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Objective Endometriosis affects 10% of women in reproductive age and alters fertility. Its management is still debated notably the timing of surgery and ART in infertility. Several tools have been created to guide the practitioner and the couple yet many limitations persist. The objective is to create a nomogram to predict the likelihood of a live birth after surgery followed by assisted reproductive technology (ART) for patients with endometriosis-related infertility. Study design All women in a public university hospital who attempted to conceive by ART after surgery for endometriosis-related infertility from 2004 to 2016 were included. We created a model using multivariable linear regression based on a retrospective database. Result Of the 297 women included, 171 (57.6%) obtained a live birth. Age, duration of infertility, number of ICSI-IVF cycles, ovarian reserve and the revised American Fertility Society (rAFS) score were included in the nomogram. The predictive model had an area under the curve (AUC) of 0.77 (95% CI, 0.75–0.79) and was well calibrated. The external validation of the model was achieved with an AUC of 0.71 (95% CI, 0.69–0.73) and calibration was good. The staging accuracy according to AUC criteria for the nomogram compared to the currently used Endometriosis Infertility Index to predict live births were 0.77 (95% CI, 0.75–0.79) and 0.60 (95% CI: 0.57–0.63), respectively. Conclusion This simple tool appears to accurately predict the likelihood of a live birth for a patient undergoing ART after surgery for endometriosis-related infertility. It could be used to counsel patients in their choice between spontaneous versus ART conception, or oocyte donation.

International audience; Background - The purpose of this study was to develop a nomogram to predict 'poor prognosis recurrence' (PPR) in women treated for endometrial cancer (EC). Methods - The data of 861 women who received primary surgical treatment between January 2001 and December 2013 were abstracted from a prospective multicenter database. Data were randomly split into two sets: training and validation with a predefined 2/3 ratio. A Cox proportional hazards multivariate model of selected prognostic features was performed in the training cohort (n=574) to develop a nomogram predicting PPRs. The nomogram was validated in the validation cohort of 287 patients. Results - In the training cohort, 82 (14.3%) developed subsequent PPR. Age, histologic type and grade, lymphovascular space invasion status, FIGO stage, and nodal staging (SLN±pelvic and/or para-aortic lymphadenectomy) were independently associated with subsequent PPR. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.82 (95% confidence interval (CI), 0.73-0.89) in the training set. The validation set showed a good discrimination with an AUC of 0.75 (95% CI, 0.65-0.83). Conclusions - We have developed a robust tool that is able to predict subsequent PPRs in women with FIGO I-III EC.

International audience; Obesity is a heterogeneous disease with many different subtypes. Epigenetics could contribute to these differences. The aim of this study was to investigate genome-wide DNA methylation searching for methylation marks associated with obesity in children and adolescents. We studied DNA methylation profiles in whole blood cells from 40 obese children and controls using Illumina Infinium HumanMethylation450 BeadChips. After correction for cell heterogeneity and multiple tests, we found that compared to lean controls, 31 CpGs are differentially methylated in obese patients. A greatest proportion of these CpGs is hypermethylated in obesity and located in CpG shores regions. We next focused on severely obese children and identified 151 differentially methylated CpGs among which 10 with a difference in methylation greater than 10%. The top pathways enriched among the identified CpGs included the " IRS1 target genes " and several pathways in cancer diseases. This study represents the first effort to search for differences in methylation in obesity and severe obesity, which may help understanding these different forms of obesity and their complications.

