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The use of new lightweight meshes in pelvic organ prolapse (POP) surgery may reduce complications related to mesh retraction (chronic pain, dyspareunia, and mesh exposure). The aim of this study was to investigate changes in the area and position of Uphold Lite™ mesh 6 weeks and 12 months after anterior and/or apical prolapse repair. This observational prospective multicenter study included patients who had undergone transvaginal surgery for symptomatic POP-Q stage ≥ II anterior and/or apical compartment prolapse with placement of Uphold Lite mesh. The dimensions and position of the mesh were evaluated at 6 weeks and 12 months by ultrasonography. Correlations between ultrasonographic mesh characteristics and POP recurrence were analyzed. Fifty evaluable women with an average age of 66.8 years were included. No statistically significant difference in mesh area was found between week 6 and month 12 postoperatively, either at rest (1746.92 vs. 1574.48 mm2; p = 0.15) or on Valsalva (1568.81 vs. 1542.98 mm2; p = 0.65). The ROC-AUC of the distance between the mesh and the bladder neck (M-BN) at 6 weeks for predicting cystocele recurrence at 12 months was 0.764 (95% CI 0.573–0.955) at rest and 0.724 (95% CI 0.533–0.916) on Valsalva. An M-BN distance > 12.5 mm could predict cystocele recurrence at month 12 with a sensitivity of 80% and a specificity of 69%. Ultrasonographic measurements of the Uphold Lite™ mesh appear to remain stable between 6 weeks and 12 months postoperatively. M-BN distance correlates with cystocele recurrence. These results appear to confirm the value of ultrasound in mesh evaluation.

Objective To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design Prospective cohort study using a registry. Setting Nineteen French surgical centres. Population A total of 2309 women participated between 2017 and 2019. Methods A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures Serious complications and subsequent reoperations for POP recurrence. Results The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. Conclusions Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Tweetable abstract Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.

Obstetric anal sphincter injury (OASI) is strongly associated with a major negative impact on women's health. Due to the consequences of an undiagnosed and therefore unrepaired OASI, it is essential to prevent or at least diagnose OASI at childbirth. We need to promote training of professionals to improve OASI screening at childbirth. High-risk situations such as operative delivery must be identified and preventive strategies such as the choice of a less traumatic instrument (vacuum) and mediolateral episiotomy should be considered. For a woman with OASI and/or symptoms, postnatal consultation with a specialist on pelvic floor disorders is essential to correctly orient her toward an adequate care pathway and to eventually identify occult or underestimated OASI. More data are required on therapeutic approaches for symptomatic women, primarily including physical therapy, sacral neuromodulation, delayed sphincter repair and palliative devices.

International audience; Objectifs : la chirurgie de l’incontinence urinaire d’effort (IUE) par bandelettes sous-urétrales (BSU) fait l’objet d’essais cliniques limités en taille, rapportant peu les complications rares et la qualité de vie (QdV). Les registres permettent de rapporter ces complications rares dans la pratique courante et de mesurer la QdV globale, du point du vue des troubles urinaires et pelviens.Méthodes : l’objectif du registre VIGI-MESH est de spécifier l’incidence de ces complications rares et graves en fonction des différents types de BSU (rétropubiennes, transobturatrices, à incision unique/mini-bandelettes) ainsi que de mesurer cette QdV après la pose de BSU. Entre février 2017 et novembre 2019, chaque chirurgie initiale ou de reprise de BSU dans un des 18 centres participants était colligée sur un formulaire par le chirurgien. Un contrôle était effectué à partir des pharmacies délivrant les dispositifs médicaux implantés et des actes codés par les centres participants. Un questionnaire recherchant une complication était envoyé à toutes les patientes à un an. Il comportait également des questions validées en français sur le bien-être ressenti et l’amélioration des symptômes (WHO, European Quality of life Questionnaire 5 Dimensions [EQ5D], Patient Global Impression of Improvement [PGI-I]) Les complications ont été gradées selon la classification de Clavien–Dindo : arrêt de l’intervention sans pose de matériel (grade III), intervention chirurgicale ultérieure secondaire à une complication (grade III), complication menaçant la vie (grade IV), décès de la patiente (grade V).Résultats : quatre-vingt-deux patientes ont eu des complications de grade ≥ III : 5,7 % (53/923) voie rétropubienne, 4,0 % (21/521) voie transobturatrice et 2,2 % (8/370) mini-bandelette. Dix complications peropératoires ont empêché la pose de BSU. La BSU a été desserrée dans les 48 h dans 6 cas. Le risque de complication était 3 fois plus faible avec une mini-bandellette par rapport à une BSU rétropubienne (RR = 0,36 [0,170,75]), le risque n’était pas significativement différent entre les approches transobturatrice et rétropubienne (RR = 0,67 [0,40–1,11]). Vingt-sept femmes (1,5 %) ont eu une reprise chirurgicale pour échec ou récidive, 15 après BSU rétropubienne (1,6 %), 7 après bandelette transobturatrice (1,4 %) et 5 après mini-bandelette (1,4 % ; p = 0,95) (Fig. 1). La procédure a consisté à retendre la BSU (9 cas), injection de Bulkamid® (2 cas) et mise en place d’une seconde BSU (16 cas). Parmi les 1167 patientes contactées par courrier, 692 réponses (59,3 %) ont été retournées à un an ou plus après la chirurgie. À la question « Que pensez-vous de votre état de santé actuel par rapport à ce qu’il était avant votre chirurgie pour incontinence ou prolapsus ? » 91,4 % (608/665) se sentaient mieux (beaucoup mieux, mieux ou un peu mieux) (PGI-I). L’amélioration ressentie était meilleure en l’absence de complications graves ≥ III (p = 0,008). Parmi les patientes, 96,2 % (630/655) ont évalué leur état de santé général comme étant bon (très bon, bon ou assez bon). L’état de santé général ressenti était similaire qu’elles aient eu ou non des complications. Par rapport à la population française du même âge, les patientes opérées d’une BSU ont déclaré avoir un meilleur état de la santé.Conclusion : les premiers résultats du registre VIGI-MESH montrent que les mini-bandelettes sont une option thérapeutique avec une efficacité à moyen terme similaire aux voies rétropubiennes et transobturatrices avec moins de complications. Ils montrent également que plus de 90 % des patientes rapportent avoir été améliorées par la mise en place d’une BSU pour IUE. Le ressenti de l’état de santé global des patientes opérées était meilleur que celui de la population française féminine du même âge. Néanmoins, une analyse à plus long terme est nécessaire pour confirmer ces premiers résultats.

