Multiplex quantitative PCR for single-reaction genetically modified (GM) plant detection and identification of false-positive GM plants linked to Cauliflower mosaic virus (CaMV) infection.

BACKGROUND:Most genetically modified (GM) plants contain a promoter, P35S, from the plant virus, Cauliflower mosaic virus (CaMV), and many have a terminator, TNOS, derived from the bacterium, Agrobacterium tumefaciens. Assays designed to detect GM plants often target the P35S and/or TNOS DNA sequences. However, because the P35S promoter is derived from CaMV, these detection assays can yield false-positives from non-GM plants infected by this naturally-occurring virus. RESULTS:Here we report the development of an assay designed to distinguish CaMV-infected plants from GM plants in a single multiplexed quantitative PCR (qPCR) reaction. Following initial testing and optimization via PCR and singleplex-to-multiplex qPCR on both plasmid and plant DNA, TaqMan qPCR probes with different fluorescence wavelengths were designed to target actin (a positive-control plant gene), P35S, P3 (a CaMV-specific gene), and TNOS. We tested the specificity of our quadruplex qPCR assay using different DNA extracts from organic watercress and both organic and GM canola, all with and without CaMV infection, and by using commercial and industrial samples. The limit of detection (LOD) of each target was determined to be 1% for actin, 0.001% for P35S, and 0.01% for both P3 and TNOS. CONCLUSIONS:This assay was able to distinguish CaMV-infected plants from GM plants in a single multiplexed qPCR reaction for all samples tested in this study, suggesting that this protocol is broadly applicable and readily transferrable to any interested parties with a qPCR platform

Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries

Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N= 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p< 0.01), and from 15.5 to 9.3% (p< 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks

How did episiotomy rates change from 2007 to 2014? Population-based study in France

International audienceBACKGROUND: Since the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy.METHODS: This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment.RESULTS: There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]).CONCLUSIONS: The episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant

Soins ambulatoires et facteurs associés à la réhospitalisation précoce des sujets âgés (65+) après un infarctus du myocarde : étude observationnelle à partir des données nationales de l’Échantillon généraliste de bénéficiaires (EGB)

International audienceÉtat de la questionLes réhospitalisations précoces (RHP), dans les 30jours suivant la sortie d’hospitalisation, sont fréquentes chez les sujets âgés, notamment après un infarctus du myocarde (IDM). Elles augmentent la morbi-mortalité et les dépenses de santé. Il a été démontré qu’une meilleure organisation de la sortie d’hospitalisation réduit significativement le risque de RHP. Néanmoins, il n’existe aucune recommandation sur le suivi ambulatoire en sortie d’hospitalisation. L’objectif de l’étude était d’analyser les soins ambulatoires post-hospitaliers et les facteurs associés à la RHP des sujets âgés après un IDM.Matériel et méthodesÉtude observationnelle rétrospective à partir des données nationales de l’Échantillon généraliste de bénéficiaires (EGB). Tous les patients ≥65 ans, hospitalisés pour un IDM entre 2011 et 2013 étaient inclus. Les patients hospitalisés pour un IDM dans l’année précédente, ou décédés pendant l’hospitalisation initiale ou dans les 30jours suivant la sortie étaient exclus. Le critère de jugement principal était la première réhospitalisation, toutes causes, dans les 30jours suivant la sortie du court-séjour. Des données socio-démographiques, médicales et de soins ambulatoires étaient recueillies. Les déterminants de la RHP étaient identifiés via des modèles de régression logistique.RésultatsParmi les 624 patients éligibles, 137 étaient réhospitalisés dans les 30jours (22 %). L’âge moyen était de 79,2 ans, avec une prédominance masculine (57 %). Le délai moyen de réhospitalisation était de 11,9jours. En analyse multivariée, la fibrillation atriale (OR=1,81 [1,12–2,91]), l’insuffisance rénale chronique (OR=1,90 [1,01–3,57]) et la délivrance d’un antiagrégant plaquettaire ou anticoagulant dans les sept jours suivant la sortie (OR=0,57 [0,38–0,83]) étaient significativement associés à la RHP.ConclusionCette étude, réalisée sur un échantillon représentatif de la population française, confirme le haut risque de RHP chez les sujets âgés en post-IDM. Des interventions ciblées sur les comorbidités et les traitements paraissent nécessaires pour réduire ces RHP

Early screening for type 2 diabetes following gestational diabetes mellitus in France: hardly any impact of the 2010 guidelines.