International audience; Background - The European Society of Medical Oncology (ESMO)/European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy & Oncology (ESTRO) classification for endometrial cancer (EC) now includes a high-intermediate risk (HIR) group of recurrence due to the adverse prognostic role of lymphovascular space involvement (LVSI) and grade 3 for women at intermediate risk. However, optimal surgical staging, and especially the place of lymphadenectomy, remains to be elucidated. We aimed to establish whether systematic nodal staging should be part of surgical staging for women with HIR EC. Methods - We abstracted from a prospectively maintained multicentre database the data of 181 women with HIR EC based on uterine factors (endometrioid type 1, grade 1-2 tumors with deep (≥50%) myometrial invasion and unequivocally positive LVSI, and those with grade 3 tumors with

International audience; Introduction: Early ultrasound fetal sex determination is of obvious interest, particularly in the context of X-linked diseases. In the human, the anogenital distance, i.e., the distance between the caudal end and the base of the genital tubercule is sexually dimorphic. This difference is apparent from 11 weeks of gestation.The aim of this prospective study was to evaluate the accuracy of anogenital distance measurement during the first trimester ultrasound in the early determination of fetal gender.Materials and methods: Fetal gender was assessed by ultrasound in 310 singleton pregnancies at 11–14 weeks of gestation. The optimal cut-off was determined by the minimal p-value technic and validated using bootstrap simulation.Results: 310 women were included. A cut-off of 4.8 mm was determined to predict male (≥4.8 mm) or female (

We studied the effects of exposure to multiple indoor air pollutants on allergic and respiratory health. The elements to consider for studying this phenomenon were, on one hand, the correlations between pollutants and, on the other hand, their potentially additive and synergistic effects. The analyses conducted in adults have shown that the prevalence of allergic and respiratory symptoms was higher in the dwellings highly polluted by many volatile organic compounds (VOCs). The observed health effects of VOCs were higher when the dwelling was also polluted by pet allergens. The analyses conducted in children have shown the difficulty to separate the effects of pollutants. However, we showed that poor air quality in schools was associated with an increased risk of respiratory symptoms. Some analyses on the total exposure to air pollution have implicated the combined effects of physico-chemical pollutants on respiratory function of children. The study of multi-pollution allowed to highlight the deleterious effect of some pollutants combined with other substances, although their individual effects were not detected. Our studies showed that associations were observed at concentrations lower than those observed in toxicological studies, involving the additive and synergistic effects between pollutants. Our results also provided some elements about the mechanism of action of indoor chemical pollutants on respiratory health, including their synergistic effects with allergens. In conclusion, our results showed combined effects between various pollutants on the respiratory health of adults and children., Nous avons étudié les effets de l'exposition à de multiples polluants de l'air intérieur sur la santé allergique et respiratoire. Les éléments à considérer pour étudier ce phénomène étaient, d'une part, les corrélations entre polluants et d'autre part leurs effets potentiellement additifs et synergiques. Les analyses menées chez les adultes ont montré que les prévalences des symptômes allergiques et respiratoires étaient plus élevées dans les logements les plus multi-pollués, notamment par les composés organiques volatils (COV). En particulier, les effets sanitaires des COV étaient plus importants lorsque dans le logement il y avait aussi des allergènes d'animaux en excès. Les analyses menées chez les enfants ont montré qu'il était difficile de séparer les effets des différents polluants. Cependant, une mauvaise qualité d'air dans les écoles était associée à une augmentation du risque de symptômes respiratoires. Des analyses prenant en compte l'exposition totale à la pollution ont mis en cause des effets combinés des polluants physico-chimique sur la fonction respiratoire des enfants. Au total, la prise en compte de la pollution multiple a permis de mettre en avant l'effet délétère de certains polluants combinés à d'autres substances, alors que leurs effets isolés n'étaient pas détectés. Nos études ont montré que des associations étaient observées à des concentrations plus faibles que celles observées dans les études toxicologiques, impliquant les effets additifs et synergiques entre les polluants. En conclusion, nos résultats ont mis en évidence des effets combinés entre des polluants variés sur la santé allergique et respiratoire des adultes et des enfants.