IntroductionAlthough aircraft noise is known to impact human health, the biological pathway is still unclear. One of the possible pathway is that aircraft noise exposure may induce a modification o...

Resume Introduction Les recommandations internationales pour l’administration de la vitamine D (25-OH) chez les prematures sont divergentes (800–1000 UI/jour en Europe, 200 UI/kg sans depasser 400 UI/j aux Etats-Unis). Les nouveau-nes prematures de faible poids de naissance sont a risque de carence, mais egalement de surdosage en 25-OH. Methode Entre 2013 et 2015, 16 anciens prematures ( Resultats L’âge gestationnel etait de 27 (24–35) SA pour un poids de 810 (560–2120) grammes. Le signe d’appel du surdosage en 25-OH avait ete une nephrocalcinose (37 %), une hypercalcemie (44 %) ou une hypercalciurie (19 %). L’âge le jour du signe d’appel etait de 36,6 (27,6–47,6) SA. Un dosage de 25-OH avait ete realise 13 (0–281) jours apres le signe d’appel ; la concentration en 25-OH etait alors de 210 (119–350) nmol/L et celle en 1-25(OH), lorsqu’elle avait ete mesuree (n = 10), de 370 (245–718) pmol/L. Apres arret de la supplementation, la 25-OH s’etait normalisee chez 10 patients dans un delai de 10 (3–32) mois. Conclusion Le diagnostic de surdosage en 25-OH chez les anciens prematures doit etre envisage devant l’existence d’une nephrocalcinose, d’une hypercalcemie ou d’une hypercalciurie. Il justifie la realisation d’un dosage de la 25-OH. La supplementation en vitamine D est essentielle pour une formation osseuse optimale mais les objectifs cibles superieurs ne devraient probablement pas exceder 120 nmol/L.

Latinoamérica ha mostrado una reducción importante de la mortalidad infantil en los últimos años. El objetivo del estudio buscó analizar los datos oficiales correspondientes a niños menores de cinco años en Colombia, haciendo énfasis en las causas externas de muerte, que han sido menos estudiadas. Pacientes y Método: Diseño descriptivo y transversal que utilizó información secundaria proveniente de los registros de defunción reportados por el Departamento Administrativo Nacional de Estadística (DANE) y las tablas dinámicas de información de estadísticas vitales del sistema oficial de información del Ministerio de Salud y Protección Social (SISPRO), entre los años 2005 y 2013. La información se organizó en tablas para el análisis descriptivo de variables como edad, sexo, y causa específica de muerte, por departamentos del país. Resultados: En este período fallecieron 106.339 niños menores de 5 años; 85.897 de ellos (81%) en el primer año de vida. De 14.266 niños fallecidos en 2005, se pasó a 9.499 en 2013. Entre las causas externas de muerte, la primera es ahogamiento, responsable de 1.749 fallecimientos, seguida de accidentes de transporte, con 1.282. Los homicidios fueron responsables de 692 muertes. En todas las causas analizadas hubo un descenso durante el decenio. Discusión: Colombia va cumpliendo el cuarto objetivo del milenio, “reducir la mortalidad de los niños menores de 5 años”. Se ha avanzado en muertes de causa externa, pero todavía hay camino por recorrer.

International audience; Objectifs : le prolapsus des organes pelviens (POP) de la femme est une situation fréquente qui mène dans 19 % des cas à un traitement chirurgical. Le registre VIGI-MESH a permis de collecter les interventions chirurgicales de POP dans 19 centres et à surveiller les complications et les révisions chirurgicales. Nous présentons ici les premiers résultats à moyen terme de notre registre.Méthodes : l’analyse comprend 2 341 patientes dont la chirurgie prévue était une promontofixation par laparoscopie avec prothèse (n = 1 143), une chirurgie transvaginale avec prothèse (n = 694) ou sans prothèse (n = 504). La promontofixation a été converti dix fois (0,9 %) : 5 par laparotomie, 2 fixations latérales par laparoscopie, 3 voies transvaginale dont 2 avec prothèse. Les patientes étaient plus jeunes, avec moins de comorbidités dans le groupe promontofixation, et avec plus d’antécédents chirurgicaux chez les patients opérés par voie vaginale. Il y a une majorité de chirurgie avec prothèse en cas de prolapsus antérieur ou apical.Résultats : avec 15 mois de suivi médian, nous avons observé des complications Clavien–Dindo grade III ou plus chez 48 patientes (2,05 %). L’incidence de complications graves à 12 mois est significativement supérieure pour la réparation vaginale prothétique soit 3,71 % [2,28–5,13] versus 1,27 pour la réparation vaginale non prothétique [0,25–2,29] et 1,44 pour la promontofixation [0,71–2,167] avec p = 0,005 (Fig. 1). Il y a 29 réinterventions (1,24 %) en raison d’échec ou de récidive du prolapsus : 11 après promontofixation (0,96 %), 6 après prothèse vaginale (0,86 %) et 12 après réparation vaginale autologue (2,38 %). La réparation vaginale native comporte un risque de reprise chirurgicale pour prolapsus récidivé trois fois plus élevé qu’en cas de promontofixation (RR 0,34 [0,15–0,77]) ou de prothèse vaginale (RR = 0,29 [0,11–0,76]) .Conclusion : dans notre registre, la promontofixation présente le meilleur ratio bénéfice/risque par rapport à la réparation vaginale. Cette dernière expose à un faible risque de complications en cas de réparation autologue mais avec un risque de récidive 3 fois plus élevé et à l’inverse à un faible risque de récidive en cas de chirurgie prothétique mais avec un risque de complication grave 3 fois plus élevé.

