Relationship between exposure to persistent organic pollutants and endometriosis

L’endométriose est une maladie gynécologique pour laquelle l’exposition à certains contaminants chimiques environnementaux est évoquée parmi les facteurs de risque associés. Les conclusions des études épidémiologiques existantes restent toutefois non convergentes. Leur hétérogénéité en termes de lésions décrites, de méthodologie et d’effectifs contribuent à ce constat, de même que l’étendue limitée des marqueurs d’exposition considérés dans ces études. Nous avons réalisé une étude cas-témoins appariés à partir d’une bio-collection de 113 patientes réunissant68 cas de patientes opérées d’endométriose profonde et 45 patientes témoins. Un ensemble unique de 78 polluants organiques persistants a été recherché, incluant dioxines, polychlorobiphényles, retardateurs de flamme polybromés, et pesticides organochlorés. Les niveaux d’exposition interne des sujets ont été mesurés à la fois dans les tissus adipeux pariétal et épiploïque ainsi que dans le sérum. La distribution de ces différents polluants au sein de ces trois compartiments a tout d’abord été caractérisée. Celle-ci a permis la prise en compte encore très rare de l’équilibre entre compartiments de stockage et compartiment circulant, ce rapport de concentration apparaissant comme un potentiel indicateur additionnel permettant d’affiner d’éventuels liens de causalité entre exposition chronique à des dangers chimiques et pathologie chez l’homme. Certains des contaminants ciblés sont ensuite apparus significativement associés à l’endométriose profonde, la stratification plus fine de notre population de cas indiquant un lien d’autant plus significatif en présence d’endométriome. Les mécanismes sous-jacents de cette association restent toutefois à élucider.Endometriosis is a gynecological disease for whichexposure to some environmental chemicals is evocatedamong the associated risk factors. Epidemiological studies are however globally non convergent and finally fairly conclusive. Their heterogeneity in terms of lesion localization and sub-phenotype, methodology, size and nature of the populations studied, as well as the limited number of monitored markers of exposure contribute to this situation. We realized a matched case-control study based on a biocollection of 113 patients including 68 patients suffering of deep endometriosis and 45 controls. We characterized the internal exposure levels of an extended range of around 78 persistent organic pollutants (including dioxins, polychlorobiphenyls, brominated flame retardants and organochlorine pesticides). Internal level exposures were measured in three biological compartments (omental fat, subcutaneous fat and serum). First, the distribution of these chemicals was characterized within these compartments. These extended exposure data from deep infiltrating endometriosis patients are the first ones available for France and give a new insight about the equilibrium of chemicals between storage and circulating compartments that should be further considered as a potential indicator permitting to establish a possible association between a chronic exposure to chemical hazards and human pathology. Afterwards, some of the targeted chemicals appeared significantly associated with deep endometriosis. A sub-stratification of our case population indicated a more significant relationship with the presence of endometrioma. Underlying mechanisms remain to be determined

Adverse pregnancy and neo-natal outcomes after assisted reproductive treatment in patients with pelvic endometriosis: a case–control study

International audienceTo assess the impact of endometriosis on obstetric outcomes and to determine whether the severity, location and surgical treatment of the disease before the pregnancy had an impact on the prevalence of these disorders, a monocentric, case-control study was performed. In total, 113 pregnancies obtained by assisted reproductive treatment among patients with endometriosis were matched with control selected among assisted reproductive treatment pregnancies due to male infertility. The main result measures were pregnancy outcome at the obstetrical and neo-natal levels. The incidence of first trimester bleeding, pre-eclampsia, premature delivery threat, pelvic pain and Caesarean section was significantly higher (P < 0.05) in women with endometriosis. Except for gestational diabetes and intrauterine growth restriction (IUGR), the severity, location of lesions and surgical treatment of endometriosis did not have an impact on either pregnancy outcome or risk of obstetric complications. The IUGR is mainly due to deep locations and the revised American Fertility Society (rAFS) stages III-IV. Newborns with a mother suffering from endometriosis are at greater risk of being premature, smaller for their gestational age and more frequently hospitalized than the control group. Deep location of endometriosis is associated with more prematurity, hospitalization and smaller birthweight than ovarian locations

A framework to estimate the contribution of weeds to the delivery of ecosystem (dis)services in agricultural landscapes