We studied the effects of exposure to multiple indoor air pollutants on allergic and respiratory health. The elements to consider for studying this phenomenon were, on one hand, the correlations between pollutants and, on the other hand, their potentially additive and synergistic effects. The analyses conducted in adults have shown that the prevalence of allergic and respiratory symptoms was higher in the dwellings highly polluted by many volatile organic compounds (VOCs). The observed health effects of VOCs were higher when the dwelling was also polluted by pet allergens. The analyses conducted in children have shown the difficulty to separate the effects of pollutants. However, we showed that poor air quality in schools was associated with an increased risk of respiratory symptoms. Some analyses on the total exposure to air pollution have implicated the combined effects of physico-chemical pollutants on respiratory function of children. The study of multi-pollution allowed to highlight the deleterious effect of some pollutants combined with other substances, although their individual effects were not detected. Our studies showed that associations were observed at concentrations lower than those observed in toxicological studies, involving the additive and synergistic effects between pollutants. Our results also provided some elements about the mechanism of action of indoor chemical pollutants on respiratory health, including their synergistic effects with allergens. In conclusion, our results showed combined effects between various pollutants on the respiratory health of adults and children.; Nous avons étudié les effets de l'exposition à de multiples polluants de l'air intérieur sur la santé allergique et respiratoire. Les éléments à considérer pour étudier ce phénomène étaient, d'une part, les corrélations entre polluants et d'autre part leurs effets potentiellement additifs et synergiques. Les analyses menées chez les adultes ont montré que les prévalences des symptômes allergiques et respiratoires étaient plus élevées dans les logements les plus multi-pollués, notamment par les composés organiques volatils (COV). En particulier, les effets sanitaires des COV étaient plus importants lorsque dans le logement il y avait aussi des allergènes d'animaux en excès. Les analyses menées chez les enfants ont montré qu'il était difficile de séparer les effets des différents polluants. Cependant, une mauvaise qualité d'air dans les écoles était associée à une augmentation du risque de symptômes respiratoires. Des analyses prenant en compte l'exposition totale à la pollution ont mis en cause des effets combinés des polluants physico-chimique sur la fonction respiratoire des enfants. Au total, la prise en compte de la pollution multiple a permis de mettre en avant l'effet délétère de certains polluants combinés à d'autres substances, alors que leurs effets isolés n'étaient pas détectés. Nos études ont montré que des associations étaient observées à des concentrations plus faibles que celles observées dans les études toxicologiques, impliquant les effets additifs et synergiques entre les polluants. En conclusion, nos résultats ont mis en évidence des effets combinés entre des polluants variés sur la santé allergique et respiratoire des adultes et des enfants.

With the introduction of highly active antiretroviral therapy in 1996, liver disease has emerged as an important cause of morbidity and mortality in HIV/HCV-coinfected patients. In 2000, RIBAVIC HC02 trial, a randomized controlled trial (the ANRS HC02 RIBAVIC study) comparing pegylated interferon alfa-2b plus ribavirin vith conventional interferon alfa-2b plus ribavirin was conducted. In order to describe the effect of interferon plus ribavirin-based therapies on the incidence of long-term clinical outcomes in HIV/HCV-coinfected patients, a prospective cohort study was performed from the patients included in the ANRS HC02 RIBAVIC trial in 2001. The RIBAVIC trial and the