[Case report: Great toe dorsal defect reconstruction by cross-toe flap]

Reconstruction of hallux soft-tissue defects is essential for the locomotor function. Some regional flaps are available and have to be preferred in case of small defect. Here, we present the case of a patient treated by a cross-toe flap in order to cover an exposed hallux proximal interphalangeal joint, after an open fracture. The functional outcome of this reliable and easy flap was very satisfying, with quick wound healing and resumption walk.

Uncovering the Concerns and Needs of Individuals with Celiac Disease: A Cross-Sectional Study

The treatment for celiac disease (CD) involves a strict gluten-free diet, which can be challenging and lead to questions for patients. Pinpointing these uncertainties can enable the creation of efficient educational resources. In this study, a questionnaire was specifically designed to gain insights into the knowledge, concerns, and needs of individuals with CD and their supporters. The questionnaire was distributed through the Instagram social network and received adequate responses from 300 participants, 258 (86%) being female and 152 (50.7%) falling in the age range of 25-44 years. The concerns of individuals with celiac disease and celiac supporters were rated on a 1-4 scale, with a mean score of 3.5 indicating significant concern. A total of 255 (85%) of all participants expressed that their principal concern was the social limitations they faced, such as difficulties in eating out and sharing food with others. Every participant evaluated their overall disease knowledge, averaging at 2.92 out of 4, indicating a reasonable level of awareness. When asked if they believed that improving general knowledge about CD in the general population would enhance their quality of life, the vast majority responded affirmatively. This finding underscores the importance of not only educating individuals with CD but also reaching out to the wider population, especially those who have a direct impact on the daily lives of individuals with CD, such as family members, friends, and food service providers.

Newly arrived migrant students' perceptions of emergency remote teaching: A Q methodology study

In an attempt to curb the spread of COVID-19, Emergency Remote Teaching was implemented worldwide. The global educational disruption led to a rise in quantitative studies investigating the effect of this shift on student outcomes. These studies suggest a greater negative impact of the pandemic on students from disadvantaged backgrounds, but often fall short of exploring learners' perspectives on online teaching practices. A Q study with 23 Newly Arrived Migrant Students in Flemish upper secondary education was conducted to investigate these pupils' perceptions of blended Emergency Remote Teaching. The results show that these students hold at least four different viewpoints regarding Emergency Remote Teaching. The importance pupils assign to interaction and the role of the teacher is an important grouping variable in these analyses.

Impact of the COVID-19 pandemic on preterm birth and stillbirth: A nationwide, population-based retrospective cohort study

Objective

This study aimed to establish whether there was a decrease in the rate of prematurity in France after the beginning of lockdown (March 17, 2020) and whether there was an increase in the rate of stillbirths compared with 2017 to 2019.

Study design

We included all births from January to September of each year from 2017 to 2020 from the national Programme de Médicalisation des Systèmes d’Information database: 496,171 newborns from women with singleton pregnancies and 15,441 newborns from women with multiple pregnancies were included for 2020. Concerning the 2017 to 2019 period, we included a mean of 518,798 newborns from women with singleton pregnancies and 16,441 newborns from women with multiple pregnancies per year.

Results

Between April to May 2017 to 2019 and April to May 2020, there was a decrease of - 7.53% in the rate of prematurity (from 5.31% to 4.91%; P < 0.01) for singleton pregnancies. Between these 2 periods, the rate of change was −12.90% between 22 and 27 WG (P = 0.03), +1.96% between 28 and 31 WG (P = 0.69), and −8.24% between 32 and 36 WG (P < 0.01). The decrease in the rate of prematurity was still observed after the end of lockdown (from June to September 2020). For multiple births, there was no decrease in prematurity between January to September 2017 to 2019 and January to September 2020: 50.14% vs. 50.36% (P = 0.63), respectively, for twins and 95.51% vs. 94.9% (P = 0.62), respectively, for high-order multiple pregnancies. In January to September, there were 363 stillbirths among singleton pregnancies in 2017 to 2019 and 114 in 2020 (0.00% change rate). Among the 1752 women with a diagnosis of SARS-CoV-2 infection with singleton pregnancies, the rate of prematurity was higher in 2020 than in 2017 to 2019 (9.93% vs. 5.32%; P < 0.01), regardless of the severity of prematurity (P < 0.05 for all).

Conclusion

Large-scale socioenvironmental modifications like the lockdown in spring 2020 may be associated with beneficial effects on perinatal morbidity. We did not find an increase in the rate of stillbirth since the beginning of the pandemic. At this stage, the practical consequences are not obvious, but our results encourage further reflection regarding behaviors that could modify the risk of prematurity outside of the context of an epidemic.

Association between SARS-Cov-2 infection during pregnancy and adverse pregnancy outcomes: a re-analysis of the data reported by Wei et al. (2021)

Objectives and background

Wei et al. have published a meta-analysis (MA), which aimed to evaluate the association between SARS-CoV-2 infection during pregnancy and adverse pregnancy outcomes. Using classical random-effects model, they found that SARS-CoV-2 infection was associated with preeclampsia, preterm birth and stillbirth. Performing MA with low event rates or with few studies may be challenging insofar as MA relies on several within and between-study distributional assumptions. The objective was to assess the robustness of the results provided by Wei et al.

Methods

We performed a sensitivity analysis using frequentist and Bayesian meta-analysis methods. We also estimated fragility indexes.

Results

For eclampsia, the confidence intervals of most frequentist models contain 1. All beta-binomial models (Bayesian) lead to credible intervals containing 1. The prediction interval, based on DL method, ranges from 0.75 to 2.38. The fragility index is 2 for the DL method. For preterm, the confidence (credible) intervals exclude 1. The prediction interval is broad, ranging from 0.84 to 20.61. The fragility index ranges from 27 to 10. For stillbirth, the confidence intervals of most frequentist models contain 1. Six Bayesian MA models lead to credible intervals containing 1. The prediction interval ranges from 0.52 to 8.49. The fragility index is 3.