International audienceThere is a pressing need for indicators and methods to quantify the provision of ecosystem services as a prerequisite to identify management options that optimize trade-offs between services. Arable weeds provide multiple services and are thus a good model to evaluate such trade–offs. This flora provides trophic resources (flowers or seeds) that support pollinators and pest natural enemies (pollination and pest control services) but can also be harmful for crop production (disservice). To date, few indicators are available to quantify the contribution of weeds to ecosystem services or their harmfulness, and no indicators account for intraspecific variability in weed traits that result from contrasting growing conditions, notably the location of weeds within fields (field edge vs field core) and crop type. Here, we developed nine proxies for potential weed harmfulness (competition, harvest difficulties and future weed infestations) and weed contributions to resources provision to pollinators (bees, bumblebees and hoverflies) and pest natural enemies (carabid beetles, birds and parasitoid wasps). These nine proxies accounted for individual weed plant response to growing conditions (combination of within-field location by crop type) for 155 weed species, resulting in 967 unique situations (combinations of species by within-field locations by crop types). Apart from harvest difficulties, all proxies were positively correlated, i.e. harmfulness increased when services increased. Weed plants located on field edges had greater contributions to all proxies than those located in field cores, especially in cereal crops. We identified that small weed species with short life cycles and low competitiveness, presented the optimum proxy combination, i.e. high services and low harmfulness. The development of these proxies and the proposed framework provide new avenues for assessing trade-offs between multiple ecosystem services at different temporal (crop sequence) and spatial scales (landscape)

Which are the ideal donor and recipient vessels for a whole ovarian transplantation

Objective : To compare deep circumflex iliac (DCI) and deep inferior epigastric (DIE) pedicles as potential recipient vessels for a whole ovarian microvascular transplantation

Modélisation d’un campus numérique pour les études en médecine à partir de l’ expérience française en gynécologie-obstétrique

L'utilisation des technologies de l'information et de la communication se développe dans l'enseignement supérieur. En Médecine, cette dynamique a été impulsée par le Ministère de la Recherche et de la Technologie par l'intermédiaire de l'aide à la mise en place de campus. Le campus de gynécologie-obstétrique a fait partie des premiers campus mis en place dans le cadre du 2ème cycle des études médicales. Depuis, ce modèle a été retenu pour toutes les disciplines médicales ; le développement des campus devrait faciliter les liens entre campus et également leur utilisation pour l'enseignement du 3ème cycle et la formation médicale continue

The ENTRAMI technique: Endoscopic transgluteal minimal invasive technique for implantation of a pudendal electrode under full visual control: A cadaver study

Aim: The aim of this article is to describe a minimal invasive trans gluteal endoscopic approach to implant a pudendal electrode for neuromodulation under full visual control. Methods: Eight trans gluteal approaches were performed on four cadavers. The sacral transforaminal percutaneous technique was performed to implant the electrode. The electrode was then picked up and placed under visual control next to the pudendal nerve. Results: The first trocar was placed in the upper lateral quadrant of the gluteal region. The 0° optical system was used to help with the pneumodissection to identify the sciatic nerve. At that point a second 3 mm trocar was placed to insert a dissecting grasping forceps. In some cases, a second 3 mm trocar was placed. A step by step dissection, based on anatomical findings, was necessary to be able to locate the pudendal nerve. The electrode, which was placed percutaneously and transforaminal through S3 or S4, was picked up and placed under full visual control next to the pudendal nerve, slightly entering the Alcock's canal. The electrode was placed in an ideal manner, meaning that all 4-contact points of the electrode are in parallel and in contact with the targeted nerve. The electrode was fixed in that ideal position at the level of the sacrospinous ligament. After placement of that electrode, an X-ray of the pelvic area was done. Conclusions: The ENTRAMI technique allows optimal pudendal electrode placement under full visual control and should now be tested in a clinical setting.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Incidence des adénocarcinomes de l'endomètre après hystérectomie pour hyperplasie atypique ou carcinome intramuqueux diagnostiqués sur biopsie ou résection endométriale.