cohort contribute to show these results : - HCV viral load kinetics could differ according to the choice of HAART regimen. - the prevalence (61%) and risk factors for steatosis are similar to that observed in HCV-monoinfected patients. None of the characteristics of HIV infection, including antiretroviral therapy, is independently associated with steatosis. - the rate of sustained virological response is lower in HIV/HCV-coinfected patients (27%) than in HCV-monoinfected patients - the rate of non response (HCV RNA decline of less than 2 logs at 12 weeks of peginterferon and ribavirin combination therapy) is high, ranging from 29% to 33% (14% in HCV-monoinfected patients). The potential loss of ribavirin efficacy on HCV during concomitant use of NRTIs, such abacavir, is suspected. - the best positive and negative predictive values of sustained virological response (SVR) were respectively obtained with an undetectable HCV RNA at W4 (97%) and with more than a 2 log10 decrease at W12 (99%). The HCV viral load decrease at week 2 and week 4 was significantly slower in relapsing patients than in patients with sustained virological response. - During anti-HCV therapy, 1- severe anemia occurred in 15.9% of patients and was significantly higher in patients receiving zidovudine-based HAART ; 2- severe weight loss (> 10% of baseline weight) is frequent (28%) and could be one of the first clinical sign of a mitochondrial toxicity; 3- markers of advanced liver fibrosis and not neutropenia are predictors of increased susceptibility to bacterial infections 4- concomitant treatment with didanosine and interferon-2b or peg-interferon-2b plus ribavirin is associated with an increase risk of symptomatic mitochondrial toxicity, hepatic decompensation and fibrosis worsening.; En 1998, le traitement de la co-infection VHC rarement discuté avant l'ère des HAART, compte tenu d'une réponse médiocre à la monothérapie par IFNα et d'un pronostic de vie lié au VIH estimé en moyenne à 10 ans, fût reconsidéré. C'est ainsi que débuta en 2000, l'essai RIBAVIC HC02, essai randomisé et multicentrique comparant l'association de la ribavirine 800 mg/j à l'Interféron 3 MUI x3/semaine ou au PEG-α-2b Interféron 1,5 μg/kg/semaine pendant 48 semaines. Une cohorte des patients inclus dans l'essai RIBAVIC (cohorte RIBAVIC EP10) débuta en 2001 pour évaluer le devenir à long terme de ces patients. L'essai RIBAVIC et la cohorte RIBAVIC ont apporté les enseignements suivants : - la cinétique de la charge virale VHC peut différer selon la nature du traitement antirétroviral. - la prévalence et les facteurs de risque de la stéatose sont similaires à ceux observés dans la population mono-infectée VHC - le taux de réponse virologique soutenue est inférieur chez les patients co-infectés (27%) comparé aux patients mono-infectés VHC (50%) - le taux de non réponse virologique (diminution de la charge virale VHC inférieure à 2 log à S12) sous traitement par pegIFN plus ribavirine est plus élevé (33%) comparé aux patients monoinfectés VHC (14%). L'interaction entre la ribavirine et l'abacavir pourrait être un facteur de risque. - l'indétectabilité de l'ARN VHC dès S4 est prédictive de la réponse à long terme (valeur prédictive positive 97%) et la décroissance de la charge virale VHC est significativement plus lente chez les patients rechuteurs comparée aux patients répondeurs long terme à S2 et à S4 - Au cours du traitement anti-VHC :1- le risque d'anémie est élevé et majoré par la coprescription de zidovudine et de ribavirine ; 2- l'amaigrissement est fréquent et sévère et peut être révélateur d'une toxicité mitochondriale ; 3- le risque bactérien n'est pas lié au taux des polynucléaires neutrophiles mais à la fibrose hépatique ; 4- le risque de toxicité mitochondriale, d'aggravation de la fibrose et de décompensation hépatique est majoré par l'interaction entre la didanosine et la ribavirine - une réponse virologique soutenue est associée à un bénéfice histologique et clinique.

