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To compare the accuracy and reliability of 10 different accelerometer-based step-counting algorithms for individuals with lower limb loss, accounting for different clinical characteristics and real-world activities. Cross-sectional study. General community setting (ie, institutional research laboratory and community free-living). Forty-eight individuals with a lower limb amputation (N=48) wore an ActiGraph (AG) wGT3x-BT accelerometer proximal to the foot of their prosthetic limb during labeled indoor/outdoor activities and community free-living. Not applicable. Intraclass correlation coefficient (ICC), absolute and root mean square error (RMSE), and Bland Altman plots were used to compare true (manual) step counts to estimated step counts from the proprietary AG Default algorithm and low frequency extension filter, as well as from 8 novel algorithms based on continuous wavelet transforms, fast Fourier transforms (FFTs), and peak detection. All algorithms had excellent agreement with manual step counts (ICC>0.9). The AG Default and FFT algorithms had the highest overall error (RMSE=17.81 and 19.91 steps, respectively), widest limits of agreement, and highest error during outdoor and ramp ambulation. The AG Default algorithm also had among the highest error during indoor ambulation and stairs, while a FFT algorithm had the highest error during stationary tasks. Peak detection algorithms, especially those using pre-set parameters with a trial-specific component, had among the lowest error across all activities (RMSE=4.07-8.99 steps). Because of its simplicity and accuracy across activities and clinical characteristics, we recommend the peak detection algorithm with set parameters to count steps using a prosthetic-worn AG among individuals with lower limb loss for clinical and research applications. [ABSTRACT FROM AUTHOR]

The Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) has emerged as a promising tool in preventing sudden cardiac death, with fewer complications reported in industry-supported trials from experienced centers. Nonetheless, its broader applicability and long-term real-world outcomes warrant comprehensive evaluation. The study aimed to provide independent long-term S-ICD outcomes. The HONEST study, a nationwide observational study, enrolled all patients receiving S-ICDs in France between 2012 and 2019. These patients are followed by telecardiology and routine clinical follow-ups, with meticulous event adjudication. Out of 5015 patients implanted with S-ICD in France, 4924 (98.2%) were enrolled in the study (mean age 49.9 ± 15.0 years, 23.31% females, 21.79% with electrical heart disease, 36.7% for secondary prevention, mean left ventricular ejection fraction 42.3 ± 16.8%). The cumulative incidence of appropriate shocks increased from 5.10% in the first year to 14.62% by the fifth year (Fig. 1). Early (within 30 days) post implant complications occurred in 3.61%, mainly local complications: infections (0.72%), pocket hematomas (0.94%), and poor wound healing (0.48%). One-year and five-year rates of complications escalated from 9.45% to 27.06% respectively, including inappropriate shocks (5.05% to 13.79%), infection (1.77% to 2.40%), Lead issues (0.21% to 1.47%), premature battery depletion (0.35% to 8.76%), and chronic discomfort (0.28% to 1.42%). Implantation of a pacing system was necessary in 3.09% at 5 years. Definitive S-ICD removals rose to 8.24% by the fifth year, predominantly due to complications, pacing needs, and heart transplant. Among the 547 deaths in the cohort, 51.74% were cardiovascular-related, with 8 directly associated with S-ICD complications and 23 cases of unexplained sudden cardiac deaths. The HONEST study advocates for the S-ICD's broader applicability and emphasizes a personalized approach to optimize outcomes. [ABSTRACT FROM AUTHOR]

