Clinical impact of the disposable ventouse iCup® versus a metallic vacuum cup: a multicenter randomized controlled trial

Experimental Protocole. (DOCX 55 kb

The Motor Protein Myosin-X Transports VE-Cadherin along Filopodia To Allow the Formation of Early Endothelial Cell-Cell Contacts: MYOSIN-X TRANSPORT OF VE-CADHERIN ALONG FILOPODIA

International audienceVascular endothelium (VE), the monolayer of endothelial cells that lines the vascular tree, undergoes damage at the basis of some vascular diseases. Its integrity is maintained by VE-cadherin, an adhesive receptor localized at cell-cell junctions. Here, we show that VE-cadherin is also located at the tip and along filopodia in sparse or subconfluent endothelial cells. We observed that VE-cadherin navigates along intrafilopodial actin filaments. We found that the actin motor protein myosin-X is colocalized and moves synchronously with filopodial VE-cadherin. Immunoprecipitation and pulldown assays confirmed that myosin-X is directly associated with the VE-cadherin complex. Furthermore, expression of a dominant-negative mutant of myosin-X revealed that myosin-X is required for VE-cadherin export to cell edges and filopodia. These features indicate that myosin-X establishes a link between the actin cytoskeleton and VE-cadherin, thereby allowing VEcadherin transportation along intrafilopodial actin cables. In conclusion, we propose that VE-cadherin trafficking along filopodia using myosin-X motor protein is a prerequisite for cell-cell junction formation. This mechanism may have functional consequences for endothelium repair in pathological settings

Vuorovaikutteisen suunnittelun haasteet ja mahdollisuudet metsätalouden vesiensuojelussa

Rapport de l'expertise scientifique collectiveLes animaux peuvent-ils éprouver des émotions, peuvent-ils penser, ont-ils une histoire de vie ? Depuis l’Antiquité, les philosophes ont proposé des réponses contrastées à ces questions. Du XIXème siècle à nos jours, la réflexion sur ce que sont les animaux s’est enrichie d’apports scientifiques : théorie de l’évolution, éthologie, neurophysiologie, sciences cognitives. Mais la conscience animale reste toujours l’objet de débats importants dans la communauté scientifique. Ainsi en 2012 un groupe de scientifiques de premier plan a éprouvé la nécessité de publier un manifeste intitulé « Déclaration de Cambridge sur la Conscience », qui énonce qu’«…une convergence de preuves indique que les animaux non humains disposent des substrats neuro-anatomiques, neurochimiques et neurophysiologiques des états conscients ainsi que la capacité d’exprimer des comportements intentionnels...».Les connaissances actuelles, dont cette expertise collective propose une synthèse, montrent que les animaux possèdent un large éventail de capacités cognitives associées à des comportements plus ou moins complexes. Les formes de conscience étudiées chez les humains supposent des capacités cognitives distinctes que l’on retrouve chez certains animaux. Peut-on en postuler que ceux-ci ont des formes de consciences équivalentes à celles de l’homme, sans être forcément identiques ?L’étude des niveaux et des contenus de la conscience chez les animaux est en passe de devenir un enjeu scientifique important en raison de la complexité du sujet et des controverses qu’il ne manquera pas de susciter. Enfin, les acquis scientifiques dans ce domaine invitent à reprendre les réflexions morales concernant les relations que les hommes entretiennent avec les animaux (et particulièrement avec les animaux domestiques

Ventouse ou forceps dans l'extraction instrumentale des présentations occipito-postérieures

