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Objectives: There are no recommendations on the way emergency ultrasound should be performed but there are Standardized Acute Female Echography (SAFE) planes with quality criteria for ultrasound scoring. The objective of this study was to evaluate the impact of the quality of ultrasound on the diagnosis of ectopic pregnancy., Methods: A retrospective study was conducted in 2016-2017 and included all Ectopic Pregnancies (EP). Clinical, biological and ultrasonographic characteristics were collected, in particular the analysis of ultrasound scans according to the scoring score of standardized planes (total score out of 15). EP diagnosed at first ultrasound and those from Pregnancy of unknown location (PUL) were compared., Results: Hundred and seventeen patients were included: 45 (38.5%) in the group "EP from PLU" and 72 (61.5%) in the group "EP diagnosed directly". The ultrasound images were significantly better in the "directly diagnosed EP" group than in the "EP from PUL" group: 11.9/15 vs. 10.07/15 respectively (P=0.005). Moreover, in the group "EP from PUL", the images were significantly better on the final ultrasound diagnosing the EP compared to the first ultrasound performed: 11.4/15 vs. 10.07/17 (P=0.04)., Conclusion: The evaluation of quality of ultrasound scan using a standardized scoring system shows an impact in the diagnosis of ectopic pregnancies., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: Surgical management of endometriosis may require different levels of surgical skill which influences the orientation of the patient. The Ultrasound-Based Endometriosis Staging System (UBESS) is a score developed in 2016 to predict the difficulty of surgery. To study the correlation between UBESS score and two main surgical classifications in the literature., Methods: Study performed at the center of Poissy, France, between July 2016 and December 2017. Patients who underwent prospective UBESS staging then operated of their endometriosis were included. The patients were classified according to the levels of surgical difficulty of the Royal College of Obstetricians and Gynecologists (RCOG) and the classification created by Chi et al. The criterion of judgment was the correlation between the UBESS stages and RCOG and CHI levels. In a second analysis, we determined the predictive value of the operative plan for items included in the systematic sonographic evaluation described by Menakaya et al. RESULTS: Thirty-three patients were included in the study. Correlation was found to be low between UBESS and RCOG (θ=0.22) and between UBESS and CHI (θ=0.30). The prediction of the operative plan was good for endometrioma, sites specific tenderness, sliding sign, vaginal and digestive tract involvement; but modest for the anterior compartment and uterosacrals ligaments., Conclusion: In our study on a small number of patients, the UBESS score does not adequately predict the surgical difficulty. Taken separately, the items of systematic sonographic evaluation based on 5 domains successfully predict the operative plan., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Objective: To identify the mechanisms of angle closure in the fellow eyes of Vietnamese subjects with unilateral primary angle-closure glaucoma (PACG) using ultrasound biomicroscopy (UBM) before and after prophylactic laser peripheral iridotomy (LPI)., Design: This is a prospective observational study., Participants: Patients diagnosed with PACG in one eye and primary angle-closure suspect (PACS) in the other eye were included in this study, conducted from January 2014 to October 2014 at Vietnam National Institute of Ophthalmology., Materials and Methods: A total of 112 PACS fellow eyes of 112 patients presenting with unilateral PACG were evaluated. All subjects underwent standard ophthalmic clinical examination and UBM imaging a week before and after LPI. On the basis of UBM images, the angle-closure mechanism was defined according to the classification of Svend Vedel Kessing and John Thygesen as pupillary block (PB), plateau iris (PI), and mixed pattern., Results: The proportion of PACS subjects who showed PB was 86.6%, while 13.4% showed a PI configuration before LPI. After LPI the pre-LPI PB group was reclassified, with 55.4% showing pure PB, and 31.3% showing mixed mechanisms (PB and PI). The proportion of patients with PI remained unchanged (13.4%) even after LPI. After the LPI, the angle opening significantly increased in the PB subgroup (14.01±2.43 degrees, P<0.01) and reclassified mixed group (6.34±1.71 degrees, P<0.01) but remained almost unchanged in the PI group (1.81±0.98 degrees, P>0.05)., Conclusion: On the basis of the UBM criteria, PI was found in 13.4% of PACS fellow eyes of Vietnamese subjects with PACG. The clinical and UBM features of patients showing PI before LPI remained almost unchanged after the procedure. The proportion of patients showing PB pre-LPI reduced from 86.6% to 55.4% showing the important role of mixed mechanisms in PACG.

