revealed pathological findings in 33.6% of cases: polyps, thick nasal secretion aspect, mucous edema, retractile scars and synechia, crusts, mucous erythema, and growth. One case of carcinoma was confirmed. Adverse effects (epistaxis, blood mark on the endo-sheath, sneezing, or rhinorrhea) after the medical procedure occurred in 30% of cases without severe complications. CONCLUSION Flexible nasoendoscopy offers meaningful efficacy and a promising safety profile, and, therefore, could become the new cornerstone of the routine screening procedure of sinonasal adenocarcinoma among woodworkers.

According to the &ldquo, developmental origins of health and disease&rdquo, (DOHaD) concept, maternal obesity predisposes the offspring to non-communicable diseases in adulthood. While a preconceptional weight loss (WL) is recommended for obese women, its benefits on the offspring have been poorly addressed. We evaluated whether preconceptional WL was able to reverse the adverse effects of maternal obesity in a mouse model, exhibiting a modification of foetal growth and of the expression of genes encoding epigenetic modifiers in liver and placenta. We tracked metabolic and olfactory behavioural trajectories of offspring born to control, obese or WL mothers. After weaning, the offspring were either put on a control diet (CD) or a high-fat (HFD). After only few weeks of HFD, the offspring developed obesity, metabolic alterations and olfactory impairments, independently of maternal context. However, male offspring born to obese mother gained even more weight under HFD than their counterparts born to lean mothers. Preconceptional WL normalized the offspring metabolic phenotypes but had unexpected effects on olfactory performance: a reduction in olfactory sensitivity, along with a lack of fasting-induced, olfactory-based motivation. Our results confirm the benefits of maternal preconceptional WL for male offspring metabolic health but highlight some possible adverse outcomes on olfactory-based behaviours.

International audience; BACKGROUND:Given the particularities of olfactory neuroblastoma (ONB) and the lack of studies on the subject, a multicenter collaborative study was conducted to assess treatment strategy.METHODS:Fifty-three patients with ONB were included from the French Rare Head and Neck Cancer Expert Network (REFCOR) database: 16T1, 8T2, 19T3, and 10T4. All cases were treated endoscopically with skull base removal and repair in 26 cases (49%) and without external craniotomy.RESULTS:The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 87% and 71%, respectively, with mean follow-up of 45.4 ± 26.5 months. The complication rate was 18.8% with 4 cases of meningitis. Pathological analysis showed positive margins in 26.8%, notably on the dura-mater and periorbita, without impairment of OS or DFS. Forty-eight patients received adjuvant radiotherapy on T ± N. Ten patients had a recurrence (18.9%). Six patients died of their disease. Prophylactic neck irradiation seemed to reduce the recurrence rate.CONCLUSION:Exclusively endoscopic treatment proved efficient and reliable in a large controlled series.

Background Computational fluid dynamic (CFD) simulations have greatly improved the understanding of nasal physiology. We postulate that simulating the entire and repeated respiratory nasal cycles, within the whole sinonasal cavities, is mandatory to gather more accurate observations and better understand airflow patterns. Methods A 3-dimensional (3D) sinonasal model was constructed from a healthy adult computed tomography (CT) scan which discretized in 6.6 million cells (mean volume, 0.008 mm3 ). CFD simulations were performed with ANSYS©FluentTMv16.0.0 software with transient and turbulent airflow (k-ω model). Two respiratory cycles (8 seconds) were simulated to assess pressure, velocity, wall shear stress, and particle residence time. Results The pressure gradients within the sinus cavities varied according to their place of connection to the main passage. Alternations in pressure gradients induced a slight pumping phenomenon close to the ostia but no movement of air was observed within the sinus cavities. Strong movements were observed within the inferior meatus during expiration contrary to the inspiration, as in the olfactory cleft at the same time. Particle residence time was longer during expiration than inspiration due to nasal valve resistance, as if the expiratory phase was preparing the next inspiratory phase. Throughout expiration, some particles remained in contact with the lower turbinates. The posterior part of the olfactory cleft was gradually filled with particles that did not leave the nose at the next respiratory cycle. This pattern increased as the respiratory cycle was repeated. Conclusion CFD is more efficient and reliable when the entire respiratory cycle is simulated and repeated to avoid losing information.

I melanomi maligni cervicofacciali devono essere divisi in due gruppi distinti: i melanomi di origine cutanea e i melanomi mucosi. In effetti, queste due entita presentano importanti differenze in termini di storia naturale, epidemiologia, gestione terapeutica e prognosi. Il melanoma cutaneo e la forma predominante. La sua incidenza e in costante aumento da diversi decenni, con dieci nuovi casi in Francia per 100 000 abitanti e per anno (all’origine di 1 600 decessi). Il principale fattore di rischio e l’esposizione al sole, mentre le forme familiari rappresentano solo il 10% dei pazienti. Nel 30% dei casi, la localizzazione e cervicofacciale. Le particolarita anatomiche di questa regione influenzano significativamente le modalita terapeutiche e la prognosi di questi pazienti, che e piu riservata. Benche il trattamento resti prima di tutto chirurgico, sono stati compiuti recentemente progressi importanti nel trattamento degli stadi avanzati con lo sviluppo delle terapie mirate (in particolare, anti-BRAF) e dell’immunoterapia (anti-PD1). Un posto importante deve essere attribuito alla prevenzione primaria e all’educazione dei pazienti, soprattutto in termini di protezione solare. Il melanoma mucoso, dal canto suo, e un tumore raro che rappresenta meno del 5% di tutti i melanomi. La sua localizzazione preferenziale e cervicofacciale, in particolare a livello nasosinusale. La prognosi del melanoma mucoso e riservata. In effetti, questa patologia e difficile da controllare localmente a causa del suo carattere spesso multifocale e dei vincoli anatomici della regione cervicofacciale, che rendono difficile la realizzazione di un’exeresi oncologica soddisfacente. Inoltre, c’e un significativo rischio metastatico all’origine di una significativa mortalita precoce. Il trattamento di riferimento e la chirurgia tipicamente seguita da una radioterapia adiuvante. Nuove tecniche di irradiazione (adroterapia, ecc.) e terapie innovative (terapie mirate, ecc.) sono in corso di valutazione.

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com. ispartof: RHINOLOGY vol:58 issue:Suppl S29 pages:I-+ ispartof: location:Netherlands status: published

International audience; Background Aphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population. Objective We aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke. Methods Patients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors. Results We included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P = 0.008) and at follow-up (P = 0.01); increased communication activity limitations at follow-up (P < 0.001); increased limitations on activities of daily life at baseline (P = 0.008) and follow-up (P < 0.001); increased fatigue at follow-up (P = 0.001); and increased depression symptoms at follow-up (P = 0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R2 = 0.756, P < 0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations. Conclusion Aphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies.

Background Patterns of nodal involvement in adenoid cystic carcinoma (ACC) of the head and neck have not been sufficiently assessed to guide a decision of prophylactic neck dissection (ND). The objective of this study is to analyse the influence of ND on event-free survival (EFS) for patients with cN0 ACC. Patients and methods A multicentre prospective study was conducted between 2009 and 2018. Patients presenting cN0 non-metastatic ACC on any site, and who received surgery on the tumour, were included. EFS was the main judgement criterion. A comparative survival analysis between the groups that received a ND versus those that did not was performed, using a propensity score. Analyses were carried out using the R software. Results Between 2009 and 2018, 322 patients with cN0 ACC were included, out of which 58% were female. The average age was 53 years. Tumours were in minor salivary glands in 58% of cases, and 52% had T3/T4 stages. ND was performed on 46% of patients. Out of them, seven had histological lymph node invasion, out of which six had tumour infiltration in the mucosa of oral cavity. After propensity score, the median EFS for N0 patients with ND was 72 months (95% Confidence Interval (CI) [48–81]), compared to 73 months (95% CI [52–85]) for patients without ND (HR = 1.33; 95% CI [0.82–2.16]; p = 0.2). Conclusion ND of cN0 patients does not provide any benefit on EFS, which suggests that its application on such patients is not necessary.

We show recent technologies for low power consumption multi-core amplifiers. We report advances concerning core pumping, cladding pumping and optimized hybrid pumping technologies for power efficient optical amplification with erbium doped multi-core fiber amplifiers.

We have successfully confirmed the feasibility of real-time optical gain spectrum monitoring of CC-MC-EDFA with the standard deviation within 0.65 dB even if the optical power per core fluctuate due to the inter-core crosstalk.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

Optical submarine cables are a crucial infrastructure as they convey 99% of internet traffic between countries and continents. Although, their history is rooted in the middle in the 19th Century with the first transatlantic telegraph cable, the uninterrupted strong growth of current internet traffic has been a prime motivation for the introduction of several disruptive technologies. In this paper, we review technologies used in past and current optical submarine cables, as well as future technological trends to increase their capacity.