IF 3.340International audienceAIMS:Women who had gestational diabetes mellitus (GDM) have a high risk of type 2 diabetes mellitus (T2DM) in the years following pregnancy. Most follow-up screening studies have been conducted in limited geographical areas leading to large variability in the results. The aim of our investigation was to measure how the publication of guidelines affected early screening for T2DM after a pregnancy with GDM during the period 2007-2013, in France.METHODS:We conducted a retrospective cohort study in a representative sample of 1/97th of the French population using data from the "National Health Insurance Inter-Regime Information System," which collects individual hospital and non-hospital data for healthcare consumption.RESULTS:The sample included 49,080 women who gave birth in 2007-2013. In the following 3 months, only 18.49% of women with GDM had an oral glucose tolerance test or a blood glucose test in 2007. This rate had not significantly increased in 2013 (p = 0.18). The proportion of women with GDM who had the recommended glycemic follow-up at 3 months (20.30 vs. 21.58%, p = 0.19) and 6 months (32.48 vs. 37.16%, p = 0.08) was not significantly different before the guidelines (2008-2009) and after the guidelines (2012-2013). At 12 months, the difference was significant (46.77 vs. 54.05%, p = 0.009).CONCLUSION:Postpartum screening has improved only slightly since the guidelines and remains largely insufficient, with less than 25% of women with GDM screened in the first 3 months. In the first year after delivery, less than 60% of women were screened for T2DM

Évaluation de la pratique chirurgicale dans le traitement du cancer bronchique en France à partir de la base nationale du PMSI

IF 0.580 (2017)International audienceBackgroundIn recent years, improving the quality of care has been a concern for health professionals in France, through the certification of institutions, accreditation and continuous professional development. Evaluation of these different measures has rarely been carried out. The objective of the study was to evaluate the quality of surgical management of lung cancer in different regions using hospital mortality as an indicator.MethodFrom the national database of the Program of Medical Information Systems (PMSI), data on all patients who had undergone surgery for lung cancer were extracted as well as the characteristics of the centers. The main outcome criterion was hospital mortality. Logistic models allowed an estimation of the risk standardized mortality rate for each center.ResultsFrom January 1, 2015 to December 31, 2015, 10,675 patients underwent surgery for lung cancer in 158 French centers. The hospital mortality rate was 3.43% (n = 366). Thirty-nine facilities (25%) performed fewer than 15 pulmonary resections. The minimum activity volume was a single pulmonary resection during the year and the maximum was 300 interventions with a coefficient of variation estimated at 147%. Hospital mortality ranged from 0 % to 50% depending on the entries with a coefficient of variation of 112%. For some regions, it is possible to count up to 5 centers per million inhabitants (Languedoc-Roussillon) or 4 centers per million inhabitants (Limousin, Pays-de-Loire). The majority of regions had 3 centers per million inhabitants. Eleven regions have no centers with a standardized mortality rate below 3%. Five regions (Languedoc-Roussillon, Pays-de-Loire, Aquitaine, Brittany and Provence Alpes Côte d'Azur) have at least two centers with a risk standardized rate of mortality above 4%. Among the academic centers, 20% have a risk standardized mortality rate of less than 3%. Among the centers with a risk standardized rate of mortality < 3%, 20% performed more than 39 pulmonary resections, 7% between 39 and 15 procedures and 0% for centers with < 15 interventions.ConclusionThis work confirms that hospital volume is one of the components of quality of care. The number of centers should be adapted to the actual needs of the population in order to enable patients to access effective services.Position du problèmeEn France depuis plusieurs années, la qualité des soins est une préoccupation des professionnels de santé par l’intermédiaire de la certification des établissements, l’accréditation et le développement professionnel continu. Rarement une évaluation de ces différentes mesures a été réalisée. L’objectif de l’étude est d’évaluer à partir de la base de données nationale du PMSI, la qualité de la prise en charge chirurgicale du cancer du poumon dans les différentes régions en utilisant comme indicateur la mortalité hospitalière.MéthodeDe la base nationale du Programme de médicalisation des systèmes d’information (PMSI) ont été extraits tous les patients opérés d’un cancer du poumon ainsi que les caractéristiques des centres. Le critère de jugement était la mortalité hospitalière. Les modèles logistiques ont permis d’estimer pour chaque établissement le taux standardisé de mortalité.RésultatsDu 1er janvier 2015 au 31 décembre 2015, 10 675 patients ont été opérés d’un cancer bronchique dans 158 centres français. Le taux de mortalité hospitalière est de 3,43 % (n = 366). Trente-neuf établissements (25 %) ont pratiqué moins de 15 résections pulmonaires. Le volume d’activité minimum est d’une résection pulmonaire en 2015 et le maximum de 300 interventions avec un coefficient de variation estimé à 147 %. La mortalité hospitalière varie de 0 % à 50 % selon les centres avec un coefficient de variation de 112 %. Pour certaines régions, on peut comptabiliser jusqu’à 5 centres par million d’habitants (Languedoc-Roussillon) ou 4 centres par million d’habitants (Limousin, Pays-de-Loire). La majorité des régions comptabilisent 3 centres par million d’habitants. Onze régions n’ont aucun centre avec un taux standardisé de mortalité inférieur à 3 %. Cinq régions (Languedoc-Roussillon, Pays-de-Loire, Aquitaine, Bretagne et Provence Alpes Côte d'Azur) ont au moins deux centres avec taux standardisé de mortalité supérieur à 4 %. Parmi les établissements universitaires, 20 % ont un taux standardisé de mortalité < 3 %. Parmi les centres avec un taux standardisé de mortalité < 3 %, 20 % pratiquaient plus 39 résections pulmonaires, 7 % entre 39 et 15 procédures et 0 % pour les centres avec < 15 interventions.ConclusionCe travail confirme que le volume d’activité est une des composantes de la qualité des soins. Le nombre de centres devrait être adapté aux besoins réels de la population afin de permettre aux patients d’accéder à des plateaux techniques performants