OBJECTIVE: To evaluate the risk of finding an infiltrating endometrial carcinoma when atypical hyperplasia (AH) or FIGO stage IA carcinoma were diagnosed on endometrial biopsy by Novak curette during ambulatory hysteroscopy or on pathological analysis of endometrial ablation product during operatoring hysteroscopy. METHOD: Retrospective unicentric study from 2000 to 2006 including 107 patients. Total hysterectomy with bilateral oophorectomy was performed on 95 of them. All patients had initial diagnosis of AH or FIGO stage IA carcinoma realised either by biopsy with Novak curette performed according to hysteroscopic data (52 cases), or on product of endometrial ablation (43 cases). AH and stage IA carcinoma were voluntarily studied together because of the same surgical treatment and because it is acknowledged that no complementary treatment is necessary if lesion remains intramucous. However, in presence of myometrial infiltration, the risk of lymph node infiltration exists and lymphadenectomy must be discussed. RESULTS: Out of the 95 hysterectomy specimens, 20 infiltrating endometrial carcinoma were diagnosed (21%). The risk of discovering an infiltrating endometrial carcinoma when diagnosis of AH or stage IA carcinoma is done by biopsy with Novak curette is 32.7% (17 out of 52 patients). Let's note that 30% of these ambulatory hysteroscopies (5 out of 17) were non suspect. When diagnosis is done on the products of endometrial ablation, infiltrating carcinoma is observed on the hysterectomy piece in 6.9% of cases (3 out of 43 patients). DISCUSSION AND CONCLUSION: Presence of AH or stage IA endometrial carcinoma on endometrial biopsies or on products of endometrial ablation can be associated with infiltrating endometrial carcinoma. In presence of AH or stage IA carcinoma diagnosed on biopsy with Novak curette, the incidence of infiltrating carcinoma on hysterectomy product is sizeable (32.7%) and check-up of infiltrating endometrial carcinoma should be realised with the view to state the prognostic factors and the possible indication of lymphadenectomy. Besides, in the case of a patient presenting with post menopausal bleeding with non suspect hysteroscopy, biopsic examination is necessary.Objectif. – Évaluer le risque de découvrir un cancer infiltrant de l’endomètre lorsqu’une hyperplasie atypique (HA) ou un carcinome intramuqueux de l’endomètre (CIM) ont été diagnostiqués sur des biopsies endométriales à la curette de Novak lors d’une hystéroscopie diagnostique en consultation ou sur l’analyse histologique de produits de résections endométriales lors d’une hystéroscopie opératoire. Patientes et méthode. – Étude rétrospective unicentrique de janvier 2000 à janvier 2006 incluant 107 patientes. Chez 95 d’entre elles, une hystérectomie totale avec annexectomie bilatérale a été réalisée. Toutes ces patientes présentaient un diagnostic initial d’HA ou de CIM réalisé soit à la biopsie à la curette de Novak dirigée après hystéroscopie diagnostique en consultation (52 cas), soit sur les produits de résection hystéroscopique (43 cas). HA et CIM ont été volontairement étudiés ensemble, car la sanction chirurgicale est la même et qu’il est admis qu’aucun traitement complémentaire n’est nécessaire si la lésion reste intramuqueuse. En revanche, en présence d’une invasion myométriale, il existe un risque d’envahissement ganglionnaire et une lymphadénectomie doit alors être discutée. Résultats. – Sur les 95 pièces d’hystérectomie, 20 adénocarcinomes infiltrants de l’endomètre ont été diagnostiqués (21 %). Le risque de découvrir un adénocarcinome infiltrant de l’endomètre lorsque le diagnostic d’HA ou de CIM est fait sur des biopsies à la curette de Novak est de 32,7 % (17 sur 52 patientes). Notons que 30 % de ces hystéroscopies (5 sur 17) étaient non suspectes. Lorsque le diagnostic d’HA ou de CIM est fait sur produit de résection endométriale, un adénocarcinome infiltrant est observé sur la pièce d’hystérectomie dans 6,9 % des cas (3 sur 43 patientes). Discussion et conclusion. – La présence d’une HA ou d’un CIM sur les biopsies d’endomètre ou sur les copeaux de résection endométriale peut être associée dans un certain nombre de cas à un adénocarcinome de l’endomètre. En présence d’une HA ou d’un CIM découvert à la biopsie à la Novak, l’incidence de cancer infiltrant sur pièce d’hystérectomie est importante (32,7 %) et un bilan de néoplasie endométriale infiltante pré-opératoire devrait être réalisé en vue de préciser les facteurs pronostiques et l’indication éventuelle d’une lymphadénectomie. Par ailleurs, devant une patiente présentant des métrorragies de la postménopause avec une hystéroscopie non suspecte, une évaluation biopsique est indispensable

Don du corps à la science : un nouveau cadre de régulation qui répond à certaines questions mais en soulève bien d’autres !

