Ultrasound assessment of haemoperitoneum in ectopic pregnancy: derivation of a prediction model

<p>Abstract</p> <p>Background</p> <p>To derive an ultrasound-based prediction model for the quantification of haemoperitoneum in ectopic pregnancy (EP).</p> <p>Methods</p> <p>Retrospective study of 89 patients operated upon EP between January 1999 and March 2003 in a French Gynaecology and Obstetrics department in a university hospital. Transvaginal sonograms, clinical and biological variables from patients with haemoperitoneum ≥ 300 ml at surgery were compared with those from patients with haemoperitoneum < 300 ml or no haemoperitoneum. Sensitivity, specificity, positive and negative likelihood ratios were calculated for each parameter after appropriate dichotomization. Multiple logistic regression analysis was used to select the best combination at predicting haemoperitoneum ≥ 300 ml.</p> <p>Results</p> <p>Three parameters predicted haemoperitoneum ≥ 300 ml independently: moderate to severe spontaneous pelvic pain, fluid above the uterine fundus or around the ovary at transvaginal ultrasound, and serum haemoglobin concentration < 10 g/dL. A woman with none of these three criteria would have a probability of 5.3% for haemoperitoneum ≥ 300 ml. When two or more criterias were present, the probability for haemoperitoneum ≥ 300 ml reached 92.6%.</p> <p>Conclusion</p> <p>The proposed model accurately predicted significant haemoperitoneum in patients diagnosed to have EP.</p

Essential Oil Trunk Injection Into Orchard Trees: Consequences on the Performance and Preference of Hemipteran Pests.

peer reviewedApples and pears are among the most widely cultivated fruit species in the world. Pesticides are commonly applied using ground sprayers in conventional orchards; however, most of it will not reach the target plant, increasing the contamination of nontarget organisms such as natural predators, pollinators, and decomposers. Trunk injection is an alternative method of pesticide application that could reduce risks to beneficials and workers. Essential oils represent a 'green' alternative to pesticides due to their reported insecticidal, antimicrobial, antiviral, nematicidal, and antifungal properties. The aim of this study was, therefore, to evaluate the impact that the injection of a cinnamon essential oil solution into the trunk of apple and pear trees could have on their respective pests, Dysaphis plantaginea and Cacopsylla pyri, respectively. The feeding behavior (preference), the life history traits (performance), and the timing of this effect were measured. The injection of an essential oil emulsion in trees impacted hemipteran host-plant colonization, as for both species a modification of their preference and of their performance was observed. The feeding behavior of D. plantaginea was altered as a significantly lower proportion of aphids ingested phloem sap on injected trees, suggesting that the aphids starved to death. On the contrary, the feeding behavior of the psyllids was little changed compared to the control condition, implying that the observed mortality was due to intoxication. The results presented here could theoretically be used to control these two orchard hemipteran pests, although the effectiveness in real conditions still has to be demonstrated

Des plateformes analytiques et technologiques pour le développement de nouveaux biostimulants et agents de biocontrôle (PHENIX_BIOCONTROL_ULIEGE)

The PHENIX-BIOCONTROL-ULIEGE project relies on the analytical and technological platforms of the PHENIX portfolio to develop new biostimulants and control agents, in connection with the IIS DigiBiocontrol. This project is coordinated by Pr. Philippe Jacques from Gembloux Agro-Bio Tech (University of Liège), who is also the leader of the IIS DigiBiocontrol initiative. Four Work Packages are brached to reinforce 6 key competence axes of innovation in biostimulation and biocontrol: new screening approaches, mode of action characterization, control mode activity, production processes, formulation and texturing, and greenhouse and field demonstration.Le projet PHENIX-BIOCONTROL-ULIEGE s'appuie sur les plateformes analytiques et technologiques du portefeuille PHENIX pour développer de nouveaux biostimulants et agents de contrôle, en lien avec l'IIS DigiBiocontrol. Ce projet est coordonné par le Pr. Philippe Jacques de Gembloux Agro-Bio Tech (Université de Liège), qui est également le chef de file de l'initiative IIS DigiBiocontrol. Quatre Work Packages sont mis en place pour renforcer 6 axes de compétences clés en matière d'innovation dans le domaine de la biostimulation et du biocontrôle : nouvelles approches de criblage, caractérisation du mode d'action, activité du mode de contrôle, processus de production, formulation et texturation, et validation en serre et en champ.Projet PHENIX Biocontrol ULiège-SP

Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy

BACKGROUND: SPARCLE is a cross-sectional survey in nine European regions, examining the relationship of the environment of children with cerebral palsy to their participation and quality of life. The objective of this report is to assess data quality, in particular heterogeneity between regions, family and item non-response and potential for bias. METHODS: 1,174 children aged 8–12 years were selected from eight population-based registers of children with cerebral palsy; one further centre recruited 75 children from multiple sources. Families were visited by trained researchers who administered psychometric questionnaires. Logistic regression was used to assess factors related to family non-response and self-completion of questionnaires by children. RESULTS: 431/1,174 (37%) families identified from registers did not respond: 146 (12%) were not traced; of the 1,028 traced families, 250 (24%) declined to participate and 35 (3%) were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61%) self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self-report. There was substantial heterogeneity between regions in response rates and socio-demographic characteristics of families but not in age or gender of children. Item non-response was 2% for children and ranged from 0.4% to 5% for questionnaires completed by parents. CONCLUSION: While the proportion of untraced families was higher than in similar surveys, the refusal rate was comparable. To reduce bias, all analyses should allow for region, walking ability, age and socio-demographic characteristics. The 75 children in the region without a population based register are unlikely to introduce bias

Do Surgeons Anticipate Women’s Hopes and Fears Associated with Prolapse Repair? A Qualitative Analysis in the PROSPERE Trial

Women’s preoperative perceptions of pelvic-floor disorders may differ from those of their physicians. Our objective was to specify women’s hopes and fears before cystocele repair, and to compare them to those that surgeons anticipate. We performed a secondary qualitative analysis of data from the PROSPERE trial. Among the 265 women included, 98% reported at least one hope and 86% one fear before surgery. Sixteen surgeons also completed the free expectations-questionnaire as a typical patient would. Women’s hopes covered seven themes, and women’s fears eleven. Women’s hopes were concerning prolapse repair (60%), improvement of urinary function (39%), capacity for physical activities (28%), sexual function (27%), well-being (25%), and end of pain or heaviness (19%). Women’s fears were concerning prolapse relapse (38%), perioperative concerns (28%), urinary disorders (26%), pain (19%), sexual problems (10%), and physical impairment (6%). Surgeons anticipated typical hopes and fears which were very similar to those the majority of women reported. However, only 60% of the women reported prolapse repair as an expectation. Women’s expectations appear reasonable and consistent with the scientific literature on the improvement and the risk of relapse or complication related to cystocele repair. Our analysis encourages surgeons to consider individual woman’s expectations before pelvic-floor repair

Impact des pratiques obstétricales sur l'incontinence urinaire de la femme de l'accouchement à la ménopause

L'objectif était de préciser l'effet des pratiques obstétricales préventives, épisiotomie et césarienne, sur l'incontinence urinaire (IU).La première cohorte provient de 2 maternités aux politiques opposées pour l'épisiotomie. Une enquête préliminaire a déterminé le nombre de sujets nécessaire. Les critères d'inclusion sont une 1ère naissance vivante à terme en présentation céphalique et une adresse postale à jour, 774 femmes remplissent ces conditions, nous avons reçu 627 réponses (81%). L'autre population est issue de la cohorte GAZEL constituée de salariées volontaires pour la recherche médicale, 3114 femmes âgées de 50 à 62 ans ont reçu le questionnaire, 2640 ont répondu (85%).Quatre ans après l'accouchement, les facteurs de risque pour l'IU d'effort sont l'âge, l'IU préexistante, l'IU de la grossesse, la durée du travail et le mode d'accouchement. La comparaison entre les 2 politiques d'épisiotomie ne montre pas bénéfice en faveur d'une utilisation systématique.A la cinquantaine, les facteurs de risque pour l'IU d'effort sévère sont la parité, l'obésité, le diabète, la chirurgie de l'IU et un jeune âge au premier. Le mode d'accouchement n'a aucun effet.L'effet du mode d'accouchement sur l'IU à l'effort s'atténue avec l'âge et n'est plus mesurable après 50 ans, qui est l'âge moyen pour la chirurgie de l'IU. Le risque lié à la grossesse est toujours identifiable à cet âge. Cette atténuation avec l'âge des conséquences de l'accouchement est en faveur d'un mécanisme d'altération de la continence indépendant du mode d'accouchement. Nos résultats suggèrent que la prévention de l'IU d'effort par des interventions à l'accouchement, épisiotomie ou césarienne, est inefficace.PARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Développement d'un autoquestionnaire pour le diagnostic des algies pelviennes aigües