Objectifs Lors d’une chirurgie pour incontinence urinaire d’effort et/ou prolapsus genital des dispositifs medicaux non-resorbables sont souvent utilises. Les complications dependent de l’experience du chirurgien, des caracteristiques des patientes, de la voie d’abord, de la technique de pose, et des materiaux utilises. L’observatoire VIGIMESH permet depuis 2017 un recueil prospectif de l’utilisation de ces dispositifs et de leurs complications (exposition, complications fonctionnelles [douleur, obstruction, consequences sexuelles]). Methodes A partir de fevrier 2017, dans les 13 centres participants toutes les patientes operees d’une incontinence urinaire d’effort (IUE) et/ou un prolapsus genital ou rectal pouvaient participer au suivi. Seuls les patientes ayant une bandelette sous-uretrale (BSU) ou une colposuspension, une reparation vaginale avec ou sans meche par voie vaginale ou abdominale ou une reparation endo-anale ont ete incluses. Les patientes ayant une pose de sphincter urinaire artificiel, de ballons peri-uretraux ou des injections de produits de comblements n’ont pas ete incluses. Chaque chirurgien declarait leurs interventions et complications. Celles-ci etaient verifiees avec les informations du departement d’information medicale et par des questionnaires de suivi. Resultats Au total, 1873 patientes ont ete incluses et analysees. Les chirurgies index ont ete reparties en 5 groupes ( Tableau 1 ). Les patientes operees d’une IUE isolee par BSU ont beneficie dans la moitie des cas d’une procedure retropubienne (338 cas soit 51,4 %). Quinze patientes ont eu un colpocleisis dans le groupe reparation vaginale sans materiel. Soixante-trois plaies peroperatoires (3,36 %) ont ete rapportes (34 de vessie, 2 de l’uretre, 2 du rectum et 19 du vagin). Seulement dans 8 cas ces plaies ont amene a l’arret de l’intervention et/ou de la mise en place de materiel. Cinquante-deux patientes (2,78 %) ont eu des complications graves durant la chirurgie ou dans les premiers mois postoperatoires (grade III ou plus) ( Tableau 2 et Fig. 1 ). Sept patientes ont necessite de multiples interventions pour traiter la complication. Conclusion L’observatoire est un outil qui permet de rapporter, de facon organisee, les complications des chirurgies du plancher pelvien et permettra sur le plus long terme de comparer les differents materiaux utilises et techniques d’implantation. Il permettra egalement a terme de proposer des recommandations sur la prevention et la prise en charge des complications de ces chirurgies et de leurs sequelles.

Resume Introduction Les benzodiazepines sont largement utilisees en geriatrie, mais exposent a des evenements iatrogenes graves comme des chutes. L’analyse de leurs consommations s’avere complexe (nombreuses specialites, dosages). Notre objectif est de construire un outil d’analyse des consommations de benzodiazepines, et d’evaluer le lien entre cette information et les chutes des patients de trois etablissements geriatriques. Methodes Des coefficients de conversion retrouves dans la litterature nous ont permis de rapporter l’action des benzodiazepines a un comparateur unique : le diazepam. Les consommations de benzodiazepines observees sur 20 mois consecutifs ont ete collectees et ponderees par l’activite des etablissements. Une correlation entre ces consommations et le nombre de chutes signalees durant la meme periode a ete recherchee. Resultats Les consommations de benzodiazepines exprimees en nombre de milligrammes d’equivalent diazepam par jour d’hospitalisation sont significativement liees au nombre de chutes signalees sur la meme periode (R = 0,63 ; p Discussion et conclusions Ces resultats sont concordants avec la litterature : les chutes sont statistiquement liees a la consommation de benzodiazepines, mais la reduction de cette consommation est de faible valeur pronostique (caractere multifactoriel des chutes). Cet indicateur permet d’analyser la consommation de benzodiazepines aussi bien en termes d’exposition globale que de repartition par molecule. Son lien avec les evenements iatrogenes majeurs que constituent les chutes en fait un outil de suivi interessant pour les cliniciens et les pharmaciens.