International audienceIn France, between 2,500 and 3,000 people donate their bodies to science each year after their death; they contribute therefore to the teaching of anatomy, to research and to the learning and improvement of surgical practices. The decision to donate must be made during the donor’s lifetime and consent must be expressed in writing to one of the 27 donation centers throughout the country. Following the scandal of the Parisian center of the Saints Pères, which revealed a lack of respect for bodies and fundamental ethical principles, the decree of April 27, 2022 concerning the donation of bodies for teaching and research purposes, which is part of the new bioethic laws, was eagerly awaited to clarify certain practices. However, this decree raises new questions because many of the rules it proposes do not appear to be relevant to the values of donation and the functioning of donation centers. The new modes of regulation proposed by the decree generate questions among donors and professionals in the field with a risk of poor regulation, detrimental to all with regard to major ethical issues. If the public authorities do not commit themselves to a regulation that is better adapted to the field, if the ethical stakes are not better clarified and if the universities do not have the means to implement these new organizations, the perpetuation of body donation and of donation centers could become challenging.En France, entre 2 500 et 3 000 personnes donnent leur corps à la science chaque année après leur mort ; elles contribuent ainsi à l’enseignement de l’anatomie, à la recherche et à l’apprentissage et l’amélioration des pratiques chirurgicales. La décision doit être prise de son vivant et le consentement exprimé par écrit auprès d’un des vingt-sept centres de don du corps répartis sur le territoire national. Suite au scandale du centre parisien des Saints-Pères, le décret du 27 avril 2022 relatif au don de corps à des fins d’enseignement et de recherche, qui s’inscrit dans le cadre des nouvelles lois de bioéthique, était très attendu pour clarifier certaines pratiques. Mais ce décret soulève de nouvelles questions car nombreuses sont les règles qu’il propose qui ne nous apparaissent pas pertinentes au regard des valeurs du don et du fonctionnement des centres de don. Les nouveaux modes de régulation proposés génèrent des questions chez les donneurs et les professionnels de terrain avec un risque de mauvaise régulation. Nous pensons que si la puissance publique ne s’engage pas dans une régulation plus adaptée au terrain, si les enjeux éthiques ne sont pas mieux clarifiés et si les universités n’ont pas les moyens pour mettre en œuvre ces nouvelles organisations, la pérennisation du don du corps et des centres de don pourrait devenir difficile

Associations between exposure to organochlorine chemicals and endometriosis in experimental studies: A systematic review protocol

Background: Endometriosis is a hormone-dependent gynaecological disease characterised by the presence and growth of endometrial tissues outside of the uterus. There is growing experimental evidence that suggests environmental endocrine disrupting chemicals, specifically organochlorine chemicals (OCCs), may play a role in the pathogenesis of endometriosis, but to date, there are no studies attempting to gather and synthesise the published literature systematically. Objectives: The main objective of this SR is to evaluate the associations between the exposure to OCCs and endometriosis in experimental models (in vivo and in vitro). Methods: The SR framework has been developed following the guidelines established in National Toxicology Program/Office of Health Assessment and Translation (NTP/OHAT) Handbook for Conducting a LiteratureBased Health Assessment, which provides a standardised methodology to implement the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to environmental health assessments. The review process will be managed and documented through HAWC, an open-source content management system, to guarantee transparency. Eligibility criteria: Only experimental studies, in vivo, ex vivo or in vitro, exploring associations between controlled exposures to OCCs and endometriosis and related outcomes will be included. Eligible studies will include peer reviewed articles of any publication date which are sources of primary data. Only studies published in English will be considered. Information sources: We will apply the search strings to the scientific literature databases NCBI PubMed, Web of Science and SCOPUS. Manual searches will be performed through the list of references of included articles. Data extraction and synthesis or results: Data will be extracted according to a pre-defined set of forms and synthesised in a narrative report. Given sufficient commensurate data, a meta-analysis may also be performed. Risk of bias: A quality assessment will be performed for in vivo and in vitro studies using the NTP/OHAT Risk of Bias Rating Tool for Human and Animal Studies. Level of evidence rating: Following a comprehensive assessment of the quality of evidence for both in vivo and in vitro studies, a confidence rating will be assigned to the body of literature and subsequently translated into a rating on the level of evidence (high, moderate, low, or inadequate) regarding the research question