Objectif. Comparer les complications maternelles et néonatales liées aux accouchements en présentation occipito-postérieure et transverse nécessitant une extraction instrumentale par ventouse ou forceps. Matériel et méthodes. Une série consécutive de 4124 accouchements au CHU de Grenoble (2644 voies basses spontanées, 602 extractions instrumentales dont 118 présentations postérieures et/ou transverses) a été analysée rétrospectivement de Juin 2004 à Juin 2006. Les grossesses multiples et accouchements prématurés ont été exclus. Les complications des extractions instrumentales ont été comparées entre deux groupes : forceps et ventouse. Résultats. Le groupe 1 (groupe forceps) représentait 51 patientes (49.0 %) et le groupe 2 (groupe ventouse) comprenait 53 patientes (51.0 %). Cette étude montre que les brèches vaginales sont beaucoup plus fréquentes lors de l'utilisation du forceps (p < 0.001). Une épisiotomie a été réalisée de manière systématique lors d'une extraction par forceps et seulement dans 41.5 % des cas lors de l'utilisation de la ventouse (p < 0.001). On remarque également une augmentation significative du taux d'hémorragies de la délivrance lors des extractions par forceps (p = 0.006). Les lésions de type plaies cutanées et ecchymoses ne sont retrouvées que dans le groupe 1 (n = 7). Les bosses séro-sanguines (p = 0.04), céphalhématomes (p = 0.02) et les ictères (p = 0.04) sont plus fréquents lors de l'utilisation de la ventouse. Conclusion. Cette étude rétrospective concernant l'extraction instrumentale des présentations postérieures montre une morbidité maternelle plus fréquente avec l'utilisation du forceps (brèche vaginale, épisiotomie et hémorragie de la délivrance). La ventouse y apparaît comme étant un instrument " protecteur " du périnée maternel. Le bien-être néonatal, après extraction par ventouse ou forceps, est similaire mais des complications bénignes sont spécifiques à chaque instrument. L'adage veut que le meilleur instrument soit celui dont on a l'habitude ; les résultats des études nous font recommander, l'utilisation de la ventouse pour l'extraction d'un fœtus en présentation postérieure. Mots-clés : Présentation postérieures persistantes, Extraction instrumentale, Ventouse, Forceps.Objectives. To compare maternal and neonatal complications following deliveries assisted by forceps or vacuum extraction in posterior presentation. Materials and methods. We conducted a retrospective study of two years activity involving 4124 deliveries of which 602 were vacuum extractor or forceps assisted and 118 were presented with a persistent occipito posterior position. We precisely defined maternal and neonatal complications to compare their rates in forceps, vacuum extractor and both instruments groups. Results. 51 patients had forceps assisted delivery (group 1, 49.0%), 53 had vacuum assisted delivery (group 2, 51.0%). This study shows vaginal lacerations are more frequent when forceps is used (p<0.001). An episiotomy was systematically performed when forceps was used, compared to 41.5% for vacuum assisted deliveries (p<0.001). We also enlighted a higher rate of postpartum hemorrhage for the forceps group (p=0.006). Stillbirth injuries such as bruises or face wounds were only noticed in group 1 (n=7) but weren't statistically significant. Caput succedaneum (OR=0.33, p=0.44), cephalohematomas (OR=0.11, p=0.02) and icterus (OR=0.33, p=0.04) were statistically more frequent in the vacuum extraction group. The stillbirth health (Apgar, pH) is similar in both groups. Conclusion. This retrospective study, comparing instrumental extractions in persistent occiput posterior presentation, shows a higher maternal morbidity associated to the forceps extraction group (vaginal laceration, episiotomy, postpartum hemorrhage). The vacuum extractor appears as safer for the maternal perineum. The stillbirth health (Apgar, pH) is similar in both groups but we found specified complications for each instruments. The statistically significant higher rate of maternal complication combined to a higher rate of face wounds, allows us to think that vacuum extraction should be performed in OS presentation.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy.

International audienceOBJECTIVE: To compare two policies for episiotomy: restrictive and systematic. DESIGN: Quasi-randomised comparative study. SETTING: Two French university hospitals with contrasting policies for episiotomy: one using episiotomy restrictively and the second routinely. POPULATION: Seven hundred and seventy-four nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37-41 weeks. METHODS: A questionnaire was mailed 4 years after delivery. Sample size was calculated to allow us to show a 10% difference in the prevalence of urinary incontinence with 80% power. MAIN OUTCOME MEASURES: Urinary incontinence, anal incontinence, perineal pain, and pain during intercourse. RESULTS: We received 627 responses (81%), 320 from women delivered under the restrictive policy, 307 from women delivered under the routine policy. In the restrictive group, 186 (49%) deliveries included mediolateral episiotomies and in the routine group, 348 (88%). Four years after the first delivery, there was no difference in the prevalence of urinary incontinence (26 versus 32%), perineal pain (6 versus 8%), or pain during intercourse (18 versus 21%) between the two groups. Anal incontinence was less prevalent in the restrictive group (11 versus 16%). The difference was significant for flatus (8 versus 13%) but not for faecal incontinence (3% for both groups). Logistic regression confirmed that a policy of routine episiotomy was associated with a risk of anal incontinence nearly twice as high as the risk associated with a restrictive policy (OR = 1.84, 95% CI: 1.05-3.22). CONCLUSIONS: A policy of routine episiotomy does not protect against urinary or anal incontinence 4 years after first delivery

Urinary incontinence 4 and 12 years after first delivery: Risk factors associated with prevalence, incidence, remission, and persistence in a cohort of 236 women.: Urinary incontinence 4 and 12 years after first delivery