Les algies pelviennes aigues constituent le premier motif de consultation aux urgences gynécologiques. Les étiologies possibles de ces algies pelviennes aigues sont nombreuses et incluent à la fois des affections gynécologiques et non gynécologiques. Certaines de ces affections peuvent, en l absence de diagnostic précoce et d un traitement adapté, avoir des conséquences très graves. Dans ce travail, nous avons développé un autoquestionnaire standardisé de manière qualitative dédié aux urgences gynécologiques par des entretiens structurés. Nous avons ensuite construit des modèles de prédiction clinique dédiés (i) au diagnostic de rupture tubaire chez les patientes porteuses de grossesses extra-utérines et (ii) au diagnostic de torsion d annexe à partir de cet autoquestionnaire. Après avoir défini le concept d urgence potentiellement à risque en gynécologie, nous avons proposé (iii) un modèle de prédiction clinique de celles-ci basé sur notre autoquestionnaire standardisé. A l issue du développement de ces modèles, nous avons sélectionné certains items de l autoquestionnaire standardisé afin d en proposer une version simplifiée. L utilisation de nos modèles pour le tri et le diagnostic des patientes aux urgences gynécologiques pourrait permettre d optimiser la prise en charge des patientes. Dans les groupes à haut risque de pathologie, les patientes pourraient bénéficier d une prise en charge plus rapide avec une éventuelle diminution de la morbidité secondaire à la pathologie. Pour les patientes classées à bas risque, une désescalade des examens complémentaires et des chirurgies inutiles pourrait aussi permettre une diminution de la morbidité d origine iatrogène.Acute pelvic pain is the main reason for emergency gynecologic consultation. The possible etiologies of acute pelvic pain are numerous and include both gynecological and non gynecological diseases. Some of these conditions may, in the absence of early diagnosis and appropriate treatment, have very serious consequences. In this work, we developed qualitatively a standardized self-assessed questionnaire dedicated to gynecological emergencies by structured interviews. We then developed clinical prediction rules for (i) the diagnosis of tubal rupture in patients who have ectopic pregnancies and (ii) the diagnosis of adnexal torsion. After a definition of the concept of potentially at risk emergencies in gynecology, we have proposed (iii) a clinical prediction rule based on our questionnaire. Following the development of these models, we selected items from the self-assessed questionnaire in order to propose a simplified version. Using our models for triaging and diagnosis of patients with gynecologic emergencies may optimize the management of patients. In groups at high risk of disease, patients may benefit from faster medical management with a possible decrease in morbidity. For patients classified as low risk, decrease of complementary tests and unnecessary surgery could also allow a reduction of iatrogenic morbidity.PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Re: First vaginal delivery at an older age: does it carry an extra risk for the development of stress urinary incontinence? Groutz A, Helpman L, Gold R, Pauzner D, Lessing JB, Gordon D. 2007. Neurourol Urodyn 26:779-782.

International audienc

Comparaison de cinq modes d'évaluation des douleurs pelviennes aigües aux urgences gynécologiques

L'objectif était d'évaluer cinq types d'échelles mesurant l'intensité des douleurs pelviennes aiguës (l'échelle visuelle analogique, l'échelle numérique simple, l'échelle verbale simple et deux échelles d'hétéro évaluation comportementales) et d'étudier la sensibilité de l'intensité des douleurs aux pathologies gynécologiques. 177 patientes ont été incluses de façon prospective avec remplissage d'un questionnaire durant la consultation. Les résultats issus de l'analyse en composante principale ont montré une excellente corrélation entre les trois échelles d'autoévaluations et une bonne corrélation avec les échelles d'hétéro évaluations comportementales. Ces cinq échelles ont des qualités métrologiques proches, avec une supériorité des échelles d'autoévaluations en terme de facilité d'utilisation et de sensibilité aux diagnostics. L'intensité de la douleur mesurée par ces échelles est d'autant plus forte que les pathologies sous jacentes sont graves. Ces échelles permettent d'améliorer la prise en charge diagnostique et thérapeutique, en particulier les échelles d'autoévaluations pour leurs facilités d'utilisations.The objective was to evaluate five types of scales measuring the intensity of the acute pelvic pains (the analogical visual scale, the simple numerical scale, the simple verbal scale and two behavioral scales of hétéro evaluation) and to study the sensitivity of the intensity of the pains to gynaecological pathologies. 177 patients were included in a prospective way with filling of a questionnaire during the consultation. The results resulting from the analysis in principal component showed an excellent correlation between the three scales of autoévaluations and a good correlation with the scales of hétéro behavioral evaluations. These five scales have close metrological qualities, with a superiority of the scales of autoévaluations in term of facility of use and sensitivity to the diagnoses. The intensity of the pain measured by these scales is all the more strong as pathologies under unclaimed are serious. These scales make it possible to improve the diagnostic and therapeutic assumption of responsibility, in particular the scales of autoévaluations for their facilities of uses.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF