A Surgical Virtual Reality Simulator Distinguishes Between Expert Gynecologic Laparoscopic Surgeons and Perinatologists

Laparoscopic virtual reality simulators can measure relevant surgical skills and so distinguish between subjects having different skills level

The Management of Uterine Leiomyomas

Objectives: The aim of this guideline is to provide clinicians with an understanding of the pathophysiology, prevalence, and clinical significance of myomata and the best evidence available on treatment modalities. Options: The areas of clinical practice considered in formulating this guideline were assessment, medical treatments, conservative treatments of myolysis, selective uterine artery occlusion, and surgical alternatives including myomectomy and hysterectomy. The risk-to-benefit ratio must be examined individually by the woman and her health care provider. Outcomes: Implementation of this guideline should optimize the decision-making process of women and their health care providers in proceeding with further investigation or therapy for uterine leiomyomas, having considered the disease process and available treatment options, and reviewed the risks and anticipated benefits. Evidence: Published literature was retrieved through searches of PubMed, CINAHL, and Cochrane Systematic Reviews in February 2013, using appropriate controlled vocabulary (uterine fibroids, myoma, leiomyoma, myomectomy, myolysis, heavy menstrual bleeding, and menorrhagia) and key words (myoma, leiomyoma, fibroid, myomectomy, uterine artery embolization, hysterectomy, heavy menstrual bleeding, menorrhagia). The reference lists of articles identified were also searched for other relevant publications. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to January 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies. Benefits, Harms, and Costs: The majority of fibroids are asymptomatic and require no intervention or further investigations. For symptomatic fibroids such as those causing menstrual abnormalities (e.g. heavy, irregular, and prolonged uterine bleeding), iron defficiency anemia, or bulk symptoms (e.g., pelvic pressure/pain, obstructive symptoms), hysterectomy is a definitive solution. However, it is not the preferred solution for women who wish to preserve fertility and/or their uterus. The selected treatment should be directed towards an improvement in symptomatology and quality of life. The cost of the therapy to the health care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat investigative or treatment modalities. Values: The quality of evidence in this document was rated using the criteria described in the Report of the Caadian Task Force on Preventive Health Care (Table 1)

Water waves over a rough bottom in the shallow water regime

This is a study of the Euler equations for free surface water waves in the case of varying bathymetry, considering the problem in the shallow water scaling regime. In the case of rapidly varying periodic bottom boundaries this is a problem of homogenization theory. In this setting we derive a new model system of equations, consisting of the classical shallow water equations coupled with nonlocal evolution equations for a periodic corrector term. We also exhibit a new resonance phenomenon between surface waves and a periodic bottom. This resonance, which gives rise to secular growth of surface wave patterns, can be viewed as a nonlinear generalization of the classical Bragg resonance. We justify the derivation of our model with a rigorous mathematical analysis of the scaling limit and the resulting error terms. The principal issue is that the shallow water limit and the homogenization process must be performed simultaneously. Our model equations and the error analysis are valid for both the two- and the three-dimensional physical problems.Comment: Revised version, to appear in Annales de l'Institut Henri Poincar\'

Monoacylglycerol lipase reprograms hepatocytes and macrophages to promote liver regeneration

Background & Aims: Liver regeneration is a repair process in which metabolic reprogramming of parenchymal and inflammatory cells plays a major role. Monoacylglycerol lipase (MAGL) is an ubiquitous enzyme at the crossroad between lipid metabolism and inflammation. It converts monoacylglycerols into free fatty acids and metabolises 2-arachidonoylglycerol into arachidonic acid, being thus the major source of pro-inflammatory prostaglandins in the liver. In this study, we investigated the role of MAGL in liver regeneration. Methods: Hepatocyte proliferation was studied in vitro in hepatoma cell lines and ex vivo in precision-cut human liver slices. Liver regeneration was investigated in mice treated with a pharmacological MAGL inhibitor, MJN110, as well as in animals globally invalidated for MAGL (MAGL-/-) and specifically invalidated in hepatocytes (MAGLHep-/-) or myeloid cells (MAGLMye-/-). Two models of liver regeneration were used: acute toxic carbon tetrachloride injection and two-thirds partial hepatectomy. MAGLMye-/- liver macrophages profiling was analysed by RNA sequencing. A rescue experiment was performed by in vivo administration of interferon receptor antibody in MAGLMye-/- mice. Results: Precision-cut human liver slices from patients with chronic liver disease and human hepatocyte cell lines exposed to MJN110 showed reduced hepatocyte proliferation. Mice with global invalidation or mice treated with MJN110 showed blunted liver regeneration. Moreover, mice with specific deletion of MAGL in either hepatocytes or myeloid cells displayed delayed liver regeneration. Mechanistically, MAGLHep-/- mice showed reduced liver eicosanoid production, in particular prostaglandin E2 that negatively impacts on hepatocyte proliferation. MAGL inhibition in macrophages resulted in the induction of the type I interferon pathway. Importantly, neutralising the type I interferon pathway restored liver regeneration of MAGLMye-/- mice. Conclusions: Our data demonstrate that MAGL promotes liver regeneration by hepatocyte and macrophage reprogramming. Impact and Implications: By using human liver samples and mouse models of global or specific cell type invalidation, we show that the monoacylglycerol pathway plays an essential role in liver regeneration. We unveil the mechanisms by which MAGL expressed in both hepatocytes and macrophages impacts the liver regeneration process, via eicosanoid production by hepatocytes and the modulation of the macrophage interferon pathway profile that restrains hepatocyte proliferation.The authors thank V. Fauveau, Institut Cochin, for help in surgery experiments; Olivier Thibaudeau of the Plateau de Morphologie Facility (INSERM UMR 1152, France) and Nicolas Sorhaindo of the Plateforme de Biochimie (CRI, INSERM UMR1149) for their help in the histology and liver function tests; and K. Bailly from the cytometry platform of Cochin Institute and H. Fohrer-Ting from the Centre de Recherche des Cordeliers, Paris University, for cell sorting analyses.Scopu

Transformations agricoles et agroalimentaires

À l’heure des robots et du numérique, la terre (habitat, agriculture, paysage, planète) et la nourriture (du corps et de l’âme) sont parmi les préoccupations majeures dans les espaces médiatiques et politiques. Le pétrole et l’abondance qui l’a accompagné nous avaient fait oublier qu’elles sont au fondement des sociétés humaines. La « crise alimentaire » de 2008, qui a secoué plusieurs continents, a rappelé aux gouvernements l’enjeu de la sécurité alimentaire. Après des décennies d’excédents, de baisse du prix des produits agricoles de base, la question de la valeur de la terre et de l’agriculture est de retour. La question de la santé et celle des droits humains prennent une place élargie tant dans les politiques publiques et dans la production de normes alimentaires. Des mouvements sociaux transnationaux s’emparent de la question de l’avenir de l’agriculture et de l’alimentation, et de celle de la « bonne vie ». Pour contribuer à cette réflexion sur l’avenir de la terre et de la nourriture, cet ouvrage étudie la socialisation de l’agriculture, c’est-à-dire sa prise en charge tant par les politiques agricoles (essentiellement nationales) que par l’organisation des marchés dans un cadre national et international. Il le fait en prenant un large recul et mobilise trois temporalités. La première est celle de la planète. La seconde, celle des régimes métaboliques, façons dont l’humanité à différents stades de développement, mobilise matériaux et énergie. La troisième est celle du capitalisme, avec la succession de systèmes hégémoniques (ce qui n’exclue pas de multiples polarités). Cet ouvrage réunit des recherches récentes d’économistes, de sociologues, d’historiens et d’agronomes, de différents pays, recherches qui ont en commun de concerner la place de l’agriculture dans l’évolution des capitalismes