Practice of laparoscopic prolapse surgery in Europe - ESGE Survey.

peer reviewedSacrocolpopexy is considered as the "gold standard" for management of women with apical prolapse. Numerous technical variants are being practiced. The first aim of this survey was to determine the habits of practice of laparoscopic sacrocolpopexy (LSCP) in Europe. The second aim was to determine whether surgeons who perform laparoscopic pelvic organ prolapse (POP) repair are familiar with the practice of alternative techniques and with mesh-less laparoscopic treatment of prolapse. The questionnaire was designed by the Urogynaecology Special Interest Group of the European Society for Gynaecological Endoscopy (ESGE). All ESGE-members were invited by email to respond to this survey consisting of 54 questions divided in different categories. Following review of ESGE member's responses, we have highlighted the great heterogeneity concerning the practice of LSCP and important variability in performance of concomitant surgeries. Alternative techniques are rarely used in practice. Furthermore, the lack of standardisation of the many surgical steps of a laparoscopic sacrocolpopexy is mainly due to the lack of evidence. There is a need for training and teaching in both standard and newer innovative techniques as well as the reporting of medium and long-term outcomes of both standard laparoscopic sacrocolpopexy and any of its alternatives

The ewe as an animal model of vaginal atrophy and vaginal Er:YAG laser application.

peer reviewed[en] OBJECTIVE: In sheep of reproductive age, we aimed to document decrease in epithelial thickness, glycogen amount, and other vaginal changes after castration and the effect of Er:YAG laser as used clinically. METHODS: On day 0, 16 sheep underwent ovariectomy. They were randomized to sham or three vaginal Er:YAG laser applications at monthly intervals. Primary outcome was vaginal epithelial thickness (d60, d71, d73, d77, and d160). Secondary outcomes included indicators of atrophy (vaginal health index = VHI), pH, cytology, morphology at the above time points, microcirculation focal depth (FD; d70 and d160), and at sacrifice (d160) vaginal dimensions and active and passive biomechanical testing. RESULTS: Menopausal changes between 60 and 160 days after ovariectomy included a progressive decrease in epithelial thickness, in VHI, FD, glycogen, elastin content and vasculature, and an increase in pH and collagen content. In lasered animals, the first day a few white macroscopic foci were visible and an increase in pH was measured. Both disappeared within 3 days. Seven days after laser the epithelial thickness increased. At sacrifice (d160), there were no differences between sham and laser group in vaginal dimensions, morphometry, mitotic and apoptotic activity, active contractility, vaginal compliance, except for a lower blood vessel density in the lamina propria of the midvagina in the laser group. CONCLUSIONS: In reproductive sheep, ovariectomy induces vaginal atrophy evidenced in different outcome measurements. Vaginal Er:YAG laser induced visual impact, a short-term increase in epithelial thickness yet no long-term changes compared to sham therapy in menopausal controls.Video Summary:http://links.lww.com/MENO/A672

A study to assess changes in myocardial perfusion after treatment with spinal cord stimulation and percutaneous myocardial laser revascularisation; data from a randomised trial

<p>Abstract</p> <p>Background</p> <p>Spinal cord stimulation (SCS) and percutaneous myocardial laser revascularisation (PMR) are treatment modalities used to treat refractory angina pectoris, with the major aim of such treatment being the relief of disabling symptoms. This study compared the change in myocardial perfusion following SCS and PMR treatment.</p> <p>Methods</p> <p>Subjects with Canadian Cardiovascular Society class 3/4 angina and reversible perfusion defects as assessed by single-photon emission computed tomographic myocardial perfusion scintigraphy were randomised to SCS (34) or PMR (34). 28 subjects in each group underwent repeat myocardial perfusion imaging 12 months post intervention. Visual scoring of perfusion images was performed using a 20-segment model and a scale of 0 to 4.</p> <p>Results</p> <p>The mean (standard deviation) baseline summed rest score (SRS) and stress scores (SSS) were 4.6 (5.7) and 13.6 (9.0) in the PMR group and 6.1 (7.4) and 16.8 (11.6) in the SCS group. At 12 months, SRS was 5.5 (6.0) and SSS 15.3 (11.3) in the PMR group and 6.9 (8.2) and 15.1 (10.9) in the SCS group. There was no significant difference between the two treatment groups adjusted for baseline (p = 1.0 for SRS, p = 0.29 for SSS).</p> <p>Conclusion</p> <p>There was no significant difference in myocardial perfusion one year post treatment with SCS or PMR.</p

Formulating 'principles of procedure' for the foreign language classroom: A framework for process model language curricula

This article aims to apply Stenhouse's process model of curriculum to foreign language (FL) education, a model which is characterized by enacting principles of procedure which are specific to the discipline which the school subject belongs to. Rather than to replace or dissolve current approaches to FL teaching and curriculum development, this article seeks to improve and enrich communicative and task-based orientations with an additional criterion for assessing the educational worth of the tasks through which these orientations are developed. Unlike the objectives and competences models, principles of procedure provide an intrinsic justification of school curriculum by enacting the epistemological structure of any given area of knowledge in the educational process. Accordingly, the article will first justify the need to come up with a process model of curriculum for FL education which is built around such principles; then, it will formulate a basic framework that reflects the logical structure, concepts and epistemological perspectives of the language studies, as a first step to allowing these to enter the FL classroom and orient the teaching conducted in it; finally, it will present three tasks whose design was inspired by the abovementioned framework, and which were put into practice with Primary education English as a Foreign Language learners during the 2013 2014 and 2014 2015 academic years

Avant-propos

de Landsheere G. Avant-propos. In: Bulletin de la Société française du Rorschach et des méthodes projectives, n°28, 1974. Le Rorschach en psychologie clinique. p. 5

Avant-propos

de Landsheere G. Avant-propos. In: Bulletin de la Société française du Rorschach et des méthodes projectives, n°28, 1974. Le Rorschach en psychologie clinique. p. 5

High Achievers in Belgium: A Partial Analysis of I. E. A. Science, Literature and Reading Comprehension Data

In this article, we examine what IEA data tell us about the situation of the gifted in Belgium. (Author) All the data indicate a low achievement in Belgium for the gifted group, at all school levels and for the different school subjects. This deficit is especially clear if we compare Belgian students with English-speaking and Scandinavian students. The underachievement of the gifted is particularly marked in Populations I and II.. The situation is better for Population IV. In this case, we can assume that improvement is not caused by specific action of the school in favor of the gifted. Undoubtedly, this ipmrovement is the result of the high retentivity of the system. The IEA survey took place during the school years 1969-1970, before new secondary school structures and methods were introduced on Belgium. None of the students tested followed the new curriculum. So, to believe that the Belgian situation is desperate would be a mistake. Also on the positive side, our country has a high retentivity rate and the flexibility of the new secondary education curriculum. On the other hand, the IEA data do indicate that insufficient opportunities are offered to the gifted, and, if our educational authorities understand the message, IEA time and effort will not have been wasted