[Display omitted] • CSP is an innovative approach but evidence and guidelines are lacking. • CSP has been widely adopted in France. • Important variations were apparent for implantation techniques and success criteria. • Lack of training and clinical guidelines remain limitations for wider CSP adoption. Conduction system pacing (CSP) is an emerging and promising approach for physiological ventricular pacing. While data from randomized controlled trials are scarce, use of His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP) has increased in France. To perform a national snapshot survey for cardiac electrophysiologists to evaluate adoption of CSP in France. An online survey, distributed to every senior cardiac electrophysiologist in France, was conducted in November 2022. A total of 120 electrophysiologists completed the survey. Eighty-three (69%) respondents reported experience in undertaking CSP procedures and 27 (23%) were planning to start performing CSP in the coming 2 years. The implantation techniques and criteria used for successful implantation differed significantly among operators. The most frequent indications for HBP and LBBAP were high-degree atrioventricular block with left ventricular ejection fraction (LVEF) < 40% (24 and 82%, respectively) or with LVEF ≥ 40% (27 and 74%, respectively), and after failure of a coronary sinus left ventricular lead (27 and 71%, respectively). The limitations respondents most frequently perceived when performing HBP were bad sensing/pacing parameters (45%), increased procedure duration (41%) and risk of lead dislodgement (30%). The most frequently perceived limitations to performing LBBAP were absence of guidelines or consensus (31%), lack of medical training (23%) and increased procedure duration (23%). Our national survey-based study supports wide adoption of CSP in France. CSP is currently used as a second-line approach for both antibradycardia and resynchronization indications, with important variations regarding implantation techniques and criteria for measuring success. [ABSTRACT FROM AUTHOR]

To assess the stress factors affecting operating theater nurses during the perioperative period. The study was conducted as a cross-sectional survey by means of a specifically drawn-up questionnaire based on the data available in the literature. Stress was measured on a 0/100 visual analogue scale (VAS). Six hundred and twelve (612) persons responded. Stress associated with an operation amounted to 31.8; it was higher at the time of the procedure (49.6) and immediately beforehand (39.4), particularly among the least experienced nurses. The most widely represented stress factors were associated with the surgical team (perceived incompetence, lack of confidence), relational problems with regard to the surgeon, and team members' disruptive behavior. By contrast, familiarity with the team or the procedure seemed to shield the nurses from stress. Feelings of stress had a relatively frequent impact on quality of life (33%), family and personal life (26%), with chronic (recurrent or constant) stress symptoms reported among 20% of respondents. Among operating theater nurses, stress associated with an operation was particularly strong among the least experienced professionals, when the type of procedure or the other team members were unfamiliar, and in the event of disruptive behavior. Stress factor improvement should be a priority, the objective being to enhance professional and personal quality of life, while better ensuring patient safety. [ABSTRACT FROM AUTHOR]

To evaluate the reliability, standard error of measurement, minimum detectable change, and item-level consistency of the Transfer Assessment Instrument (TAI) version 4.0 when used to evaluate transfer quality remotely. Participants transferred from their wheelchair to a mat table (transfer 1), repeated this after a 10-minute delay to assess intrarater reliability (transfer 2), and repeated this 1-2 days later to assess test-retest reliability (transfer 3). Each transfer was scored in person by 4 raters and asynchronously by a remote clinician rater. 2017 National Veterans Wheelchair Games. Convenience sample of 44 full-time wheelchair users (N=44). Not applicable. TAI total score, subscores (wheelchair setup, body setup, flight/landing), and item scores (15 items). Moderate to excellent reliability was found when scoring remotely for TAI total and subscores for intrarater (intraclass correlation coefficient (ICC(3,1)=0.687-0.854), test-retest (ICC(3,1)=0.695-0.836), and interrater reliability (ICC(3,5)=0.746-0.962). Remote rater total score and flight/landing subscore were greater (indicating higher transfer quality) compared to the average in-person raters (P =.021 and P =.005, respectively). There were no differences between transfers 1-3 in remote rater scores. Item-level percentage agreement between the remote rater and in-person exceeded the 75% cutoff for clinical utility for all items. The TAI is a reliable outcome measure for assessing transfer technique remotely. [ABSTRACT FROM AUTHOR]