Conclusion

Given the available data and the results of our broad sensitivity analysis, we can suggest that SARS-CoV-2 infection during pregnancy is associated with preterm, and that it may be associated with preeclampsia. For stillbirth, more data are needed as none of the Bayesian analyses are conclusive.

[Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of anesthesiology and intensive care (SFAR) and the French College of gynaecologists and obstetricians (CNGOF)]

OBJECTIVE

To provide national guidelines for the management of women with severe preeclampsia.

DESIGN

A consensus committee of 26 experts was formed. A formal conflict of interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.

METHODS

The last SFAR and CNGOF guidelines on the management of women with severe preeclampsia was published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analyzed according to the GRADE® methodology.

RESULTS

The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1±), 9 have a moderate level of evidence (GRADE 2±), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations.

CONCLUSIONS

There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe preeclampsia.

Latent TGFβ-binding proteins regulate UCP1 expression and function via TGFβ2

Objective

Activation of brown adipose tissue (BAT) in humans has been proposed as a new treatment approach for combating obesity and its associated diseases, as BAT participates in the regulation of energy homeostasis as well as glucose and lipid metabolism. Genetic contributors driving brown adipogenesis in humans have not been fully understood.

Methods

Profiling the gene expression of progenitor cells from subcutaneous and deep neck adipose tissue, we discovered new secreted factors with potential regulatory roles in white and brown adipogenesis. Among these, members of the latent transforming growth factor beta-binding protein (LTBP) family were highly expressed in brown compared to white adipocyte progenitor cells, suggesting that these proteins are capable of promoting brown adipogenesis. To investigate this potential, we used CRISPR/Cas9 to generate LTBP-deficient human preadipocytes.

Results

We demonstrate that LTBP2 and LTBP3 deficiency does not affect adipogenic differentiation, but diminishes UCP1 expression and function in the obtained mature adipocytes. We further show that these effects are dependent on TGFβ2 but not TGFβ1 signaling: TGFβ2 deficiency decreases adipocyte UCP1 expression, whereas TGFβ2 treatment increases it. The activity of the LTBP3–TGFβ2 axis that we delineate herein also significantly correlates with UCP1 expression in human white adipose tissue (WAT), suggesting an important role in regulating WAT browning as well.

Conclusions

These results provide evidence that LTBP3, via TGFβ2, plays an important role in promoting brown adipogenesis by modulating UCP1 expression and mitochondrial oxygen consumption.

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Inhibition of LTBP2 and LTBP3 reduces secretion of TGFβ2.

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Both knockout of LTBP2/3 or TGFβ2 inhibit UCP1 expression and mitochondrial respiration in human adipocytes.

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Expression of TGFβ2 correlates with UCP1 expression in human adipose tissue.

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Treatment with TGFβ2 rescues inhibition of UCP1 by LTBP knockout during adipogenesis.

[Case report: Epigastric dermatofibroma reconstruction by reverse abdominoplasty with umbilic transposition]

Dermatofibrosarcoma is the most common cutaneous sarcoma. Its surgical management is a technical challenge due to the high amount of substance loss. We explain a new technique of abdominal wall reconstruction by a reverse abdominoplasty with umbilical transposition. This new surgical technique allowed, in one time, the excision and the abdominal wall reconstruction. Functional and esthetic results are really satisfactory.

Increased risk of acute stroke among patients with severe COVID-19: a multicenter study and meta-analysis

BACKGROUND AND PURPOSE

Recent observations linked coronavirus disease 2019 (COVID-19) to thromboembolic complications possibly mediated by increased blood coagulability and inflammatory endothelial impairment. We aimed to define the risk of acute stroke in patients with severe and non-severe COVID-19.

METHODS

We performed an observational, multicenter cohort study in four participating hospitals in Saxony, Germany to characterize consecutive patients with laboratory-confirmed COVID-19 who experienced acute stroke during hospitalization. Furthermore, we conducted a systematic review using PubMed/MEDLINE, Embase, Cochrane Library and bibliographies of identified papers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines including data from observational studies of acute stroke in COVID-19 patients. Data were extracted by two independent reviewers and pooled with multicenter data to calculate risk ratios (RRs) and 95% confidence intervals (95% CIs) for acute stroke related to COVID-19 severity using a random-effects model. Between-study heterogeneity was assessed using Cochran's Q and I2 statistics. International Prospective Register of Systematic Reviews registration number: CRD42020187194.

RESULTS

Of 165 patients hospitalized for COVID-19 (49.1% males, median age = 67 years [57-79 years], 72.1% severe or critical) included in the multicenter study, overall stroke rate was 4.2% (95% CI: 1.9-8.7). Systematic literature search identified two observational studies involving 576 patients that were eligible for meta-analysis. Amongst 741 pooled COVID-19 patients, overall stroke rate was 2.9% (95% CI: 1.9-4.5). Risk of acute stroke was increased for patients with severe compared to non-severe COVID-19 (RR = 4.18, 95% CI: 1.7-10.25; P = 0.002) with no evidence of heterogeneity (I2  = 0%, P = 0.82).

CONCLUSIONS

Synthesized analysis of data from our multicenter study and previously published cohorts indicates that severity of COVID-19 is associated with an increased risk of acute stroke.

[Factors influencing drainage productivity in breast reduction: A retrospective study of 222 breasts]

INTRODUCTION

The objective of this study is to highlight the factors that influence drain productivity in reduction mastoplasty.