Osteocalcin is a hormone secreted by osteoblasts, which regulates energy metabolism by increasing β-cell proliferation, insulin secretion, insulin sensitivity, and energy expenditure. This has been demonstrated in mice, but to date, the evidence implicating osteocalcin in the regulation of energy metabolism in humans are indirect. To address this question more directly, we asked whether a benign osteoblastic tumor, such as osteoma osteoid in young adults, may secrete osteocalcin. The study was designed to assess the effect of surgical resection of osteoid osteoma on osteocalcin and blood glucose levels in comparison with patients undergoing knee surgery and healthy volunteers. Blood collections were performed the day of surgery and the following morning after overnight fasting. Patients and controls were recruited in the orthopedic surgery department of New York Presbiterian Hospital, NY-USA and Hospices Civils de Lyon, France. Seven young males were included in the study: two had osteoid osteoma, two underwent knee surgery, and three were healthy volunteers. After resection of the osteoid osteomas, we observed a decrease of osteocalcin by 62% and 30% from the initial levels. Simultaneously, blood glucose increased respectively by 32% and 15%. Bone turnover markers were not affected. This case study shows for the first time that osteocalcin in humans affects blood glucose level. This study also suggests that ostoid osteoma may be considered, at least in part, as an osteocalcinoma.

Resume Les tests ELISA et d'inhibition de l'hemagglutination ont ete compares pour la recherche des anticorps Newcastle lors de vaccination par goutte oculaire au moyen de virus type La Sota. Les deux tests sont positifs des le 6eme jour, moment ou seules des IgM specifiques sont observees. Les IgG specifiques apparaissent entre le 7eme et le 8eme jour. On ne trouve pas d'IgA specifiques dans le serum des volailles vaccinees. Une fixation non specifique des IgM sur l'antigene s'observe en methode ELISA. Le test d'inhibition de l'hemagglutination est aussi sensible et plus specifique que le test ELISA pour la recherche des anticorps Newcastle. Zusammenfassung Serologische Diagnostik der Newcastle Disease durch Hamagglutinationshemmungstests und ELISA Kinetik der verschiedenen vakzinalen Antikorperklassen Die ELISA- und Hamagglutinationshemmungstests wurden, um die Newcastle-Antikorper bei der Vakzinierung durch Augentropfen mittels Virus des Types La Sota zu untersuchen, verglichen. Die beiden Tests sind ab dem 6. Tag, wenn nur die spezifischen IgM beobachtet werden, positiv. Die spezifischen IgG erscheinen zwischen dem 7. und 8. Tag. Es gibt keine spezifischen IgA im Serum des vakzinierten Geflugels. Eine unspezifische Verbindung der IgM am Antigen wird mit dem ELISA beobachtet. Um die Newcastle-Antikorper zu untersuchen, ist der Hamagglutinationshemmungstest gleich sensible und spezifischer als der ELISA-Test. Summary Serological diagnosis of Newcastle Disease by haemagglutination inhibition and ELISA tests Kinetics of different classes of vaccinal antibodies The ELISA and HI tests were compared in investigating the antibody response following eyedrop vaccination with La Sota types of Newcastle Disease virus. Both were positive from day 6, when only specific IgM was detected. Specific IgG in the serum of vaccinated fowls appeared between days 7 and 8. No specific IgA was detected in the serum of vaccinated birds. A non-specific binding of IgM to the antigen was revealed by the ELISA test. For the study of ND antibodies the HI test is just as sensitive and more specific than the ELISA test. Resumen El diagnostico de la enfermedad de Newcastle por las pruebas de inhibicion de la hemaglutinacion y ELISA Se compararon las pruebas ELISA y de inhibicion de la hemaglutinacion para examinar los anticuerpos Newcastle en la vacunacion por gota ocular mediante virus tipo La Sota. Ambas pruebas son positivas a partir del dia 6°, si solo se tienen en cuenta las IgM especificas. Las IgG especificas aparecen entre el dia 7° y 8°. No hay ninguna IgA especifica en el suero sanguineo de las aves vacunadas. Se observa con la ELISA una fijacion inespecifica de las IgM als antigeno. Para estudiar los anticuerpos Newcastle, la prueba de inhibicion de la hemaglutinacion es mas sensible y especifica que la prueba ELISA.

International audience; We found for the first time that in maintenance hemodialysis patients, higher sclerostin serum level was associated with severe abdominal aortic calcification (AAC). In addition, cortical bone microarchitecture (density and thickness) assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at tibia was also independently associated with severe AAC. These results suggest that sclerostin may be involved in the association of mineral and bone disorder with vascular calcification in hemodialysis patients. INTRODUCTION: Severe abdominal aortic calcifications are predictive of high cardiovascular mortality in maintenance hemodialysis (MHD) patients. In patients with end-stage renal disease, a high aortic calcification score was associated with lower bone turnover on bone biopsies. Thus, we hypothesized that sclerostin, a Wnt pathway inhibitor mainly secreted by osteocytes and acting on osteoblasts to reduce bone formation, may be associated with vascular calcifications in MHD patients. METHODS: Fifty-three MHD patients, aged 53 years [35-63] (median [Q1-Q3]) were included. Serum was sampled before the MHD session to assay sclerostin. Framingham score was computed and the abdominal aortic calcification (AAC) score was assessed according to Kauppila method on lateral spine imaging using DEXA. Tibia bone status was evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT). Patients were distributed into two groups according to their AAC score: patients with mild or without AAC (score below 6) versus patients with severe AAC (score of 6 and above). RESULTS: In multivariate analysis, after adjustment on age, dialysis duration and diabetes, serum sclerostin and cortical thickness were independently associated with severe AAC (odds ratio (OR) = 1.43 for each 0.1 ng/mL increase [95 % confidence interval (CI) 1.10-1.83]; p = 0.006 and 0.16 for 1 SD increase [0.03-0.73]; p = 0.018, respectively). A second cardiovascular model adjusted on Framingham score and the above mentioned confounders showed similar results. CONCLUSIONS: Elevated sclerostin serum level and poorer tibia cortical bone structure by HR-pQCT were positively and independently associated with higher odds of severe AAC in MHD patients. Serum sclerostin may become a biomarker of mineral and bone disorder and vascular risk in MHD patients.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 8 - p. 822-825