Background: Same-day home discharge after common atrial flutter catheter ablation (CAFCA) is a feasible, safe, and cost-effective practice, but there are currently no data for patients treated with direct oral anticoagulants (DOAs).Objective: We evaluated the safety, efficacy, and feasibility of ambulatory CAFCA in patients treated with DOAs compared with those treated with vitamin K antagonists (VKAs).Methods: Patients scheduled for isolated and elective ambulatory CAFCA in our tertiary university center between 2009 and 2019 were included. Propensity score for anticoagulant type was calculated from age, sex, body mass index, HAS-BLED and CHA2DS2-VASc scores, chronic kidney disease, associated antiplatelet treatment, procedure duration, and number of femoral venipunctures.Results: Propensity score matching yielded 820 patients (mean age 67 ± 11 years). Catheter ablation was performed under uninterrupted VKA (n = 410; international normalized ratio 2.5 ± 0.6) or uninterrupted DOA (n = 410). The procedural success rate was 91%, and the effective same-day discharge rate was 93%. The occurrence of the primary end point, defined as any early and clinically significant bleeding (Bleeding Academic Research Consortium classification ≥ 2) at 1 week, was similar between patients treated with DOAs and those treated with VKAs (2.9% vs 3.7%; P = .70). Female sex, high HAS-BLED score, and prolonged procedure duration were independently associated with the primary end point.Conclusion: Uninterrupted DOA regimens are safe for patients undergoing ambulatory CAFCA in a high-volume center with a dedicated ambulatory unit and standardized procedural and postoperative management. [ABSTRACT FROM AUTHOR]

In the context of global warming and ice melting in the Arctic Ocean, maritime activities have significantly increased over recent years. However, the Arctic remains a wild and risky region where marine accidents regularly occur. Despite the difficulty in compiling relevant data on Arctic shipping casualties, we have identified 156 accidents along the North-East Passage (NEP) over the last twenty years. Following a data-driven approach, we combine multiple sources and use the standardized International Maritime Organization (IMO) taxonomy on casualty investigation. We disclose and classify the concerned cases by severity level, cause, age, and type of vessels. We draw the profile of the vessels with the highest accidentology level, ascertain the high-risk areas and the seasons with the highest accident rate. Our results stress that serious casualties represent the largest part of the accidents occurring in this area. Fishing vessels show the highest accident rate, and machinery issues are one of the most common accident types. Furthermore, the NEP accidentology during the last two decades does not seem to decline unlike the downward trend elsewhere around the globe. Finally, we call for greater reporting of marine accidents and compliance with the IMO risk classification to better understand accidentology in this growing shipping zone. A plea in favor of stricter enforcement of the Polar Code and a holistic risk-based policy combining mandatory and non-mandatory measures are notably suggested to prevent casualties in the near future. [ABSTRACT FROM AUTHOR]

Highly localized impedance (LI) in combination with contact force (CF) during atrial fibrillation (AF) ablation may improve tissue characterization and lesion prediction during pulmonary vein isolation (PVI). This analysis explores the relationship between LI parameters, ablation spot locations and procedural success during isolation of PVs. Two-hundred twelve consecutive patients from 16 European centers undergoing de novo AF radiofrequency (RF) catheter ablation with an open-irrigated tip catheter enabled by CF and LI measurement (Stablepoint) were included. Ablation was guided by LI drop during RF delivery. The interlesion distance was set ≤ 6 mm. First pass isolation (FPI) was defined as successful PVI at or before completion of the first encircling. Procedural endpoint was PVI as assessed by entrance and exit block. Data are reported as mean ± SD. A total of 13891 ablation spots performed around PVs were analyzed (baseline LI = 161.2 ± 19 Ω; LI drop = 21.9 ± 9 Ω; LI drop rate = 3.1 ± 2 Ω/s; RF Delivery time = 9.2 ± 4 s; CF = 12.5 ± 7 g). LI drop was predicted by baseline LI (r = 0.56, 95%CI: 0.55 to 0.57, P < 0.0001). A total of 80 PV gaps were detected, mostly at the right pairs of the PV (63.7%, P = 0.013). The FPI rate per vein was 93.3% resulting from 180 patients (84.9%) with FPI (Figure 1). PV gaps were located at anterior (31.3%), posterior (31%), and carina (16%) sites after the FPI evaluation. At successful ablation spots, both baseline LI and LI drop were larger than at PV gap spots (161.4Ω vs. 153.0Ω, P < 0.0001 for baseline LI; 22.1Ω vs. 14.4Ω, P < 0.0001 for LI drop), whereas RF delivery time was shorter (9.1s at successful ablation spots vs. 10.1s at PV gap spots, P < 0.0001). CF values seem to be higher at successful ablation spot that at PV gap spots (12.5 g vs. 11.4 g, P = 0.0592). The best LI drop that predicts successful ablation spots was > 20Ω (sensitivity = 56.8%, specificity = 93.2%, PPV = 99.7%, area under the ROC curve = 0.7841, P < 0.0001). Optimal LI drops were identified by left atrial region and were > 21Ω at anterior sites and > 18Ω at posterior sites. No steam pops or complications were reported during the procedures. All PVs were successfully isolated in all study patients. Ablation strategy guided by LI and CF information results in a high first pass isolation rate. LI drop is predictive of PV segment isolation. A regional approach to RF ablation guided by LI information may be useful in patients with AF. [ABSTRACT FROM AUTHOR]