MATERIALS AND METHODS

We have retrospectively referenced from November 2015 to November 2017 all breast reduction performed in the plastic surgery, reconstructive and esthetic surgery department of the University Hospital of Nancy. A total of 222 breasts were analyzed by listing age, weight, height, Body Mass Index (BMI), smoking status, surgeon, technical used, hospitalization stay, breast volume removed, type and size of drain and their productivity. Multivariate analysis were realised.

RESULTS

118 patients were included with an average age of 42.2 years. The average productivity of drains was 50 millilitres (ml). There was a significant difference in productivity of drainage according to the operator with a median ranging from 10ml to 60ml (P<0.0001). The median was 20ml for 10 Redon-Jost drains versus 50ml for the 16 Redon-Jost drains (P<0.0001). Multivariate analysis of the various factors influencing the total productivity of postoperative drainage showed a relative risk of 1.16 for smokers, 0.24 for one surgeon, 1.68 for the Skoog technique, and 1.000 for breast volume removed.

CONCLUSION

The drain productivity is not predictable before a breast reduction. Indeed, none of the characteristics studied have sufficient influence on the productivity of the drains.

[Mistreatment during childbirth: A prospective multicentric survey among women in maternities in Burgundy]

OBJECTIVES

The purpose of this study was to estimate the prevalence of mistreatment during childbirth (MDCB), to assess the subjective experience of women and to identify the factors associated with MDCB.

METHODS

This prospective multicentered study included every single public maternity of the Burgundy Perinatal Network from the 15th of February to the 15th of March 2019. An anonymous questionnaire was distributed on postpartum's second day. It encompassed the following categories of MDCB: verbal, physical abuse, information, consent, failure to meet professional standards of care (PSC), poor rapport between women and providers (PRBWP), and discrimination, as well as the subjective experience, physical and psychological.

RESULTS

Out of 1793 eligible women, 1149 answered (64.1%). Women reported a positive experience of childbirth, physical (89.8%) and psychological (93.4%). On the other hand, 506 women (44%) reported MDCB. The incidence of verbal (2.3%) or physical (0.4%) abuse or discrimination (3.5%) was marginal. MDCB reported was mainly a lack of research and/or respect of consent (21.5%), lack of satisfying information for at least one procedure (14.4%), declaration of lack of respect of PSC (24.2%), PRBWP (11.1%). When the subjective experience of childbirth was negative on the physical aspect, one MDCB was declared in 80% of cases (P<0.01).

CONCLUSIONS

This study highlights the importance of involving women in care's decisions. We should systematize the information and seeking of consent in a dynamic way and promote free choice for women.

[Comparing outcomes of Immediate Breast reconstruction with and without use of radiotherapy]

BACKGROUND

Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results.

METHODS

We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications.

RESULTS

Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable.

CONCLUSIONS

Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful.

Simulation of delayed gamma rays from neutron-induced fissions using MCNP 6.1

As part of its R&xD activities in the fields of radioactivewaste drum storage and homeland security, the NuclearMeasurement Laboratory of CEA Cadarache has started studiesrelated to the detection of induced delayed fission gamma rays asa signature of U/Pu presence either in radioactive wastes or incargo containers and luggage. The study described in the presentpaper explores the feasibility of detecting fission delayed gammarays of nuclear materials interrogated by a pulsed neutrongenerator. For this purpose, Monte Carlo simulations have beenperformed with ACT, the MNCP6 Activation Control Card.Simulated results have been compared with experimental data tovalidate the numerical model. Samples of uranium andplutonium have been irradiated for 2 hours with a pulsed D-Tneutron generator delivering 14 MeV neutrons with an averageemission of 8.107n/s, which are thermalised in a graphite cellcalled REGAIN. At the end of irradiation, activated nuclearmaterials were placed in a low-background, high-resolutiongamma spectroscopy station in order to detect delayed gammarays emitted by fission products. Anomalies have been observedin the calculated time decay curve of fission delayed gamma rayswith MCNP6 ACT card, but the time behavior is correct for non-fission activated materials like aluminum or copper. On the otherhand, the number of counts recorded in the main simulatedgamma ray lines from activated nuclear material fission productsis consistent with the experimental results, thus validating thesimulation scheme in view of further studies on thecharacterization of radioactive waste drums or special nuclearmaterial detection in cargo containers.

[Analysis of microsurgical reconstruction activity in a university hospital: A 14-year historical cohort]

INTRODUCTION

Each university hospital has its own specificities in microsurgical reconstructions. Activities may focus on breast reconstruction, ENT reconstruction or traumatic substance loss. This study analyzes the specificities at the University Hospital of Nancy, studies the indications, the operating data and the failure rates.

METHOD

We realized a historical cohort of microsurgical reconstructions at Nancy University Hospital from January 1, 2004 to December 31, 2017. All free flaps were included and analyzed.

RESULTS

A total of 359 free flaps were made. The failure rate was 9.47%. Forty eight different operators have been identified. Substance losses were essentially traumatic (56.8%). A total of 20 different flaps were use with 49% bone reconstruction. The fibula flap was the first flap used (26.5%). Arterial anastomoses were performed in termino-lateral in 44% and venous anastomoses were single in 70.5%. High BMI, diabetes, high blood pressure, atherosclerosis, and arterial or venous graft were identified as risk factors for failure (P<0.05). The smoking and the realisation of the intervention by a young operator have no impact on the success rate.

CONCLUSION

Our specificity is the bone reconstruction which represents a significant part of our activity. In the university center, the number of etiology of substance losses, operator and flap used is important but it still allows to obtain results in adequacy with the literature.