Adrenal insufficiency is a rare but life-threatening disease. Replacement therapy sometimes fails to prevent an acute adrenal crisis and most often does not lead to restoration of well-being. We report here the 1-year outcome of the first simultaneous kidney-adrenal gland-pancreas transplantation in a 33-year-old patient with type 1 diabetes and concomitant autoimmune adrenal insufficiency. En bloc left adrenal gland and kidney grafts were anastomosed on the left iliac vessels in normal vascular conditions and the pancreas graft was anastomosed on the right iliac vessels. The immunosuppressive regimen was not modified by the addition of the adrenal gland. We observed no additional morbidity due to the adrenal gland transplantation, as there were no surgical complications. One-year kidney and pancreas graft functions were satisfactory (estimated glomerular filtration rate: 55 mL/min/1.73 m(2) and HbA1c: 4.8%). The adrenal graft functioned well at 12 months with a normalization of cortisol and aldosterone baseline levels. Functional imaging at 3 months showed good uptake of [(123) I]-metaiodobenzylguanidine by the adrenal graft. Transplantation of the adrenal gland en bloc with the left kidney appears to be a good therapeutic option in patients with adrenal insufficiency awaiting kidney or kidney-pancreas transplantation.

Administration of large oral doses of retinyl palmitate has become the most widely practised vitamin A deficiency prevention strategy in developing countries. We conducted a follow-up study among 220 Senegalese children aged 2–7 years suffering from moderate undernutrition to determine the efficacy of vitamin A treatment on their vitamin A status assessed by biochemical and cytological (impression cytology with transfer) methods. The first examination (T= 0 m[onth]) was carried out during April 1989, before the mango (Mangifera indicaL,) harvest. The second examination (T= 2 m) was carried out 2 months after vitamin A treatment during June 1989 when ripe mangoes become widely available. Conjunctival cells of the eyes of the children with or without ocular inflammation were responsive to vitamin A administration (P< 0.01). There was a significant increase (P< 0.001) in mean serum retinol and β-carotene levels betweenT= 0 m andT= 2 m. Mean serum retinol-binding protein (RBP) and transthyretin (TTR) levels did not differ significantly (P> 0.05) atT= 0 m andT= 2 m. Despite the intake of vitamin A, 54% of the children who had abnormal cytology atT= 0 m remained abnormal atT= 2 m. This was due to inadequate levels of TTR and RBP, presumably due to the cereal diet eaten by the Senegalese population. Children with abnormal eye cytology had lower serum retinol levels than those with normal eyes atT= 0 m, and β-carotene values did not correlate with eye cytological abnormalities atT= 0 m. Children with normal cytology had higher serum retinol and also β-carotene levels than those with abnormal cytology after massive oral doses of vitamin A and consumption of mangoes atT= 2 m. Retinyl palmitate may, therefore, only lead to partial cytological improvement due to a lack of retinol-carrier proteins but dietary β-carotene may also be involved

The evaluation of the prevalence of ophthal- mological diseases and vitamin A deficiency in Senegalese pre- school-aged children enabled us to confirm the method of impression cytology with transfer (ICT) and to assess the impact of ophthalmological diseases on the cytological appearance of conjunctival cells. A simplification ofthe ICT method consisted of transferring cells present on a strip of paper to a glass slide by finger pressure. Harris-Schorr staining of the sample papers confirmed the results obtained by the transfer. Inflammatory trachoma influenced the results of the test. This simple method will prove very helpful for detection of vitamin A deficiency in children in underdeveloped areas. Am J Clin Nutr 1991; 53:66-9.

Aminoglycoside-resistant strains of Staphylococcus and Enterococcus, approximately 500 of each, were screened by dot blot hybridization for the presence of genes encoding aminoglycoside-modifying enzymes. The MICs of various aminoglycosides for the strains were determined, and the enzyme contents of the cells were inferred from the resistance phenotypes. The agreements (in percent) of the hybridization results with the deduced enzyme contents for Staphylococcus and Enterococcus species were, respectively, 80 and 87.6 for ANT(6) (aminoglycoside nucleotidyltransferase), 99.8 and 100 for both APH(3') (aminoglycoside phosphotransferase) and APH(2")-AAC(6') (aminoglycoside acetyltransferase), and 100 and 100 for ANT(4'). The weak correlation obtained with the probe for ANT(6) was due to the fact that gram-positive cocci can also be streptomycin resistant by synthesis of APH(3") or ANT(3")(9) and by ribosomal mutation. The remaining probes appeared to be specific: they hybridized with all the resistant clinical isolates but not with the susceptible strains. These results indicate that, except for streptomycin, nucleic acid hybridization is a valid approach for the detection and characterization of aminoglycoside resistance in gram-positive cocci.