We have confirmed 1.5 dB optical gain improvement with a ±0.6 dB dependence among cores by applying the turbo cladding pumping scheme. The turbo scheme does not degrade optical gain and NF, nor their uniformity.

Background Nasal irrigation is now widely recognized as a treatment for chronic rhinosinusitis and during the postoperative period. However, there are no guidelines for performing irrigation. This study used computational fluid dynamics (CFD) simulation objective physical parameters to optimize and increase the efficiency of nasal irrigation and to compare large-volume, manual, and gravity pressure irrigation vs small-volume continuous spraying. Methods A 3-dimensional (3D) sinonasal model was constructed from a healthy adult high-resolution computed tomography (CT) scan. The 3D nasal model was constructed using a tetrahedral and hex-dominant mesh grid with TGRID™ 16 (ANSYS Inc., Villeurbanne, France) software. A structured hex mesh was created inside the domain using the Hexcore meshing method. The final mesh had a total of 9.6 × 106 cells with an average size of 0.29 mm3 , or an average volume of 2.42 × 10-2 mm3 . Navier-Stokes equations were resolved with the standard k - e model. Results Large-volume irrigation (15 mL/s) covered all zones (136 to 310 cm2 ) rapidly with strong shear stress and prolonged contact time (310 mPa 3.26 seconds for gravity mode and 280 mPa 3.35 seconds for manual pressure mode). Continuous spraying (3 mL/second) covered all areas (76 to 310 cm2 ) but with far less volume, more slowly, with low shear stress (50 mPa), and with shorter contact time (1.84 seconds). The surface wetted by time in contact was 135.4, 113.9, and 46.6 cm2 for gravity, manual pressure mode, and continuous spraying, respectively. Conclusion CFD simulation visualizes the circulation of water during nasal irrigation and makes it possible to determine objective parameters to decide which mode of irrigation may be used.

International audience; Background:The incidence of cancer during pregnancy is low but is slightly increas-ing. Data on incidence and etiology of head and neck (HN) cancers in pregnantwomen are rare. We evaluated the frequency, tumor type, associated factors, and spe-cific biomarkers in HN cancers occurring in pregnant (and peripartum) women.Methods:A systematic literature search was performed on PubMed, for any HNtumor site occurring in pregnant women.Results:Sixty cases of HN cancers occurring during pregnancy were identified.Most of them were oral cavity cancers. Relationships with oncogenic viruses, hor-monal disturbance, and shift in maternal immunity profile were identified.Conclusion:Carcinogenesis of HN cancers in pregnant women may be led by dif-ferent cancer type–specific hallmarks. Relevance of these etiological factors withrespect to treatments and birth control recommendations is being investigated bythe REFCOR in an ambispective study.

International audience; BACKGROUND:The purposes of this study were to describe the characteristics of a prospective multicenter series of patients with salivary duct carcinoma and to investigate prognostic factors.METHODS:Patients included for salivary duct carcinoma between 2009 and 2016 in the Réseau d'Expertise Français des Cancers ORL Rares (REFCOR) database were selected. Immunohistochemical analyses were performed.RESULTS:Sixty-one patients were included in this study. The primary site was the parotid gland in 90% of the cases. Fifty-seven percent of the tumors were stage IV, 65% of patients had lymph node involvement, and 10% had metastases. Tumors showed androgen receptor (89%) and human epidermal growth factor receptor 2 (HER2)/neu (36%). Ninety-four percent of patients underwent surgery and 86% had postoperative radiotherapy. Six patients were treated with targeted therapies. The 3-year overall survival (OS) was 74% and the 3-year disease-free survival (DFS) was 44%. Tumor stages III to IV reduced DFS (hazard ratio [HR] 4.3; P = .04). The N2/3 class reduced distant metastasis-free survival (HR 7.3; P = .007).CONCLUSION:Salivary duct carcinoma prognosis is poor and is correlated with tumor stage and lymph node classification. Androgen receptor and HER2/neu should be tested as they offer the possibility of targeted therapies.