Objectives To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI). Design Prospective observational study using the SCIRehab database. Setting Six IPR facilities. Participants Patients with new SCI (N=1376) receiving initial rehabilitation. Interventions Patients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM. Main Outcome Measures Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART). Results Nearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training ( P <.001). CHART physical independence ( P =.002), mobility ( P =.024), and occupation ( P =.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART. Conclusions A significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR. [ABSTRACT FROM AUTHOR]

This paper aims to synthesize the perceptions of early career specialists regarding trends in dry bulk shipping flows to 2050, the ship type which generates the second highest total volume of carbon emissions. Specialists' insights have implications for formulating polices to manage global trade and shipping emissions. Established Delphi survey techniques achieved consensus in a novel long-term industrial context amongst international panelists with long-term industrial commitment, highlighting trends in drivers including Arctic ice melt, canal upgrades, piracy and mode splits. Globally, expected doubling of raw materials shipments to Western economies and quadrupling elsewhere will be partially offset by specialists' perceptions of shorter hauls. Moderate annual expected tonnage growth globally compares with rapid annual growth in coal shipments, although more localized and multi-sourcing will shorten global coal hauls. After 2030, ocean routing is expected to slightly shorten global hauls. Climate change brings both Arctic ice melt with shorter expected average hauls from Northeast Asia to Western Europe and longer hauls elsewhere as more droughts and failed states force ship re-routing to avoid piracy. Canal upgrades will offer shorter average hauls. Within the UK rising expected demand for biofuels and intolerance of fossil fuels will reduce shipping demand, inviting investigation of a systems approach to planning. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Medical Mycology / Journal de Mycologie Médicale is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of International Economics (2110-7017) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To determine the effectiveness of a web-based, direct-to-user transfer training program in improving transfer quality and maintaining improvements for up to 1 month after training as compared with a control group. Randomized controlled trial with participants randomized to an immediate intervention group (IIG) or waitlist control group (WLCG) that received the training after a 6-month delay. Wherever the participants accessed the web-based training, likely the home environment. Convenience sample of full-time wheelchair users (N=72; IIG, n=34; WLCG, n=38 for between-group analysis, n=48 for combined within-group analysis) with spinal cord injury or disorder who were able to independently perform a lateral scoot transfer. Self-paced, web-based transfer training module. Transfer Assessment Instrument Questionnaire (TAI-Q) score at baseline, 1 month, and 6 months postbaseline (WLCG only), immediately posttraining, and 1 month posttraining. The TAI-Q is an 18-item self-assessment that covers several aspects of a quality transfer. The IIG significantly increased particpants' baseline TAI-Q score from 6.91±0.98 to 7.79±1.12 (P <.001) by 1 month posttraining. The WLCG also increased from baseline to the 1-month postbaseline assessment (from 6.52±1.13 to 7.00±1.09; P =.014), potentially from learning effects secondary to self-assessment with the TAI-Q. The extent of change over time did not differ significantly between the IIG and WLCG from baseline to 1 month (P =.169). However, significant improvements in TAI-Q scores were still evident after the training for the WLCG (P <.001). Those with a lower pretraining TAI-Q score and more shoulder pain were most likely to benefit from the training. Repeated TAI-Q self-assessments likely contributed to improved transfer quality, with web-based training having an additive effect. Wheelchair users are likely to benefit from transfer training and self-assessment of transfer quality in their home environments. This has the potential to decrease injury risk while avoiding barriers to in-person training. [ABSTRACT FROM AUTHOR]

