Caesarean section at term: the relationship between neonatal respiratory morbidity and microviscosity in amniotic fluid.

None of the authors report any conflicts of interest.International audienceOBJECTIVES: The incidence of neonatal respiratory morbidity following an elective caesarean section is 2-3 times higher than after a vaginal delivery. The microviscosity of surfactant phospholipids, as measured with fluorescence polarisation, is linked with the functional characteristics of fetal surfactant and thus fetal lung maturity, but so far this point has received little attention in new-borns at term. The aim of the study is to evaluate the correlation between neonatal respiratory morbidity and amniotic microviscosity (Fluorescence Polarisation Index) in women undergoing caesarean section after 37 weeks' gestation. STUDY DESIGN: The files of 136 women who had undergone amniotic microviscosity studies during elective caesarean deliveries at term were anonymised. Amniotic fluid immaturity (AFI) was defined as a Fluorescence Polarisation Index higher than 0.335. RESULTS: Respiratory morbidity was observed in 10 babies (7.3%) and was independently associated with AFI (OR: 6.11 [95% CI, 1.20-31.1] with p=0.029) and maternal body mass index (OR: 1.12 [95% CI, 1.02-1.22] with p=0.019). Gestational age at the time of caesarean delivery was inversely associated with AFI (odds ratio, 0.46 [95% confidence interval, 0.29-0.71], p<0.001), especially before 39 weeks, and female gender was associated with an increased risk (odds ratio, 3.29 [95% confidence interval, 1.48-7.31], p=0.004). CONCLUSIONS: AFI assessed by amniotic microviscosity was significantly associated with respiratory morbidity and independently correlated with shorter gestational age especially before 39 weeks. This finding provides a physiological rationale for recommending delaying elective caesarean section delivery until 39 weeks of gestation to decrease the risk for respiratory morbidity

First Human Model of In Vitro Candida albicans Persistence within Granuloma for the Reliable Study of Host-Fungi Interactions

BACKGROUND: The balance between human innate immune system and Candida albicans virulence signaling mechanisms ultimately dictates the outcome of fungal invasiveness and its pathology. To better understand the pathophysiology and to identify fungal virulence-associated factors in the context of persistence in humans, complex models are indispensable. Although fungal virulence factors have been extensively studied in vitro and in vivo using different immune cell subsets and cell lines, it is unclear how C. albicans survives inside complex tissue granulomas. METHODOLOGY/PRINCIPAL FINDING: We developed an original model of in vitro human granuloma, reproducing the natural granulomatous response to C. albicans. Persistent granulomas were obtained when the ratio of phagocytes to fungi was high. This in vitro fungal granuloma mimics natural granulomas, with infected macrophages surrounded by helper and cytotoxic T lymphocytes. A small proportion of granulomas exhibited C. albicans hyphae. Histological and time-lapse analysis showed that C. albicans blastoconidia were located within the granulomas before hyphae formation. Using staining techniques, fungal load calculations, as well as confocal and scanning electron microscopy, we describe the kinetics of fungal granuloma formation. We provide the first direct evidence that C. albicans are not eliminated by immunocompetent cells inside in vitro human granulomas. In fact, after an initial candicidal period, the remaining yeast proliferate and persist under very complex immune responses. CONCLUSIONS/SIGNIFICANCE: Using an original in vitro model of human fungal granuloma, we herein present the evidence that C. albicans persist and grow into immunocompetent granulomatous structures. These results will guide us towards a better understanding of fungal invasiveness and, henceforth, will also help in the development of better strategies for its control in human physiological conditions