Background The purpose of this study was to propose a prognostic classification of intestinal-type adenocarcinoma (ITAC) based on literature search and prognostic modeling of cohort data. Methods We first conducted a literature search to assess the homogeneity of the reported estimates of 5-year survival and to identify the influence of T classification. We then pooled prospective data from 3 large French and Italian series to predict time to all-cause mortality. The sample was randomly split to derive and then to validate the proposed prognostic model. Results Literature analysis confirmed the heterogeneity in 5-year survival rates, partly explained in subsets of homogeneous T-values. The sample included 223 patients, randomly separated into a derivation (n = 141) and a validation set (n = 82). Invasion of the sphenoid lateral and/or posterior walls and dura/cerebral invasion were systematically associated with a poor survival. Conclusion The incorporation of the invasion of the sphenoid lateral or posterior walls should be considered for ITAC management and prognostication. © 2017 Wiley Periodicals, Inc. Head Neck 39: 668–678, 2017

Background: The aim of our work was to design and assess the comprehensibility of an anatomical diagram for recording surgical and pathological results after the removal of sinonasal malignant tumours by endoscopic endonasal surgery. Methodology: To create the first version of the diagram, we determined the functional and technical specifications for its use. The anatomical structures that appear on it were selected from the pathological reports of previous interventions. The comprehensibility of the diagram was tested by two successive multicentre labelling tests. Successive modifications led to the creation of a definitive version of the diagram. Results: A diagram of the sinonasal cavities in exploded view was created from 47 selected anatomical structures. Labelling tests led to modifying the diagram by the overall restructuring and removal of the least recognized structures. In the labelling test of version 2, the mean global identification rate was 97.1 plus/minus 4.9% for 36 participants and all tested structures achieved a specific identification rate equal to or greater than 75%. Conclusions: This diagram of the sinonasal cavities is a comprehensible validated tool that allows the resection and invasion of sinonasal malignant tumours to be recorded. This three-dimensional diagram facilitates the understanding of the size, location and extensions of tumours. It may improve case presentations and communication in multidisciplinary team meetings.

Background The regulation of mucociliary clearance is a key part of the defense mechanisms developed by the airway epithelium. If a high aggregate quality of evidence shows the clinical effectiveness of nasal irrigation, there is a lack of studies showing the intrinsic role of the different irrigation solutions allowing such results. This study investigated the impact of solutions with different pH and ionic compositions, eg, normal saline, non-diluted seawater and diluted seawater, on nasal mucosa functional parameters. Methods For this randomized, controlled, blinded, in vitro study, we used airway epithelial cells obtained from 13 nasal polyps explants to measure ciliary beat frequency (CBF) and epithelial wound repair speed (WRS) in response to 3 isotonic nasal irrigation solutions: (1) normal saline 0.9%; (2) non-diluted seawater (Physiomer®); and (3) 30% diluted seawater (Sterimar). The results were compared to control (cell culture medium). Results Non-diluted seawater enhanced the CBF and the WRS when compared to diluted seawater and to normal saline. When compared to the control, it significantly enhanced CBF and slightly, though nonsignificantly, improved the WRS. Interestingly, normal saline markedly reduced the number of epithelial cells and ciliated cells when compared to the control condition. Conclusion Our results suggest that the physicochemical features of the nasal wash solution is important because it determines the optimal conditions to enhance CBF and epithelial WRS thus preserving the respiratory mucosa in pathological conditions. Non-diluted seawater obtains the best results on CBF and WRS vs normal saline showing a deleterious effect on epithelial cell function.

C-band and L-band wavelength division multiplexing (WDM) transmission performance was improved by using bidirectional signal assignment (BSA) to reduce crosstalk (XT) in square lattice structure 16-core fiber. Transmission of 16 WDM channels with 256-Gb/s polarization multiplexed-16 quadrature amplitude modulation signals on a 50-GHz grid with a net spectral efficiency of 4 b/s/Hz over 55-km of 16-core fiber spans was achieved. Use of BSA to reduce XT extended the transmission distance to 880 km in both types of transmission. Furthermore, transmission was achieved over eight mixed spans consisting of 16-core fiber and conventional single-mode fiber (SMF), demonstrating the possibility of gradually upgrading standard SMF-based lines to multicore fiber-based lines. With BSA, six 16-core fiber spans can be acceptable if the Q penalty from XT is below 0.5 dB.