To investigate the changes in total internet and mobile internet use over time and determine how demographic characteristics are related to changes in internet and mobile internet use among individuals with spinal cord injury (SCI). Cross-sectional analysis of a multicenter cohort study. National SCI Database. Individuals with traumatic SCI with follow-up data collected between 2012 and 2018 (N=13,622). Not applicable. Proportion of sample reporting internet use at all or through a mobile device over time and specifically in 2018. The proportion of internet users increased from 77.7% in 2012 to 88.1% in 2018. Older participants (P <.001); those with lower annual income (P <.001), less education (P <.001), non-White race or Hispanic ethnicity (P <.001), or motor incomplete tetraplegia (P =.004); and men (P =.035) were less likely to use the internet from 2012-2018. By 2018, there were no longer differences in internet use based on race and ethnicity (P =.290) or sex (P =.066). Mobile internet use increased each year (52.4% to 87.7% of internet users from 2012-2018), with a participant being 13.7 times more likely to use mobile internet in 2018 than 2012. Older age (P <.001), income <$50,000 (P <.001), high school diploma or less (P =.011), or non-Hispanic White race/ethnicity (P =.001) were associated with less mobile internet use over time. By 2018, there were no differences in mobile internet use by education (P =.430), and only participants with incomes >$75,000 per year had greater odds of mobile internet use (P =.016). Disparities associated with internet access are decreasing likely as a result of mobile device use. Increased internet access offers an important opportunity to provide educational and training materials to frequently overlooked groups of individuals with SCI. [ABSTRACT FROM AUTHOR]