Abstract P1-13-01: Final results of the ASG1-3 study, a randomized phase III study comparing a standard dose chemotherapy with epirubicin/cyclophosphamide and paclitaxel with a dose dense regimen with epirubicin and paclitaxel

Background

Dose dense chemotherapy (DDT) has shown improvements of disease-free survival (DFS) and overall survival for primary breast cancer patients with a high risk of relapse. There are much less data about the effect of DDT in patients with intermediate risk of recurrence (1-3 positive axillary lymph nodes). Aim of this prospectively randomized trial was to investigate the superiority of a DDT schedule over a standard chemotherapy (ST) in primary breast cancer patients with 1-3 positive axillary lymph nodes.

Methods

The ASG1-3 study is a prospectively randomized, open label phase III study of the Adjuvant Study Group of the NOGGO association. Patients were eligible for the trial, if they had a primary invasive breast cancer (pT1-3) with 1-3 positive axillary lymph nodes and no evidence of distant metastases. Patients were randomized to an adjuvant therapy with either 4 cycles epirubicin (90mg/m2 body surface area, BSA) and cyclophosphamide (600mg/m2 BSA) q3w, followed by 4 cycles of paclitaxel (175mg/m2 BSA) referred to as ST or to a therapy with 4 cycles of epicubicin (120 mg/m2 BSA) q2w and primary G-CSF support followed by 4 cycles of paclitaxel (175mg/m2 BSA) q2w and primary G-CSF support referred to as DDT. Trastuzumab was not given in this study. The study was designed to show an increase of 70% DFS (ST) to 80% DFS (DDT) 5 years after randomization. Comparisons were conducted using Kaplan Meier estimates, log rank tests and Cox regression analyses. In an exploratory way, subgroup analyses were performed for HER2, hormone receptor status and grading using Cox regression models with interaction terms.

Results

A total of 936 patients were eligible for survival analysis, of which 465 were randomized to ST and 471 to DDT from 2001 to 2004. Patient characteristics were mainly well balanced, with patients being 52.5/52.1 years old, 71.9/78.1% being hormone receptor positive, 24.4/24.6% being HER2 positive and 38.6/38.8% having a tumor grade of 3 in the ST arm and DDT arm respectively. 53 events occurred after ST and 46 after DDT. Adjusted hazard ratio (HR) was 0.87 (95%CI: 0.57-1.35; p=0.54). 5 year DFS rates were 85% (ST) vs. 87% (DDT). Hematological toxicities were the most common grade 3 or 4 adverse events. Grade 3/4 neutropenia occurred in 57.2 vs. 28.0%, grade 3/4 anemia in 15.3% vs. 17.1% and grade 3 /4 pain symptoms were seen in 13.2 vs. 12.4% of the patients in the ST arm vs. DDT arm respectively. Other grade 3/4 toxicities were less frequent than 10%. Subgroup analysis showed a significant interaction (p&lt;0.001) between HER2 status and randomization arm with regard to DFS. In HER2 negative patients the HR was 1.53 (95%CI: 0.91-2.59), whereas in HER2 positive patients the HR was 0.22 (95%CI: 0.09-0.55). Patients with HER2 positive disease and DDT had a similar prognosis like HER2 negative patients.

Conclusion

In the overall population a statistically significant improvement of DFS could not be shown for the DDT arm. In patients with HER2 positive breast cancer DDT chemotherapy improved the disease-free survival to a prognosis which was similar to patients with HER2 negative disease.

Citation Format: Fasching PA, Eggemann H, Krocker J, Häberle L, Volz B, Kleine-Tebbe A, Blohmer J-U, Kittel K, Hufnagel M, Janni W, Emons G, Simon E, Köhler U, Thomssen C, Kohls A, Beckmann MW, Hielscher C, Krabisch P, Zeiser T, Brodkorb T, Baier F, Nabieva N, Kellner S, Untch M, Stadie S, Budner M, Breitbach G-P, Keller M, Stickeler E, Kühn T, Tolkmitt M, Belau AK, Schmidt M, Ulm K, Kümmel S. Final results of the ASG1-3 study, a randomized phase III study comparing a standard dose chemotherapy with epirubicin/cyclophosphamide and paclitaxel with a dose dense regimen with epirubicin and paclitaxel [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-01.

PD-1 deficiency is not sufficient to induce myeloid mobilization to the brain or alter the inflammatory profile during chronic neurodegeneration

Innate immune activation is a major driver of neurodegenerative disease and immune regulatory pathways could be potential targets for therapeutic intervention. Recently, Programmed cell death-1 (PD-1) immune checkpoint inhibition has been proposed to mount an IFN-γ-dependent systemic immune response, leading to the recruitment of peripheral myeloid cells to the brain and neuropathological and functional improvements in mice with Alzheimer's disease-like β-amyloid pathology. Here we investigate the impact of PD-1 deficiency on murine prion disease (ME7 strain), a model of chronic neurodegeneration. Although PD-1 was found to be increased in the brain of prion mice, the absence of PD-1 did not cause myeloid cell infiltration into the brain or major changes in the inflammatory profile. However, we observed a slight exacerbation of the behavioural phenotype of ME7 mice upon PD-1 deficiency. These results do not support the possibility of using immune checkpoint blockade as a therapeutic strategy in neurodegenerative disease.