We used paired prototypes of spatial pump combiner and splitter to improve the pump recycling ratio of turbo cladding pumped MC-EDFA from 12% to 42%. This enables a potential 1.2dB improvement of the optical gain.

We report advances in low power consumption multi-core amplifiers. We namely show recent advances concerning core pumping, cladding pumping and hybrid pumping technologies for power efficient optical amplification with erbium doped multi-core fiber amplifiers.

International audience; BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown the effectiveness of tDCS in improving language recovery in post-stroke aphasia. However, this innovative technique is not currently used in routine speech and language therapy (SLT) practice. OBJECTIVE: This systematic review aimed to summarise the role of tDCS in aphasia rehabilitation. METHODS: We searched MEDLINE via PubMed and Scopus on October 5, 2018 for English articles published from 1996 to 2018. Eligible studies involved post-stroke aphasia rehabilitation with tDCS combined or not with SLT. RESULTS: We retained 5 meta-analyses and 48 studies. Among the 48 studies, 39 were randomised controlled trials (558 patients), 2 prospective studies (56 patients), and 5 case studies (5 patients). Two articles were sub-analyses of a randomised clinical trial. Methods used in these studies were heterogeneous. Only 6 studies did not find a significant effect of tDCS on language performance. As compared with earlier meta-analyses, the 2 latest found significant effects. CONCLUSION: Evidence from published peer reviewed literature is effective for post-stroke aphasia rehabilitation at the chronic stages. tDCS devices are easy to use, safe and inexpensive. They can be used in routine clinical practice by speech therapists for aphasia rehabilitation. However, further studies should investigate the effectiveness in the subacute post-stroke phase and determine the effect of the lesion for precisely identifying the targeted brain areas. We discuss crucial challenges for future studies.

Configurations of cladding pumped MC-EDFA with pump recycling have been researched to improve optical amplification efficiency. The difference between the four researched configurations is the pump injection and re-injection method. The optical amplification performance was compared experimentally by evaluating the optical gain, noise figure, and the maximum output signal power. The results show the spatial injection and the fiber re-injection with spatial splitting configuration improved the pump recycling efficiency the most, and the configuration offered an additional 3.5 dB of optical gain and boosted the maximum output signal power by 4.0 dB compared to the standard cladding pumping without pump recycling. The improvement in the optical gain due to the pump recycling was constant at 1.0 dB in the fixed experimental set-up even if the input optical signal power was changed. The effect of the spatial intensity distribution widening due to the fiber pump combiner is considered to be effective in improving the pump recycling efficiency. An additional 0.2 dB improvement (1.2 dB in total) in the optical gain was achieved by modifying the free-space lens optics design of the spatial pump splitter.

Purposes: The purpose of this study was to compare the efficacy of a mineral-rich solution vs normal saline solution (0.9% NaCl) following endoscopic complete bilateral ethmoidectomy. Methods: This was a prospective, multicenter, randomized, controlled, open-label trial in subjects suffering from steroid-resistant sinonasal polyposis. Adults performed 4 nasal irrigations of mineral or saline solutions daily for 28 days. Evaluations included subject-reported RHINO quality of life (QoL) and NOSE scores, tolerability, and satisfaction, the Lund-Kennedy endoscopic score and assessments of crusting, secretions and mucociliary clearance (rhinoscintigraphy). Results: A total of 189 subjects were randomized. Clinically relevant improvements (> 20 points) in RhinoQOL and NOSE scores were measured in both groups without any significant inter-group difference. Among the subjects with impaired RhinoQOL at pre-inclusion, the change in Impact-RhinoQOL score was significantly superior in mineral-rich vs saline solution at day 21 (p = 0.028) and day 28 (p = 0.027). The Lund-Kennedy score continuously improved in both groups earlier with the mineral-rich solution. Crusts were significantly fewer in number and less severe/obstructive in patients receiving mineral-rich vs saline solution at day 7 (p = 0.026) and day 14 (p = 0.016). Furthermore, secretions disappeared significantly more quickly and were less thick/purulent with mineral-rich solution at day 14 (p = 0.002) and day 21 (p = 0.043). Less epistaxis was reported in the mineral vs saline solution (p = 0.008 at day 21). Conclusions: Our findings indicate that the composition of a nasal irrigation solution influences endoscopic scores and QoL after sinus surgery for patients over 60, those with an initially poor QoL and higher symptom score, and smokers.