Introduction: Cancer is a disease with a global burden and is a major and increasing threat to public health. The demand for new modalities to treat and prevent cancer is high. Given the toxic side effects of standard treatments, such as chemotherapy, there is greater research interest in naturally derived compounds due to their selective toxicity to cancer cells. This study aimed to test the anticancer activity of a crude extract of Hopea odorata on hepatocellular carcinoma (HCC) HepG2 cell line., Methods: Methanol extracts of H. odorata were prepared from the bark of H. odorata plants ( H. odorata extract). The in vitro cytotoxicity of H. odorata extracts on human HCC cell line HepG2 compared to normal human fibroblasts (HFs) was assessed by Alamar Blue assay. Caspase-3/7 was detected using a reagent that consists of DEVD peptide conjugated to a nucleic acid-binding dye. Apoptosis induction by the H. odorata plant extract on HepG2 was evaluated by Annexin V/7-AAD using flow cytometry. Disintegrated nuclei of plant-treated cells were observed under a fluorescent microscope using Hoechst and propidium iodide (PI) staining. In addition, using the Hoechst/PI staining technique, the ratio of dead to total cells was determined by distinguishing Hoechst and PI fluorescent signals., Results: We found that the IC 50 value of H. odorata extract on HepG2 was 12.67±5 µg/mL and on HF was 44±3 µg/mL. The IC 50 value of doxorubicin on HepG2 was 153.3±15 ng/mL and on HF was 6.3±0.6 ng/mL. The selectivity index (SI) of H. odorata extract for HepG2 cells was ~3.48, while the SI of doxorubicin for HepG2 cells was ~0.04. The ratio of dead to total cells increased in a dose-dependent manner for HepG2 cells when observed under a fluorescent microscope, while the ratio of dead to total cells barely changed for HF cells. The H. odorata extract inhibited HepG2 cells via the activation of caspase-3/7. At 250 µg/mL concentration of the H. odorata extract, 35% of HepG2 cells were induced into apoptosis, and the cells exhibited disintegrated nuclei under a fluorescent microscope., Conclusion: These findings demonstrate that the methanolic bark extracts of H. odorata plant induce apoptosis and selective cytotoxicity toward HepG2 but not HF. Therefore, purification of compounds from H. odorata bark extracts may be useful as anticancer agents, and thus, more studies are warranted to investigate the anticancer properties of H. odorata ., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction: Randomized controlled trials (RCT) in surgery are often subject to difficulties inherent in the study design and recruitment of patients. Women's participation rate to RCTs in surgery is relatively low and varies from 30 to 70%. These recruitment problems might induce a weak scientific value and even stop the study. Thus, optimizing recruitment is a challenge for surgical research. In contemporary literature, we lack data on motivations and profile of women who refuse to participate in a RCT in surgery., Objective: To explore the potentially influential factors affecting women's decision to decline participation in PROSPERE trial, comparing laparoscopic sacrocolpopexy (LSCP) to vaginal mesh for cystocele repair., Patient and Method: Retrospective, observational, qualitative, bicentric study conducted in the department of gynecology of Poissy and Lille hospitals. Patients included were those who refused to participate to PROSPERE trial in both centers. Factors of non-participation in the trial were recorded at the time of the first visit. A control group consisted of women who agreed to participate in the trial was also analyzed., Results: In both centers, 139 were eligible to participate in the trial but 35 of them (25%) refused. Thirty-two women agreed to declare their refusal motivations. Vaginal mesh was finally performed in 18 (56,2%) patients and LSCP in 14 patients (43,8%). The control group consisted of 20 women, including 9 operated by vaginal mesh and 11 by LSCP. Patient's characteristics were similar in the both groups. Most influencing factor in refusal for participation was "previous choice of technique" in 50% cases (16/32), followed by "geographical remoteness and difficulties for additional visits" in 40.6% cases (13/32), and finally by "do not accept the concept of randomization" in 21.8% cases (7/32). The most influencing factor in women's acceptance was interest in helping others by "supporting medical research" in 100% cases (20/20), followed by "potential personal benefits and close follow-up" in 60% (12/20)., Conclusion: Our study identified the most influential factors relevant to women decision-making whether or not to participate in RCT in surgery. A number of factors leading to refusal of participation are potentially correctable leading to better recruitment rates in future RCTs. Optimization of information on the principle of randomization, limiting the number of additional visits could help researchers improve participation rates., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Varicella (VZV) infection in pregnancy can result in serious outcomes: maternal pneumoniae irrespective of the term of pregnancy, and lead to congenital varicella syndrome before 18 weeks of gestation and neonatal varicella. There are between 350 and 500 cases a year in France. Until now, there have been no scientific obstetrical guidelines for clinical practice in France for VZV infection during pregnancy., Objectives: To evaluate health care providers' knowledge and practices concerning varicella infection during pregnancy in France., Study Design: An anonymous survey on VZV infection was sent by e-mail to gynecologists-obstetricians and midwives. We evaluated their knowledge and practices concerning VZV transmission, maternal varicella, congenital varicella syndrome, neonatal varicella and prevention., Results: The survey was completed by 271 professionals: gynecologists (161/271; 60%) and midwives (110/271; 40%). Among 20 items, 5 were multiple choice questions. 29 correct answers were expected. Scores ranged from 6/29 to 28/29 (mean score: 17.44/29)., Conclusions: The consequences of VZV primary infection in pregnancy are poorly known. We reveal a diversity of management among practitioners in our study population, not always in accordance with the international scientific literature or with the guidelines of other countries. Health care providers should update their knowledge of varicella infection during pregnancy. The publication of national guidelines could help to achieve this objective., (Copyright © 2015 Elsevier B.V. All rights reserved.)

A 42-year-old man presented with impaired nasal breathing and a slowly growing mass on the tip of the nose. Examination revealed a multilobulated sebaceous nodule protruding from the nasal tip.