[Lower Uterine Segment Trial: A pragmatic open multicenter randomized trial]

BACKGROUND

The data from literature show that trial of labor and elective repeat cesarean delivery after a prior cesarean delivery both present significant risks and benefits, and these risks and benefits differ for the woman and her fetus. The benefits to the woman can be at the expense of her fetus and vice-versa. This uncertainty is compounded by the scarcity of high-level evidence that preclude accurate quantification of the risks and benefits that could help provide a fair counseling about a trial of labor and elective repeat cesarean delivery. An interesting way of research is to evaluate the potential benefits of a decision rule associated to the ultrasound measurement of the lower uterine segment (LUS). Indeed, ultrasonography may be helpful in determining a specific risk for a given patient by measuring the thickness of the LUS, i,e, the thickness of the cesarean delivery scar area. Although only small and often methodologically biased data have been published, they look promising as their results are concordant: ultrasonographic measurements of the LUS thickness is highly correlated with the intraoperative findings at cesarean delivery. Furthermore, the thinner the LUS becomes on ultrasound, the higher the likelihood of a defect in the LUS. Finally, ultrasound assessment of LUS has an excellent negative predictive value for the risk of uterine defect. Therefore, this exam associated with a rule of decision could help to reduce the rate of elective repeat cesarean delivery and especially to reduce the fetal and maternal mortality and morbidity related to trial of labor after a prior cesarean delivery.

METHODS/DESIGN

This is a pragmatic open multicenter randomized trial with two parallel arms. Randomization will be centralized and computerized. Since blindness is impossible, an adjudication committee will evaluate the components of the primary composite outcome in order to avoid evaluation bias. An interim analysis will be planned mid-strength of the trial. Ultrasound will be performed by expert sonographers after certification by the main investigator. Women aged 18 years or older are eligible for this trial if they have a singleton pregnancy in cephalic presentation at a gestational age from 36 to 38 weeks, a previous low transverse cesarean delivery and sign the informed consent sheet. Women will be asked to participate in this study when they reach a term of 36 to 38 weeks of gestation. After agreement, women will be randomized into two groups: in the study group, they will have the LUS measured by ultrasound and the patient will be informed that, based on a threshold value of 3.5mm for the ultrasound measurement of the LUS thickness, the patient with a higher measurement will be considered at low risk and will be encouraged to choose a trial of labor whereas the patient with a measurement is equal to or less than this threshold will be considered at risk and encouraged to choose an elective repeat cesarean; in the control group, ultrasound LUS measurement will not be performed. The mode of delivery will be decided according to standard practice at the center. The primary composite outcome will include: uterine rupture, uterine dehiscence, hysterectomy, thromboembolic complications, transfusion, endometritis, maternal mortality, fetal prenatal and intrapartum mortality, hypoxic-ischemic encephalopathy and neonatal mortality.

DISCUSSION

This trial assesses the efficacy of ultrasound measurement of the lower uterine segment in women with a prior cesarean delivery in reducing fetal and maternal morbidity and mortality and it will provide evidence in order to establish clinical recommendations.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01916044 (date of registration: 5 August 2013).

[Postoperative quality of life of patients with a bacterial necrotizing dermis-hypodermitis or necrotizing fasciitis, a ten-year study]

INTRODUCTION

Bacterial necrotizing dermis-hypodermitis and necrotizing fasciitis (BNDH-NF) are serious life-threatening soft-tissue infections. The object is to evaluate the quality of life (QOL) of patients who have been operated in our plastic surgery departement.

PATIENTS AND METHODS

This is a retrospective study of cases who have been treated at Nancy University Hospital between 2005 and 2014. We analyzed the perioperative data (demographic, clinical, bacteriological), the surgical data (excision, reconstruction) and the follow up data (consequences, mortality). The quality of life was assessed by the Short-Form 36 score, and the patients' satisfaction was assessed by a four-level scale.

RESULTS

We analyzed 23 patients with an average age of 60 years (28-84 years). The main comorbidities were diabetes (43 %) and obesity (39 %). The average number of surgical excision was about 1.9 (1-5) and the average excised body surface area was about 5 % (1-16 %). The short-term mortality was about 17 %. The mortality rate has been statistically correlated with the surgically excised body surface area (short-term 95 days: P=0.02; and long-term: P=0.003). The statistical analysis has shown a strong relative linear relationship between number of surgical excision and the physical score of QOL (P<0.001), between number of surgical excision and mental score of QOL (P=0.032), and between age and physical score of QOL (P≤0.021). The statistical analysis has also shown a strong relative linear relationship between E. coli infections and physical score of QOL (P=0.01). The percentage of patients' satisfaction in our study was evaluated at 86 %.

CONCLUSION

We have found that multiple surgical excisions, an advanced age of patients and E. coli infections have been associated with poor QOL. The mortality rate increased in relation with the importance of excised body surface. In spite of the gravity of these infections, our patients were satisfied of their treatment.

Performance assessment of imaging plates for the JHR transfer Neutron Imaging System

The underwater Neutron Imaging System to be installed in the Jules Horowitz Reactor (JHR-NIS) is based on a transfer method using a neutron activated beta-emitter like Dysprosium. The information stored in the converter is to be offline transferred on a specific imaging system, still to be defined. Solutions are currently under investigation for the JHR-NIS in order to anticipate the disappearance of radiographic films commonly used in these applications. We report here the performance assessment of Computed Radiography imagers (Imaging Plates) performed at LLB/Orphée (CEA Saclay).

Several imaging plate types are studied, in one hand in the configuration involving an intimate contact with an activated dysprosium foil converter: Fuji BAS-TR, Fuji UR-1 and Carestream Flex XL Blue imaging plates, and in the other hand by using a prototypal imaging plate doped with dysprosium and thus not needing any contact with a separate converter foil. The results for these imaging plates are compared with those obtained with gadolinium doped imaging plate used in direct neutron imaging (Fuji BAS-ND).

The detection performances of the different imagers are compared regarding resolution and noise.

The many advantages of using imaging plates over radiographic films (high sensitivity, linear response, high dynamic range) could palliate its lower intrinsic resolution.