The National Kidney Foundation/Kidney-Dialysis Outcome Quality Initiative guidelines recommend to maintain the serum intact parathyroid hormone (PTH) concentration between 150 and 300 ng/l in chronic kidney disease (CKD) stage 5 patients. As these limits were derived from studies that used the Allegro intact PTH assay, we aimed to evaluate whether they were applicable to other PTH assays. We compared the PTH concentrations measured with 15 commercial immunoassays in 47 serum pools from dialysis patients, using the Allegro intact PTH assay as the reference. We also evaluated the recovery of graded amounts of synthetic 1–84 and 7–84 PTH added separately to a serum pool. Although the assays were highly correlated, the concentrations differed from one assay to another. The median bias between the tested assays and the Allegro intact PTH assay ranged from -44.9 to 123.0%. When the PTH concentrations were 150 or 300 ng/l with the Allegro intact PTH assay, they ranged with other assays from 83 to 323 ng/l and from 160 to 638 ng/l, respectively. The tested assays recognized 7–84 PTH with various cross-reactivities, whereas a given amount of 1–84 PTH was recovered differently by these assays. We found important inter-method variability in PTH results owing to both antibody specificity and standardization reasons. The unacceptable consequence is that opposite therapeutic attitudes may be reached in a single patient depending on the PTH assay used. We propose to use assay-specific decision limits for CKD patients, or to apply a correcting factor to the PTH results obtained with a given assay.

Biochemical markers of bone turnover have for several years been considered as valuable parameters in research clinical studies, but their use in individual patients is still debated. Recently several position papers have proposed guidelines for their use in clinical practice in patients with post menopausal osteoporosis. In the present article, we report the results of a survey which aims at comparing the actual modalities of prescription of French physicians with the above-mentioned recommendations. We contacted by phone clinical chemists from 158 different hospitals and asked them to transmit to the concerned physicians of their hospital a detailed questionnaire for assessing which bone marker(s) is (are) prescribed and for which purpose (s), and if not prescribed, the reason of non prescription. We were able to analyze 309 questionnaires from 89 hospitals including 5 specialties, rheumatology (35.9%), endocrinology (18.1%), gynecology (11.0%), internal medicine (22.0%) and geriatry (12.9%). The results showed large discrepancies between the mode of prescription of a subset of physicians and the guidelines. The most often evoked reason for non prescription was a lack of information about bone markers suggesting a need for teaching courses. This survey has also shown that many physicians do not know exactly which parameters are effectively measured in their hospital and which are addressed to specialized laboratories underlining the importance of the dialogue between clinicians and clinical chemists. We propose that in a given hospital, the present article may serve as a basis for a discussion between clinicians and biologists about the development and/or the optimization of the measurements of these markers of bone turnover.

BACKGROUND YKL-40 is a 40 kDa glycoprotein secreted by chondrocytes and synoviocytes. It has been suggested that it is a surrogate marker of synovial inflammation and joint destruction in rheumatoid arthritis (RA) and osteoarthritis (OA) and related to C reactive protein (CRP) serum levels in RA. OBJECTIVE To study serum levels of YKL-40 in patients with hip OA and its relation with CRP. METHODS YKL-40 and CRP were assayed in serum samples from 45 patients (24 women, 21 men, mean age 65) with symptomatic OA of the hip and 33 healthy controls. YKL-40 was assayed by immunoassay and CRP by ultrasensitive immunonephelometry. OA severity was assessed by the measurement of joint space width with a computer analysis system of digitised hip radiographs. Statistical analysis was performed to determine correlations between serum markers and radiological joint space width. RESULTS The mean (standard error) YKL-40 level was 90.3 (8.2) ng/ml in patients with hip OA and 66.9 (8.2) ng/ml in controls (p=0.03). The mean CRP level was 2.93 (3.03) mg/l in OA and 1.40 (1.61) mg/l in controls (p=0.006). The serum levels of YKL-40 and CRP increased with age and were significantly correlated (Spearman test: r s =0.42, p=0.005) in patients but not in controls. Neither YKL-40 nor CRP correlated with radiographic joint space width. CONCLUSIONS Serum YKL-40 was significantly increased in patients with hip OA. The correlation between YKL-40 and CRP suggests that YKL-40 may be a marker of joint inflammation in OA. Longitudinal studies are required to assess the usefulness of YKL-40 in the monitoring of patients with hip OA.

OBJECTIVES--To determine whether beta carotene is therapeutically equivalent to retinyl palmitate in the formulation currently recommended by the World Health Organisation. DESIGN--Randomised blind equivalence trial. SETTING--Rural area in Senegal. SUBJECTS--Children aged 2-15 years suffering from vitamin A deficiency as defined by abnormal results on eye cytology were randomly allocated treatment with retinyl palmitate (n = 256) and beta carotene (n = 254). MAIN OUTCOME MEASURE--Reversion to normal results on eye cytology as defined by the reappearance of goblet cells and normalisation of the epithelial cells. RESULTS--Seven weeks after the supplement was given the percentages were 51.2% (124/242) children taking retinyl palmitate and 50.0% (123/246) of those taking beta carotene, who had reverted to normal eye cytology, a difference of 1.2% (95% confidence interval 6.2% to 8.6%) [corrected]. According to an equivalence testing procedure, the two treatments were statistically equivalent; the null hypothesis of non-equivalence was rejected (one tailed p value = 0.03). CONCLUSIONS--beta Carotene supplementation seems to be a promising candidate for the alleviation of vitamin A deficiency. It could be given either as high dose capsule or through increased dietary intake. The challenge now is to improve dietary intake of vitamin A in programmes that are effective and sustainable at the community level.