To determine if functional measures of ambulation can be accurately classified using clinical measures; demographics; personal, psychosocial, and environmental factors; and limb accelerations (LAs) obtained during sleep among individuals with chronic, motor incomplete spinal cord injury (SCI) in an effort to guide future, longitudinal predictions models. Cross-sectional, 1-5 days of data collection. Community-based data collection. Adults with chronic (>1 year), motor incomplete SCI (N=27). Not applicable. Ambulatory ability based on the 10-m walk test (10MWT) or 6-minute walk test (6MWT) categorized as nonambulatory, household ambulator (0.01-0.44 m/s, 1-204 m), or community ambulator (>0.44 m/s, >204 m). A random forest model classified ambulatory ability using input features including clinical measures of strength, sensation, and spasticity; demographics; personal, psychosocial, and environmental factors including pain, environmental factors, health, social support, self-efficacy, resilience, and sleep quality; and LAs measured during sleep. Machine learning methods were used explicitly to avoid overfitting and minimize the possibility of biased results. The combination of LA, clinical, and demographic features resulted in the highest classification accuracies for both functional ambulation outcomes (10MWT=70.4%, 6MWT=81.5%). Adding LAs, personal, psychosocial, and environmental factors, or both increased the accuracy of classification compared with the clinical/demographic features alone. Clinical measures of strength and sensation (especially knee flexion strength), LA measures of movement smoothness, and presence of pain and comorbidities were among the most important features selected for the models. The addition of LA and personal, psychosocial, and environmental features increased functional ambulation classification accuracy in a population with incomplete SCI for whom improved prognosis for mobility outcomes is needed. These findings provide support for future longitudinal studies that use LA; personal, psychosocial, and environmental factors; and advanced analyses to improve clinical prediction rules for functional mobility outcomes. [ABSTRACT FROM AUTHOR]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives To determine the efficacy of a web-based transfer training module at improving transfer technique across 3 groups: web-based training, in-person training (current standard of practice), and a waitlist control group (WLCG); and secondarily, to determine subject factors that can be used to predict improvements in transfer ability after training. Design Randomized controlled trials. Setting Summer and winter sporting events for disabled veterans. Participants A convenience sample (N=71) of manual and power wheelchair users who could transfer independently. Interventions An individualized, in-person transfer training session or a web-based transfer training module. The WLCG received the web training at their follow-up visit. Main Outcome Measure Transfer Assessment Instrument (TAI) part 1 score was used to assess transfers at baseline, skill acquisition immediately posttraining, and skill retention after a 1- to 2-day follow-up period. Results The in-person and web-based training groups improved their median (interquartile range) TAI scores from 7.98 (7.18–8.46) to 9.13 (8.57–9.58; P <.01), and from 7.14 (6.15–7.86) to 9.23 (8.46–9.82; P <.01), respectively, compared with the WLCG that had a median score of 7.69 for both assessments (baseline, 6.15–8.46; follow-up control, 5.83–8.46). Participants retained improvements at follow-up ( P >.05). A lower initial TAI score was found to be the only significant predictor of a larger percent change in TAI score after receiving training. Conclusions Transfer training can improve technique with changes retained within a short follow-up window, even among experienced wheelchair users. Web-based transfer training demonstrated comparable improvements to in-person training. With almost half of the United States population consulting online resources before a health care professional, web-based training may be an effective method to increase knowledge translation. [ABSTRACT FROM AUTHOR]

Résumé Objectif Mise au point sur la place de l’extraction chirurgicale de spermatozoïdes testiculaires (TESE) en amont de tout traitement anticancéreux potentiellement gonadotoxique (onco-TESE) dans la stratégie de préservation de la fertilité en contexte néoplasique. Méthode Rappel du principe, des indications et de la technique de l’onco-TESE basé sur l’analyse de la littérature et l’expérience personnelle de l’auteur. Résultats L’incidence des cancers de l’homme jeune (testicule, lymphome) est en augmentation. Les prises en charges actuelles alliant chirurgie, radiothérapie ou chimiothérapie permettent une amélioration des taux de survie mais peuvent induire une stérilité. L’extraction chirurgicale de sperme testiculaire en amont de tout traitement à visée oncologique (onco-TESE) est proposée en cas d’impossibilité de réalisation d’une autoconservation. Elle permet de s’affranchir de la gonadotoxicité des thérapeutiques et augmente les taux de cryoconservation chez les patients ayant une azoospermie lors de la découverte du cancer. Facilement réalisable au décours d’une chirurgie testiculaire (ou de la mise en place d’une chambre implantable), elle ne retarde pas l’initiation d’un traitement à visée oncologique. Conclusion Ces éléments doivent inciter les urologues et oncologues à proposer l’onco-TESE à leurs patients en cas d’échec d’autoconservation afin de leur offrir via l’assistance médicale à la procréation les meilleures chances de paternité. Summary Objective Focus on the place of surgical testicular sperm extraction (TESE) prior to any potentially gonadotoxic cancer therapy (Onco-TESE) in the fertility preservation strategy in neoplastic context. Method Reminder principle, indications and technique of onco-TESE based on the analysis of the literature and personal experience of the author. Results The incidence of young men cancers (testicular, lymphoma) is growing. The current treatment combining surgery, radiotherapy or chemotherapy permits an improvement in survival rate but can induce infertility. The surgical testicular sperm extraction prior to any oncological therapy (Onco-TESE) is proposed in case of impossibility of performing a self-preservation. It eliminates the therapeutic gonadotoxicity and increases the rates of cryopreservation in patients with azoospermia when discovering cancer. Easily achievable with the waning of a testicular surgery (or the establishment of an implantable chamber), it does not delay the initiation of oncological treatment. Conclusion These data should encourage urologists and oncologists to propose the onco-TESE to their patients in case of failure of self-preservation so as to offer them better chances of paternity via medically assisted procreation. [ABSTRACT FROM AUTHOR]