Auswirkung der Sexualsteroide auf die Gefäßwand

Es wird die Wirkung der verschiedenen synthetischen und natürlichen Estrogene und Gestagene auf Arterien und Venen dargestellt. Dabei werden die Unterschiede zwischen den einzelnen Derivaten ebenso aufgezeigt, wie die Bedeutung der Applikationsform und -dosis. Von der physiologischen Wirkung ausgehend werden Indikationen, Nutzen und Risiken bei der praktischen Anwendung besprochen sowie Problemsituationen bei der hormonalen Kontrazeption und der Hormonersatztherapie wie Varikosis, Thrombose, Indikationen zum Absetzen, Antikoagulanzien und Pille erläutert.

Abstract P3-08-06: Screening, management, cancer diagnoses, and outcomes of women with germline BRCA mutations in Israel: The Noga Clinic experience

Background: Women with germline BRCA (gBRCA) mutations in the United States are typically diagnosed at the time of cancer diagnosis and most often undergo bilateral mastectomy. Israel's population of 8 million includes over 3 million Jews of Ashkenazi ancestry, of whom 2.5% would be expected to have gBRCA based on population studies. Cross-ancestral and -racial marriages in Israel continue to expand the population at risk for gBRCA mutations. Gene typing for any woman in Israel can be obtained without cost through either the national health care system or genetic screening studies. The Noga Clinic (NC) in Jerusalem was started in September 2007 for women with documented gBRCA mutations at risk for breast and/or ovarian cancer to counsel them on risk-reducing (rr) surgical interventions and provide rigorous screening to diagnose cancer at its earliest stages. Screening is performed in compliance with NCCN and international recommendations. This report presents information from that unique population and clinical experience.

Methods: Clinical records of women with at least one screening visit at NC through December 2015 were retrospectively reviewed. Women with a documented gBRCA mutation with or without a clinical history of breast/ovarian cancer were eligible for assessment every (q) 6 months (m): bilateral breast exam by an experienced breast surgeon (q6m), serum CA-125 (q6m), trans-vaginal ultrasound (q6m), bilateral mammography (q12m) and bilateral breast ultrasound (q12m) alternating with bilateral contrast enhanced MRI (q12m) beginning at age 25. Women are offered rr bilateral mastectomy (BMast); rr salpingo-oophorectomy is recommended by the age of 40. Cancer diagnoses and rr surgeries were recorded.

Results: 611 women have undergone at least one screening assessment at the NC, of whom 44 had a prior cancer diagnosis. Age at the time of initial gene testing ranged from 20-87y (median 38). Of those with recorded mutation data, 272 women (57%) had mutations in gBRCA1, 205 (43%) in BRCA2, and 1 in both. Mutation specifics will be presented in detail. For the 567 women without a prior cancer diagnosis, median age at first screening visit was 37y (range 21-87) and total follow up was 2,141 person-years (per person range 1-9y, median 3.3). Only 21 women (4%) elected rrBMast at a median age of 42y (range 26-60); none developed breast cancer. In the remaining individuals, 31 breast cancers were diagnosed (58% gBRCA1, 42% gBRCA2) from the initiation of screening at a median age of 51y (range 28-88); the majority were DCIS and diagnosed at a median screening follow up of 2.8y. No participant was treated with anti-endocrine chemoprevention. There have been no breast cancer deaths. 5 women were diagnosed with ovarian cancer (all gBRCA1) of whom 1 died of the disease. Methods of cancer detection will be presented.

Conclusion: This is the largest reported data set of women with gBRCA mutations without a prior breast or ovarian cancer diagnosis screened and followed over time. In this highly selected predominantly Jewish population in Israel, the great majority of women chose not to undergo rrBMast and have excellent outcomes when participating in regular and rigorous screening. Further follow-up is ongoing.

Citation Format: Mor P, Levy-Lahad E, Beler U, Carmon M, Strano S, Hadar T, Olsha O, Rabinowitz R, Srebnik N, Simon E, Duchin R, Jackson M, Rabinovitch R. Screening, management, cancer diagnoses, and outcomes of women with germline BRCA mutations in Israel: The Noga Clinic experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-08-06.

Assessment of contamination based on trace element concentrations in Gomphus flavipes (Odonata: Insect) larvae of the Upper Tisza Region

Odonata larvae are frequently used to assess the contamination of aquatic systems, because they tolerate a wide range of chemical and biological conditions in freshwater systems. In early 2000, the sediments of the Hungarian section of the River Tisza and the River Szamos were strongly enriched with heavy metals by an accidental mining spill. Earlier studies demonstrated higher contamination levels in the Szamos than in the Tisza, based on sediment analysis. The aim of our study was to assess the contamination in the Upper Tisza Region, along the upper reach of the Tisza, and the lower reach of the Szamos, based on the trace element concentrations of the Gomphus flavipes larvae. We collected 269 dragonfly specimens for the analyses. The Al, Ba, Cr, Cu, Fe, Mn, Pb, Sr and Zn element contents were analysed in the dragonfly larvae by microwave plasma atomic emission spectrometry (MP-AES). Significantly higher Ba and Cu concentrations were found in the dragonfly larvae of the Tisza than the Szamos. In spite of this, the Cr, Mn, Pb, Sr and Zn concentration was significantly lower in the dragonfly larvae of the Tisza than the Szamos. For all trace elements significant differences were found along the Tisza. Significant differences were also found in all trace element concentrations of dragonfly larvae among studied localities in the Szamos, except in the cases of Al and Ba. Our results demonstrated that the Szamos was more contaminated with Cr, Mn, Pb, Sr and Zn than the Tisza, but that the Tisza was more contaminated with Ba and Cu than the Szamos, based on the trace element concentrations in Gomphus flavipes larvae, which was likely to have been caused by the tributaries of the Tisza. In summary, our results indicated a continuous pollution of the Tisza and the Szamos and their tributaries.