The increasing importance of vitamin A deficiency in even its mild subclinical form underlines the need for a mass screening test. Clinical, biochemical and cytological methods of assessing vitamin A deficiency in a public health setting have been described and widely used. The cytological method shows promise because it enables early detection of vitamin A deficiency. However interpretation is problematic since histopathological changes are gradual with the progressive disappearance of goblet cells and appearance of enlarged epithelial cells. The reliability and validity of the impression cytology with transfer (ICT) test were assessed in order to produce a meaningful standard for this cytological method. The ICT test was performed in Senegal on 1451 children, in the course of two surveys conducted in 1989 and 1990 in rural areas. Reliability, estimated by Cohen's kappa test for evaluating intra-reader variability, and sensitivity were highest for the abnormal-normal classification (kappa = 0.91; 95% confidence interval (CI): 0.89-0.93; and sensitivity = 74%; 95% CI 66-82%). The ICT method is a cheap, noninvasive and easy test to perform in the field. This method is also reproducible and fairly sensitive according to the abnormal-normal classification. As illustrated by our proposed 50% cutoff of abnormal cytology calculated in relation to 5% of serum retinol values below 0.35 mumol/L criterion, ICT only requires a small sample for the assessment of the overall health of a community in contrast to xerophthalmia and blood vitamin A deficiency tests.In Senegal an ophthalmologist conducted eye examinations on 192 preschool children from 2 rural villages in Niakhar district in the Diourbel region in April 1989 and on 1259 preschool and school age children from 30 rural villages from Malicounda community in the Thies coastal region in February-March 1990 to assess the reliability and validity of the impression cytology with transfer (ICT) test as a field indicator of vitamin A status. Researchers also intended to standardize the cytological results. Cohen's kappa test revealed almost perfect agreement between the observed and expected interpretations of the conjuctival imprints for the classification abnormal-normal (kappa=0.91; 95% confidence interval [CI] for ICT=0.89-0.93). Thus the ICT test was reliable. Serum retinal concentrations indicated that the ICT test was specific for the deficient-nondeficient classification (serum retinal concentrations [SRC]=96%; 95% CI 93-97%) and fairly sensitive for the abnormal-normal classification (SRC=74%; 95% CI=66-82%). These serum retinal concentration results indicated that the ICT test was valid. The researchers proposed 2 classifications--normal and abnormal--to increase reproducibility of the ICT test. Since the ICT test can detect insufficient peripheral supply of vitamin A to the eye at an early stage and has only a 50% cut off, the ICT test can determine the public health of a community with only a small sample. Further the ICT test is a reproducible diagnostic test that is inexpensive, noninvasive, and easy to perform in the field.

The purpose of our study was to determine the prevalence of protein-calorie malnutrition (PCM), ocular diseases, and vitamin A deficiency in preschool children selected at random in a rural zone of the groundnut belt of Senegal. The prevalence of PCM was 37.1% (95% CI 33.8-40.2%) according to the Waterlow classification, with a majority of stunting, and prevalence of hypovitaminosis A was estimated to be 11.4% (95% CI 9.3-13.5%) by using impression cytology. Furthermore, 19.4% (95% CI 15.8-22.0%) of the children might be defined at risk of deficiency. The prevalence of Bitot's spots was equal to 0.2% (95% CI 0.03-0.9%). A problem of PCM associated with a health-endangering vitamin A deficiency existed.

Vitamin A is an essential nutrient for man and animals. The long-term lack of an adequate supply of vitamin A or its precursors leads to the appearance of disorders of increasing gravity. Ultimately, the subject becomes blind and then dies. Vitamin A deficiency is a major problem in public health. It is serious because it is the primary cause of blindness throughout the world; it is serious because partial or total blindness is a burden not only for the individual but also for the community; it is serious because it affects children first and foremost and is one factor increasing infant morbidity and mortality.

Two hundred and six Senegalese preschool children included in an epidemiological study were selected by their results from impression cytology with transfer (ICT) for assessment of their nutritional state by means of biological variables and for assessment of the diagnostic values of the ICT. A problem of protein-calorie malnutrition existed (transthyretin and retinol-binding protein concentrations were low) associated with vitamin A deficiency (retinol concentrations were low). The sensitivity and specificity of the ICT defined with respect to retinol (threshold fixed at 0.35 mumol/L) varied with the classification criteria of ICT and seemed to be fairly insensitive but specific.

To cover the need in paediatric organ transplantation, every potential donor should be considered as a multi-organ donor. Successful transplantation may be performed with kidneys retrieved from very young infants, even anencephalic neonates if the en-bloc technique using both kidneys is used. Regarding the liver, paediatric donors can be accepted from one month of age while livers harvested from older children and even young adults can be transplanted into small children after ex-vivo reduction of the size of the graft. Multi-organ procurement from the same donor provides valuable organs if the anaesthetic management of the donor is appropriate. Active transplant programs needs international cooperation which is made possible by the organ exchange organizations.

We have developed a vector strategy that allows transfer of plasmid DNA by conjugation from Escherichia coli to various Gram-positive bacteria in which transformation via natural competence has not been demonstrated. The prototype vector constructed, pAT187, contains the origins of replication of pBR322 and of the broad host range streptococcal plasmid pAMβ1, a kanamycin resistance gene known to be expressed in both Gram-negative and Gram-positive bacteria, and the origin of transfer of the IncP plasmid RK2. This shuttle plasmid can be mobilised efficiently by the self-transferable IncP plasmid pRK212.1 co-resident in the E. coli donors, and was successfully transferred by filter matings at frequencies of 2 × 10−8 to 5 × 10−7 to Enterococcus faecalis, Streptococcus lactis, Streptococcus agalactiae, Bacillus thuringiensis, Listeria monocytogenes and Staphylococcus aureus.