The objective of our study was to determine whether nucleic acid testing could detect HIV RNA or hepatitis C virus (HCV) RNA in a large series of seronegative organ and tissue donors, and whether this technique should be routinely used to improve viral safety of grafts. We studied 2236 organ donors, 636 tissue donors, and 177 cornea donors. We identified five HCV RNA-positive donors in 2119 HCV-seronegative organ donors, and one HCV RNA-positive donor in 631 HCV-seronegative tissue donors. No HIV-seronegative, HIV RNA-positive donor was identified. Our data suggest that routine nucleic acid testing of organ and tissue donors might increase viral safety in transplantation. [Copyright &y& Elsevier]

Résumé Introduction Depuis la naissance de Louise Brown par fécondation in vitro en 1978, les avancées en aide médicale à la procréation n’ont cessé de se développer. Le présent article a pour objet de faire un état des lieux des principaux examens réalisés dans le cadre de l’aide médicale à la procréation. Méthodes Résumé des recommandations, des guides de bonnes pratiques, des guides de formation et d’articles de référence. Résultats Certains examens sont utilisés en routine alors que d’autres sont du domaine de la recherche clinique. Discussion La prescription d’examens en infertilité doit prendre en compte la pertinence de ces examens toujours orientés par la clinique et le coût qu’ils engendrent. Summary Introduction Since the birth of Louise Brown in 1978 with IVF, assisted reproductive technologies (ART) are continually involving. The goal of this present study is to make a current situation of principles exams used in ART. Methods Summary of recommendations, best practice's guides, formation's guides and reference articles. Results Some exams are routine clinical used and others are not validated yet or are still in research field. Discussion Exams prescriptions in infertility have to be relevant and clinical-oriented and have to take into account the cost of these exams. [ABSTRACT FROM AUTHOR]

The aim Of this work was to check the hypothesis that increased cardiac aldosterone level combined with arterial hypertension may enhance the deleterious effects at the heart level. Transgenic mice overexpressing Aldo Synthase (AS) in cardiomyocytes and wild type (WT) littermates were submitted to AngII-induced hypertension by osmotic pump (1mg/kg/day) during 3 or 8 weeks. Results: 1) Physiological analysis indicated that the arterial pressure increased similarly (+50 mmHg) in AngII-perfused groups whatever the genotype. At the ventricular level, the hypertrophy and the fibrosis (×3, p<0.05) developed identically in the 2 AngII-groups (p<0.05 versus matched groups) independently of the time. In contrast, at the level of the atria, 3 wk AngII perfusion significantly worsened the dilatation +46% for AS mice and +33% for WT (p<0.05 versus matched groups) and fibrosis in AS mice (+20% AngII AS versus AngII WT, p<0.05). In the 8 wk perfused groups, the atrial diameters and the fibrosis were increased compared to 3 weeks. Besides, we noticed that AngII increased more P wave duration in AS mice than in WT. Interestingly Eplerenone treatment (50mg/kg/day) prevented all these changes. 2) The electrical changes led us to study the atrial expression of connexin (C×) 40 and 43. In AS mice at basal state, we found a 4-fold increase in functional C×43 when compared to WT whereas the functional levels of C×40 were similar in both groups. In AngII-mice we found a decrease of functional C×40 (–50% and –40% in AS and WT mice, respectively) whereas functional C×43 increased by 30% whatever the genotype. In conclusion: We show for the first time that both cardiac aldosterone and AngII regulate the expression of C×40 and 43 in mouse left atria. In addition our results suggest that cardiac aldosterone worsened the deleterious effects of AngII-induced hypertension on left atria, through increases in dilatation, fibrosis and it increases conduction time. [Copyright &y& Elsevier]