[Response to treatment with interferon beta in patients with multiple sclerosis. Validation of the Rio Score]

INTRODUCTION

Different criteria have been proposed for the response to treatment with interferon beta, and the Rio Score is one of the most widely used. The aim of this study was to validate the usefulness of the Rio Score in an independent cohort.

PATIENTS AND METHODS

A multi-centre, prospective, longitudinal study was conducted on patients with relapsing-remitting multiple sclerosis treated with interferon beta. The patients were classified according to the presence of attacks, active lesions (new in T2 or gadolinium enhancing lesions) in magnetic resonance imaging, a confirmed increase in disability or combinations of these variables (attacks, increase on the Expanded Disability Status Scale and active lesions) after one year's treatment. Regression analysis was used in order to identify the response-predicting variables after a three-year follow-up.

RESULTS

The sample consisted of 249 patients with relapsing-remitting multiple sclerosis. The logistic model confirmed that the presence of two (odds ratio = 6.6; CI 95% = 2.7-16.1; p < 0.0001) or three (odds ratio = 8.5; CI 95% = 1.6-46; p < 0.01) positive variables during the first year of treatment were indicative of a significant risk of activity (attacks or progression) in the next two years.

CONCLUSIONS

The usefulness of the Rio Score is confirmed, in an independent cohort, as a means of identifying patients with a higher risk of developing clinical activity or progression of disability during treatment with interferon beta.

Effect of diet supplementation with live yeast (Saccharomyces cerevisiae) on performance of rabbit does and their progenies

<p>A study was conducted to determine the effect of live yeast supplementation in the diet of rabbit does on their mortality and reproductive performance and the performance of their progeny. A total of 52 cross-bred rabbit does (New Zealand×Californian) were divided into 2 groups differing in diet offered during 2 reproductive cycles and containing (group S; n=26) or not (group C; n=26) 1 g of yeast (Actisaf Sc 47, S.I. LESAFFRE, France)/kg of feed. Natural mating was performed 11 d after kindling and kits were weaned at 28 d of age. Body weight of litters was measured at birth, 21 d and at 28 d of age (weaning). Mortality of kits and rabbit does was monitored daily, and fertility of rabbit does and viability rate of kits at birth were also determined. Weight and litter size at birth and at weaning, litter weight gain during lactation and length of gestation were similar between the 2 groups during the 2 cycles. The mortality of does during the experiment was higher in group C than in group S (27 vs. 4%; P&lt;0.05). Fertility rate of rabbits does and viability rate of kits at birth were higher (P&lt;0.05) in rabbits fed with the supplemented diet than those with the control diet during the second lactation. In the first cycle, kit mortality was lower in S group (15.5%) than the C group (24.7%) during the first 21 d (P&lt;0.05). However, no difference was observed during the second lactation. In conclusion, our results suggest that the inclusion of yeast in the diet of rabbit does could trigger positive effects on the fertility and mortality of rabbit does, as well as on the viability rate of kits at birth.</p>

[Post-partum: Guidelines for clinical practice--Short text]

OBJECTIVE

To determine the post-partum management of women and their newborn whatever the mode of delivery.

MATERIAL AND METHODS

The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.

RESULTS

Because breastfeeding is associated with a decrease in neonatal morbidity (lower frequency of cardiovascular diseases, infectious, atopic or infantile obesity) (EL2) and an improvement in the cognitive development of children (EL2), exclusive and extended breastfeeding is recommended (grade B) between 4 to 6 months (Professional consensus). In order to increase the rate of breastfeeding initiation and its duration, it is recommended that health professionals work closely with mothers in their project (grade A) and to promote breastfeeding on demand (grade B). There is no scientific evidence to recommend non-pharmacological measures of inhibition of lactation (Professional consensus). Pharmacological treatments for inhibition of lactation should not be given routinely to women who do not wish to breastfeed (Professional consensus). Because of potentially serious adverse effects, bromocriptin is contraindicated in inhibiting lactation (Professional consensus). For women aware of the risks of pharmacological treatment of inhibition of lactation, lisuride and cabergolin are the preferred drugs (Professional consensus). Whatever the mode of delivery, numeration blood count is not systematically recommended in a general population (Professional consensus). Anemia must be sought only in women with bleeding or symptoms of anemia (Professional consensus). The only treatment of post-dural puncture headache is the blood patch (EL2), it must not be carried out before 48 h (Professional consensus). Women vaccination status and their family is to be assessed in the early post-partum (Professional consensus). Immediate postoperative monitoring after caesarean delivery should be performed in the recovery room, but in exceptional circumstances, it may be performed in the delivery unit provided safety rules are maintained and regulatory authorities are informed (Professional consensus). An analgesic multimodal protocol developed by the medical team should be available and oral way should be favored (Professional consensus) (grade B). For every cesarean delivery, thromboprophylaxis with elastic stockings applied on the morning of the surgery and kept for at least 7 postoperative days is recommended (Professional consensus) with or without the addition of LMWH according to the presence or not of additional risk factors, and depending on the risk factor (major, minor). Early postoperative rehabilitation is encouraged (Professional consensus). Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, after normal pregnancy and delivery (Professional consensus). Starting effective contraception later 21 days after delivery in women who do not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). According to the postpartum risk of venous thromboembolism, the combined hormonal contraceptive use before six postpartum weeks is not recommended (grade B). Rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long-term is not recommended (Expert consensus). Pelvic-floor rehabilitation using pelvic-floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C). Postpartum pelvic-floor rehabilitation is not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). The optimal time for maternity discharge for low risk newborn depends more on the organisation of the post-discharge follow up (Professional consensus). The months following the birth are a transitional period, and psychological alterations concern all parents (EL2). It is more difficult in case of psychosocial risk factors (EL2). In situations of proven psychological difficulties, the impact on the psycho-emotional development of children can be important (EL3). Among these difficulties, postpartum depression is the most common situation. However, the risk is generally higher in the perinatal period for all mental disorders (EL3).