We have confirmed 110 km MCF stable real-time transmission of PM-16QAM signal amplified with novel turbo cladding pumping scheme. Optical gain was improved by 2 dB as we recycled residual $0.98\ \mu m$ pump, enabling 32% reduction of power consumption.

National audience; Located at the feto-maternal interface, the placenta is involved in exchange, endocrine and immune functions, which impact fetal development. In contact with the maternal environment, this organ is sensitive to metabolic disorders as over-nutrition, obesity or diabetes. The alteration of blood parameters associated with these pathologies affects placental histology, vascularization and nutrient transfers and, according to the types of troubles, induces local inflammation or hypoxia. These placental changes lead to disturbance of development and fetal growth, which increase the risk of pathologies in offspring in adulthood. The placenta thus appears as a crucial player in the fetal programming.; Situé à l’interface fœto-maternelle, le placenta exerce des fonctions d’échanges, endocrines et immunitaires qui influencent le développement fœtal. En contact direct avec l’environnement maternel, cet organe est sensible aux désordres métaboliques comme la surnutrition, l’obésité ou le diabète. L’altération des paramètres sanguins associée à ces conditions affecte l’histologie, la vascularisation et les transferts des nutriments placentaires et induit, en fonction du trouble métabolique, une inflammation locale ou une hypoxie. Ces modifications placentaires perturbent le développement et la croissance fœtale, ce qui augmente le risque de pathologies à l’âge adulte chez la descendance. Le placenta est donc un acteur incontournable de la programmation fœtale.

Adult abdominal fat, which is known to contain pluripotent stem cells, is frequently used to treat cerebrospinal fluid leak. The aim of this study was to assess the efficacy and reliability of abdominal fat graft to close large skull base defects after extirpation of malignant sinonasal tumors.Case series with chart review performed between 2009 and 2014.Twenty-nine cases were included of consecutive patients who were suffering from malignant sinonasal tumors, operated by an endoscopic endonasal approach with anterior skull base extirpation and surgically induced cerebrospinal fluid leak. Skull base was repaired by 1 layer of "en bloc" autologous fat graft used as a plug in the onlay position. Epidemiologic data, medical history, defect size, length of hospitalization, and morbidity were analyzed.Radiotherapy was given pre- and postoperatively in 4 (13.8%) and 23 (79.3%) patients, respectively. Mean defect size was 4.47 ± 2.9 cm(2) (range, 0.24-9.1 cm(2)). Mean operative time was 210 ± 86 minutes. Mean length of hospitalization was 8.6 ± 3.7 days and 4.9 ± 2 days in the intensive care unit. No lumbar drain was used in this study. There was 1 case of cerebrospinal fluid leak (3.5%) and 2 cases of meningitis (6.9%), which resolved after medical treatment. Mean follow-up was 17 ± 13 months (range, 3-53 months).Abdominal fat graft is a safe and reliable material to close the anterior skull base after extirpation of malignant sinonasal tumors.

International audience

Objectives The French Otorhinolaryngology Society (SFORL) set up a work group to draw up a consensus document on day-case surgery in four rhinologic procedures: endoscopic middle meatal antrostomy (French National Health Insurance (CCAM) code GBPE001), septoplasty (GAMA007), and reduction of nasal bone fracture using a direct approach (LAEA007) and using a closed technique (LAEP002). Materials and methods Methodology followed the French Health Authority (HAS) “Methodological Bases for Drawing Up Professional Guidelines by Formalized Consensus” published in January 2006; the method chosen was the short version of the RAND/UCLA Appropriateness Method (without editorial group), as the work group topic was highly specialized, with few experts available. Results Ahead of any day-case sinonasal surgery, it is recommended that patient eligibility criteria be respected and hemorrhagic risk assessed; preference should be given to short procedures involving little variation in surgery time and minimizing blood-loss, and associated procedures (e.g., septoplasty + turbinectomy) should be avoided. The patient and family should be informed of specific hemorrhagic, orbital and/or neuromeningeal risks, onset of which may preclude discharge home. Uni- or bilateral postoperative nasal packing is not a contraindication to day-case management. Conclusion All four procedures may be performed on a day-case basis. Eligibility criteria should be systematically respected, but hemorrhagic risk, which is very specific to the sinonasal organ, is to be assessed on a case-by-case basis, as it is a major issue in this kind of management for a non-negligible number of patients.