We studied two outbreaks of calf salmonellosis caused by apramycin and gentamicin-resistant Salmonella typhimurium strains. In both cases, the responsible strains were resistant to ampicillin, chloramphenicol, kanamycin, streptomycin, tetracycline, and trimethoprim; one strain was also resistant to nalidixic acid in one outbreak. A systematic survey of the intestinal Escherichia coli strains of calves from the two affected flocks showed that 11 of 24 animals sampled were also colonized by apramycin- and gentamicin-resistant E. coli strains. These isolates belonged to four biotypes and were resistant to ampicillin, chloramphenicol, kanamycin, streptomycin, tetracycline, trimethoprim, and nalidixic acid. All of the strains were resistant to high levels of apramycin (MICs, 512 to 1,024 micrograms/ml) and to gentamicin (MICs, 8 to 32 micrograms/ml), and these resistances were always transferred en bloc. In S. typhimurium, this coresistance was borne by plasmids that were approximately 39 kilobases long (outbreak 1) or 90 kilobases long (outbreak 2), whereas in E. coli, the coresistance was due to plasmids that were approximately 110 kilobases long in both outbreaks. The two plasmids of Salmonella and four plasmids of E. coli encoded type IV aminoglycoside 3-N-acetyltransferases. The intensive use of curative and preventive treatments in calf production could be responsible for the emergence of enzymic resistance to apramycin and gentamicin.

Staphylococcus haemolyticus BM4610 was resistant to high levels of lincomycin and susceptible to macrolides, clindamycin, and streptogramins. This resistance phenotype, not previously reported for a human clinical isolate, was due to inactivation of the antibiotic. The gene conferring resistance to lincomycin in strain BM4610 was carried by a 2.5-kilobase plasmid, pIP855, which was cloned in Escherichia coli. Plasmid pIP855 caused inactivation of both lincomycin and clindamycin in S. haemolyticus and in E. coli but conferred detectable resistance to lincomycin only in S. haemolyticus and to clindamycin only in E. coli.

Streptococcus faecalis BM4100 was resistant to high levels of gentamicin, kanamycin, and structurally related antibiotics. The genes conferring resistance to aminocyclitols in this strain were carried by a plasmid, pIP800, self-transferable to other S. faecalis strains. The aminocyclitol resistance was mediated by constitutively synthesized phosphotransferase and acetyltransferase activities. It was inferred that phosphorylation occurred at the 2"-hydroxyl group and that acetylation occurred at the 6'-hydroxyl group of the aminocyclitols. The enzyme activities were not separable by gel filtration or by isoelectric focusing. Their apparent molecular weight was 31,000, and their isoelectric point was 5.3. With respect to substrate profile, size, and charge, the transferases from strain BM4100 resembled closely those with identical site specificity described in staphylococci. These results suggest that plasmid gene transfer may occur between the two pathogenic bacterial genera.

The apparently chromosomally encoded 3',5"-aminoglycoside phosphotransferase (type III), from the high-level aminoglycoside-resistant Streptococcus pneumoniae BM4200, was compared with homologous enzymes coded for by the plasmids pJH1 and pSH2, originally isolated from Streptococcus faecalis and Staphylococcus aureus, respectively, and also found in a wild strain of S. aureus, BM4600. The enzymes appeared to be indistinguishable, and we conclude that the gene encoding 3',5"-aminoglycoside phosphotransferase (type III) can cross generic barriers within gram-positive cocci.

Objectives The aim of this study was to assess long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI). Methods This retrospective cohort study included 237 cases of OASI (0.86% of deliveries) identified at Poitiers University Hospital between 2000 and 2011. Symptoms were assessed using validated self-administered questionnaires, including Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale (VAS). Results One hundred and sixty women (67%) filled out the questionnaires, on average 46 months after delivery (8–152). Among them, 93 (54%) reported at least one symptom occurring “frequently” (the most common being dyspareunia), and 45 (28%) a symptom occurring “daily” (the most common being flatus incontinence). Anal incontinence was reported by 32 (20%) women, flatus incontinence “frequently” or “daily” by 28 (18%), and stool incontinence “frequently” or “daily” by 9 (6%). Urinary incontinence was reported “frequently” or “daily” by 27 women (17%) at stress, 17 (11%) at urge, and 11 (7%) at mixed circumstances. Prolapse symptoms were reported “frequently” or “daily” by 6 women (4%). Pain during intercourse was reported “frequently” or “daily” by 17 women (11%). Twenty-four women (18%) reported chronic pelvic pain (VAS score ≥ 4/10). Ninety-five percent of women reported a normal quality of life for mobility, self-care, and usual activities; however, alterations in pain/discomfort (32%) and anxiety/depression (33%) domains were frequently reported. Conclusion Pelvic floor symptoms 4 years after OASI were highly prevalent.

The possibility of transfer of genetic information by conjugation from gram-positive to gram-negative bacteria was investigated with a pBR322-pAM beta 1 chimeric plasmid, designated pAT191. This shuttle vector, which possesses the tra functions of the streptococcal plasmid pAM beta 1, was conjugatively transferred from Enterococcus faecalis to Escherichia coli with an average frequency of 5 x 10(-9) per donor colony formed after mating.

29. IMPRESSION CYTOLOGY (IC): A SIMPLE METHOD FOR DETECTING VITAMIN A DEFICIENCY IN CHILDREN