CONCLUSION

Postpartum is, for clinicians, a unique and privileged opportunity to address the physical, psychological, social and somatic health of their patients.

Evaluation of the Effect of Hypercapnia on Vascular Function in Normal Tension Glaucoma

INTRODUCTION

Altered ocular perfusion and vascular dysregulation have been reported in glaucoma. The aim of this paper was to evaluate the vascular response to a hypercapnic stimulus.

METHODS

Twenty normal tension glaucoma (NTG) patients and eighteen age- and gender-matched controls had pulsatile ocular blood flow (POBF) measurements, systemic cardiovascular assessment, and laser Doppler digital blood flow (DBF) assessed. Measurements were taken at baseline, after 10-minutes rest, in the stable sitting and supine positions and following induction and stabilization of hypercapnia, which induced a 15% increase in end-tidal pCO2. The POBF response to hypercapnia was divided into high (>20%) and low responders (<20%).

RESULTS

65% of NTG patients had a greater than 41% increase in POBF following CO2 rebreathing (high responders). These high responders had a lower baseline POBF, lower baseline DBF, and a greater DBF response to thermal stimulus.

CONCLUSION

NTG patients that have a greater than 20% increase in POBF after a hypercapnic stimulus have lower baseline POBF and DBF values. This suggests that there is impaired regulation of blood flow in a significant subgroup of NTG patients. This observation may reflect a generalised dysfunction of the vascular endothelium.

Effect-based assessment of persistent organic pollutant and pesticide dumpsite using mammalian CALUX reporter cell lines

A combined chemical and biological analysis of samples from a major obsolete pesticide and persistent organic pollutant (POP) dumpsite in Northern Tajikistan was carried out. The chemical analytical screening focused on a range of prioritized compounds and compounds known to be present locally. Since chemical analytics does not allow measurements of hazards in complex mixtures, we tested the use of a novel effect-based approach using a panel of quantitative high-throughput CALUX reporter assays measuring distinct biological effects relevant in hazard assessment. Assays were included for assessing effects related to estrogen, androgen, and progestin signaling, aryl hydrocarbon receptor-mediated signaling, AP1 signaling, genotoxicity, oxidative stress, chemical hypoxia, and ER stress. With this panel of assays, we first quantified the biological activities of the individual chemicals measured in chemical analytics. Next, we calculated the expected sum activity by these chemicals in the samples of the pesticide dump site and compared the results with the measured CALUX bioactivity of the total extracts of these samples. The results showed that particularly endocrine disruption-related effects were common among the samples. This was consistent with the toxicological profiles of the individual chemicals that dominated these samples. However, large discrepancies between chemical and biological analysis were found in a sample from a burn place present in this site, with biological activities that could not be explained by chemical analysis. This is likely to be caused by toxic combustion products or by spills of compounds that were not targeted in the chemical analysis.

Magnetism of Gadolinium: A First-Principles Perspective

By calculating the spectral density of states in the ferromagnetic ground state and in the high temperature paramagnetic phase we provide the first concise study of finite temperature effects on the electronic structure of the bulk and the surface of gadolinium metal. The variation of calculated spectral properties of the Fermi surface and the density of states in the bulk and at the surface are in good agreement with recent photoemission experiments performed in both ferromagnetic and paramagnetic phases. In the paramagnetic state we find vanishing spin splitting of the conduction band, but finite local spin moments both in bulk and at the surface. We clearly demonstrate that the formation of these local spin moments in the conduction band is due to the asymmetry of the density of states in the two spin channels, suggesting a complex, non-Stoner behavior. We, therefore, suggest that the vanishing or nearly vanishing spin splitting of spectral features cannot be used as an indicator for Stoner-like magnetism.

[Coverage of anterior knee defect by reverse flow anterolateral thigh flap: About two cases]

The coverage of soft-tissue defects concerning the front of the knee and the proximal lower leg is a complex procedure. The reverse flow anterolateral thigh flap represents a good solution for this defects, especially when the coverage surface is large-sized and a free flap is not appropriate regarding the difficulty of the process. Flap retrograde vascularization is based on the anastomosis between the descending branch of the circumflex femoral artery and lateral superior genicular artery. It is an easy solution with low morbidity. The authors have chosen this flap to cover soft-tissue defect of anterior knee from two patients with total knee prothesis.

Analysis of Body Composition and Food Habits of Spanish Celiac Women

The purpose of the present work was both to analyze composition of Spanish celiac women and to study the food habits and gluten-free diet of these celiac patients, in order to determine whether they achieve a balanced and healthy diet as well as to highlight nutritional qualitative and/or quantitative differences. 54 adult celiac women (34 ± 13 years) took part in the six-month study. Height, weight and body composition were measured. An analysis of energy consumption and of the macronutrient distribution of their diet was carried out. Their fulfillment of micronutrient intake recommendations was verified. Participants showed a Body Mass Index of 21.6 ± 2.4 kg/m2. Energy Intake was slightly lower than the Dietary Reference Intakes. Excessive protein apart from over-consumption of fat was observed. More than three quarters of participants consumed meat in excess. Carbohydrate consumption along with that of fiber was below recommended levels. Vitamin D, iron, and iodine had a low percentage of recommendation compliance. In general, participants followed the recommendations of dairy products and fruit intake whereas vegetable consumption was not enough for the vast majority. We conclude that although the diet of celiac women does not differ much from the diet of general population, some considerations, such as reducing fat and protein consumption and increasing fiber intake, must be taken into account.