International audienceAIMS: Our aim was to study risk factors associated with prevalence, incidence, and remission of UI 4 and 12 years after first delivery. METHODS: Seven hundred seventy-four nulliparous women who gave birth in 1996 in two French maternity units at term received a questionnaire about their urinary symptoms in 2000 and again in 2008. Two hundred thirty-six women returned a questionnaire about UI 4 and 12 years after first delivery. Four groups of women were built: (A) women continent 4 and 12 years after first delivery; (B) women continent at 4 and incontinent at 12 years; (C) women incontinent at 4 and continent at 12 years; and (D) women incontinent at 4 and 12 years. Multivariate logistic regressions were used to determine risk factors of UI prevalence (groups B + D vs. A + C), incidence (B vs. A), remission (C vs. D), and onset of UI (D vs. B). RESULTS: Factors associated with UI 12 years after first pregnancy were: BMI (OR = 1.17 [95%CI: 1.04-1.32], by 1 kg/m(2) ) and increasing BMI (1.43 [1.19-1.73]), first child's weight (1.08 [1.001-1.16], by 100 g) and UI during first pregnancy (3.77 [1.83-7.76]). Factors associated with UI incidence were age at first delivery (0.86 [0.75-0.98]) and high BMI (1.24 [1.05-1.45]). Increasing BMI, UI during first pregnancy, and heavy first child reduce the likelihood of UI remission (0.37 [0.20-0.68], 0.11 [0.02-0.63], and 0.73[0.59-0.91], respectively). CONCLUSIONS: UI during first pregnancy could be indicative of individual susceptibility to UI. Obesity appears to be a modifiable factor for remission of UI in women. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc

Is a planned cesarean necessary in twin pregnancies?

International audienceOBJECTIVE: Evaluation of elective cesarean section for twin delivery as a standard of care. DESIGN: Historical cohort in a national database (2 597 twin pregnancies). SETTING: France. SAMPLE: Twins with first child in cephalic presentation. METHODS: Decision analysis. MAIN OUTCOME MEASURES: All neonatal complications, i.e. death, whether intrapartum or in the delivery room or the immediate postpartum period, or neonatal transfer to intensive (or special) care, or trauma, of one or both twins. RESULTS: When we focused on neonatal complications for either or both twins, the strategy of planned vaginal delivery was preferable; the weight of its decision tree branch was lower than that for planned cesarean (26.5 vs. 31.7). If only twin 2 was considered, vaginal delivery was also preferred (weight of vaginal delivery=27.6 vs. 32.7 for planned cesarean). As long as the morbidity and mortality of twin 1 or twin 2 or both during a cesarean for twin 2 in the case of planned vaginal delivery does not exceed 31.5%, all else being equal, vaginal delivery should be preferred to a planned cesarean for twin 1 and twin 2. The two-variable sensitivity analysis confirmed the robustness of the results. CONCLUSIONS: The results of our study do not support a policy of planned cesarean delivery for twin pregnancies at and after 34 weeks of gestation. Level of evidence: II

VALUE OF TOXOPLASMA GONDII DETECTION IN ONE HUNDRED THIRTY-THREE PLACENTAS FOR THE DIAGNOSIS OF CONGENITAL TOXOPLASMOSIS.

The placenta examination by polymerase chain reaction and mouse inoculation increased the sensitivity of the diagnosis of congenital toxoplasmosis at birth from 60% (use of serologic techniques on the newborn's blood only) to 75% (both serologic techniques and placental analysis). The specificity of Toxoplasma gondii detection in the placenta was 94.7%

Contribution of Annexin 2 to the Architecture of Mature Endothelial Adherens Junctions▿ †

The vascular endothelial cadherin (VE-cad)-based complex is involved in the maintenance of vascular endothelium integrity. Using immunoprecipitation experiments, we have demonstrated that, in confluent human umbilical vein endothelial cells, the VE-cad-based complex interacts with annexin 2 and that annexin 2 translocates from the cytoplasm to the cell-cell contact sites as cell confluence is established. Annexin 2, located in cholesterol rafts, binds to both the actin cytoskeleton and the VE-cad-based complex so the complex is docked to cholesterol rafts. These multiple connections prevent the lateral diffusion of the VE-cad-based complex, thus strengthening adherens junctions in the ultimate steps of maturation. Moreover, we observed that the down-regulation of annexin 2 by small interfering RNA induces a delocalization of VE-cad from adherens junctions and consequently a destabilization of these junctions. Furthermore, our data indicate that the decoupling of the annexin 2/p11 complex from the VE-cad-based junction, triggered by vascular endothelial growth factor treatment, facilitates the switch from a quiescent to an immature state

Brachytelephalangic chondrodysplasia punctata: prenatal diagnosis and postnatal outcome.

International audienceWe report the prenatal management of a brachytelephalangic chondrodysplasia punctata (CDPX1) case and how postnatal findings confirmed the diagnosis. The mother was initially referred after ultrasound revealed an abnormal fetal mid-face and punctuation of upper femoral epiphyses. Chondrodysplasia punctata (CP) with Binder anomaly was suspected. 3D-HCT revealed brachytelephalangy suggesting CDPX1. At birth, mid-face hypoplasia was marked. Postnatal imaging and genetic analysis confirmed the initial diagnosis. Binder anomaly is probably always associated with CP. The newly revised CP classification facilitates the diagnosis. The main etiologies are metabolic and chromosomal abnormalities, and arylsulfatase E enzyme dysfunction. Thus, screening for arylsulfatase E mutation is mandatory for an accurate diagnosis and can lead to better delineation among CP etiologies associated with a Binder phenotype