With the introduction of highly active antiretroviral therapy in 1996, liver disease has emerged as an important cause of morbidity and mortality in HIV/HCV-coinfected patients. In 2000, RIBAVIC HC02 trial, a randomized controlled trial (the ANRS HC02 RIBAVIC study) comparing pegylated interferon alfa-2b plus ribavirin vith conventional interferon alfa-2b plus ribavirin was conducted. In order to describe the effect of interferon plus ribavirin-based therapies on the incidence of long-term clinical outcomes in HIV/HCV-coinfected patients, a prospective cohort study was performed from the patients included in the ANRS HC02 RIBAVIC trial in 2001. The RIBAVIC trial and the cohort contribute to show these results : - HCV viral load kinetics could differ according to the choice of HAART regimen. - the prevalence (61%) and risk factors for steatosis are similar to that observed in HCV-monoinfected patients. None of the characteristics of HIV infection, including antiretroviral therapy, is independently associated with steatosis. - the rate of sustained virological response is lower in HIV/HCV-coinfected patients (27%) than in HCV-monoinfected patients - the rate of non response (HCV RNA decline of less than 2 logs at 12 weeks of peginterferon and ribavirin combination therapy) is high, ranging from 29% to 33% (14% in HCV-monoinfected patients). The potential loss of ribavirin efficacy on HCV during concomitant use of NRTIs, such abacavir, is suspected. - the best positive and negative predictive values of sustained virological response (SVR) were respectively obtained with an undetectable HCV RNA at W4 (97%) and with more than a 2 log10 decrease at W12 (99%). The HCV viral load decrease at week 2 and week 4 was significantly slower in relapsing patients than in patients with sustained virological response. - During anti-HCV therapy, 1- severe anemia occurred in 15.9% of patients and was significantly higher in patients receiving zidovudine-based HAART ; 2- severe weight loss (> 10% of baseline weight) is frequent (28%) and could be one of the first clinical sign of a mitochondrial toxicity; 3- markers of advanced liver fibrosis and not neutropenia are predictors of increased susceptibility to bacterial infections 4- concomitant treatment with didanosine and interferon-2b or peg-interferon-2b plus ribavirin is associated with an increase risk of symptomatic mitochondrial toxicity, hepatic decompensation and fibrosis worsening., En 1998, le traitement de la co-infection VHC rarement discuté avant l'ère des HAART, compte tenu d'une réponse médiocre à la monothérapie par IFNα et d'un pronostic de vie lié au VIH estimé en moyenne à 10 ans, fût reconsidéré. C'est ainsi que débuta en 2000, l'essai RIBAVIC HC02, essai randomisé et multicentrique comparant l'association de la ribavirine 800 mg/j à l'Interféron 3 MUI x3/semaine ou au PEG-α-2b Interféron 1,5 μg/kg/semaine pendant 48 semaines. Une cohorte des patients inclus dans l'essai RIBAVIC (cohorte RIBAVIC EP10) débuta en 2001 pour évaluer le devenir à long terme de ces patients. L'essai RIBAVIC et la cohorte RIBAVIC ont apporté les enseignements suivants : - la cinétique de la charge virale VHC peut différer selon la nature du traitement antirétroviral. - la prévalence et les facteurs de risque de la stéatose sont similaires à ceux observés dans la population mono-infectée VHC - le taux de réponse virologique soutenue est inférieur chez les patients co-infectés (27%) comparé aux patients mono-infectés VHC (50%) - le taux de non réponse virologique (diminution de la charge virale VHC inférieure à 2 log à S12) sous traitement par pegIFN plus ribavirine est plus élevé (33%) comparé aux patients monoinfectés VHC (14%). L'interaction entre la ribavirine et l'abacavir pourrait être un facteur de risque. - l'indétectabilité de l'ARN VHC dès S4 est prédictive de la réponse à long terme (valeur prédictive positive 97%) et la décroissance de la charge virale VHC est significativement plus lente chez les patients rechuteurs comparée aux patients répondeurs long terme à S2 et à S4 - Au cours du traitement anti-VHC :1- le risque d'anémie est élevé et majoré par la coprescription de zidovudine et de ribavirine ; 2- l'amaigrissement est fréquent et sévère et peut être révélateur d'une toxicité mitochondriale ; 3- le risque bactérien n'est pas lié au taux des polynucléaires neutrophiles mais à la fibrose hépatique ; 4- le risque de toxicité mitochondriale, d'aggravation de la fibrose et de décompensation hépatique est majoré par l'interaction entre la didanosine et la ribavirine - une réponse virologique soutenue est associée à un bénéfice histologique et clinique.