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PURPOSE: A history of cryptorchidism is one of the most common causes of azoospermia. It is traditionally associated with forms of non-obstructive azoospermia (NOA). We sought to study the andrological characteristics and the possibility of using ICSI with sperm removed surgically in patients with azoospermia and with a history of cryptorchidism. MATERIAL AND METHODS: A retrospective study of a population of 180 patients with azoospermia, operated for a surgical extraction of sperm between 1995 and 2007. Analysis of the andrological phenotype, azoospermia mechanisms and rates of surgical extraction of sperm. Comparison of extraction rates between a group of NOA with history of cryptorchidism and a group of idiopathic NOA. RESULTS: The rate of surgical extraction of sperm is 65%. This rate is not influenced by the uni- or the bilateral cryptorchidism. Twenty nine patients in our series (16.1%) have obstructive azoospermia (OA) with a surgical extraction rate of sperm of 93%. The mechanism of non-obstructive azoospermia is predominant as it concerns 151 patients (83.9%). The extraction rate is 59.6%. Of these, 11 patients have other factors of infertility that could explain the NOA (genetic, toxic …). The 140 patients with NOA and with only factor of infertility a history of cryptorchidism, were compared to a group of patients with idiopathic NOA. The rate of extraction is significantly higher if history of cryptorchidism: 60.7% versus 39.8% (p <0.01). CONCLUSIONS: The history of cryptorchidism is not synonymous with NOA, although it remains the predominant mechanism of azoospermia in this population. Where there is OA, extraction rates remain excellent and do not seem influenced by the history of cryptorchidism. In the case of NOA, the history of cryptorchidism is a factor of better prognosis in terms of surgical extraction of sperm than the idiopathic forms. [Copyright &y& Elsevier]

The aim of this work was to check the hypothesis that increased cardiac aldosterone level combined with arterial hypertension may be deleterious for the heart. Transgenic mice overexpressing Aldo Synthase (AS) in cardiomyocytes and wild type (WT) littermates were submitted to AngII treatment by osmotic pump (1mg/kg/day) during 3 and 8 weeks. Results: 1) Same levels of hypertension were observed in all treated groups whatever the genotype. Ventricular remodelling was equivalent in terms of LVH at 3wks and 8 wks in AngII-treated groups (ratio HW/BW +10 % for AS and WT after AngII, p<0.05) and fibrosis (×3 for AngII groups, p<0.05). Eplerenone treatment (50mg/kg/day) prevented these changes. In contrast, after 3 wks of AngII treatment atrial remodelling was worsened with increased dilatation (0.220±0.003cm vs 0.200±0.003cm for WT, p<0.05) and fibrosis (3.13±0.26 % vs 2.64±0.16 % for WT, p<0.05) in AS mice. This phenotype was aggravated in 8 weeks treated mice with an atrial diameter of 0.240±0.004cm in AS vs 0.220±0.004cm (p<0.05) in WT mice. Atrial fibrosis was 4.2±0.6 % in AS vs 3.6±0.2 % in WT (p<0.55). We also observed a longer P wave duration in AS mice after AngII than in WT (for 3 wks treatment, 18.78±0.45ms vs 17.15±0.38ms for WT, p<0.01 and at 8 wks 22.00±0.42ms vs 20.98±0.83ms for WT, p<0.05). 2) This electrical change led us to study the expression of atrial connexin (Cx) 40 and 43. AS mice showed a decrease of about 50 % of C×43 at basal state compared to WT but C×40 levels remained unchanged. AngII treatment decreased about 50 % C×43 and C×40 expression in WT mice. For AS mice, AngII induced an increase of about 50 % of C×40 expression but C×43 expression was not affected. In conclusion, these results suggest that cardiac aldosterone combined with AngII hypertension have deleterious effects on left atria: it increases dilatation and fibrosis and it increases conduction time by regulating expression of C×40 and 43. [Copyright &y& Elsevier]