Comparative Analysis of Acinetobacters: Three Genomes for Three Lifestyles

Acinetobacter baumannii is the source of numerous nosocomial infections in humans and therefore deserves close attention as multidrug or even pandrug resistant strains are increasingly being identified worldwide. Here we report the comparison of two newly sequenced genomes of A. baumannii. The human isolate A. baumannii AYE is multidrug resistant whereas strain SDF, which was isolated from body lice, is antibiotic susceptible. As reference for comparison in this analysis, the genome of the soil-living bacterium A. baylyi strain ADP1 was used. The most interesting dissimilarities we observed were that i) whereas strain AYE and A. baylyi genomes harbored very few Insertion Sequence elements which could promote expression of downstream genes, strain SDF sequence contains several hundred of them that have played a crucial role in its genome reduction (gene disruptions and simple DNA loss); ii) strain SDF has low catabolic capacities compared to strain AYE. Interestingly, the latter has even higher catabolic capacities than A. baylyi which has already been reported as a very nutritionally versatile organism. This metabolic performance could explain the persistence of A. baumannii nosocomial strains in environments where nutrients are scarce; iii) several processes known to play a key role during host infection (biofilm formation, iron uptake, quorum sensing, virulence factors) were either different or absent, the best example of which is iron uptake. Indeed, strain AYE and A. baylyi use siderophore-based systems to scavenge iron from the environment whereas strain SDF uses an alternate system similar to the Haem Acquisition System (HAS). Taken together, all these observations suggest that the genome contents of the 3 Acinetobacters compared are partly shaped by life in distinct ecological niches: human (and more largely hospital environment), louse, soil

HERNIE DE COUPOLE DIAPHRAGMATIQUE (FACTEURS PRONOSTIQUES ANTENATALS)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La douleur foetale (état des connaissances actuelles)

RENNES1-BU Santé (352382103) / SudocSudocFranceF

Traitements médicamenteux des vomissements incoercibles chez la femme enceinte (prise en charge thérapeutique)

RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Le rôle de la progestérone dans la prévention des accouchements prématurés

L'accouchement prématuré est le principal problème de santé publique en obstétrique. A côté des tocolytiques classiques, la progestérone a commencé à être utilisée depuis une dizaine d'années. On ne connaît qu'en partie les mécanismes conduisant à l'accouchement ainsi que les modes d'action de la progestérone. Mais d'après de récentes études, celle-ci est capable de réduire l'incidence des accouchements prématurés pour des grossesses à risque . Ainsi, elle doit être administrée en prévention, chez des femmes qui présentent des facteurs de risque bien définis. La voie d'administration de la progestérone (vaginale ou intramusculaire), doit varier en fonction de ces facteurs de risque (antécédents d'accouchements prématurés, col raccourci). Cette nouvelle thérapeutique, dont l'efficacité, l'innocuité et les avantages économiques ont été démontrés, doit aujourd'hui s'inscrire dans le protocole de soin de la prévention des accouchements prématurés auprès des thérapeutiques déjà utilisées.Premature delivery has long been the main public health problem in obstetrics. Progesterone started to be used in this indication ten years ago combined with the traditional tocolytic drugs. The process leading to delivery as well as how progesterone works and its targets are only partly known. But according to recent studies, progesterone can reduce the incidence of premature delivery in high risk pregmancies. Thus, it must be administered in prevention, to women who present clearly defined risk factors. The way of administering progesterone (vaginal or intramuscular) should differ according to these risk factors (previous premature delivery, early cervical shortening...). This new therapy whose effectiveness, safety and economic advantages have been proved, must now be part of the course of action for the prevention of premature delivery along with other therapies already used.LYON1-BU Santé (693882101) / SudocRENNES1-BU Santé (352382103) / SudocSudocFranceF

SURVENUE D'UN LEIOMYOSARCOME PELVIEN AU COURS DE LA GROSSESSE DANS LE CADRE D'UNE MALADIE DE VON RECKLINGHAUSEN (A PROPOS D'UN CAS ; REVUE DE LA LITTERATURE)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Devenir gynécologique et obstétrical après embolisation des artères utérines d'indication obstétricale

RENNES1-BU Santé (352382103) / SudocSudocFranceF