La phase de latence : déterminants de son respect et issues materno-foetales

Objective: To evaluate the maternal and neonatal outcomes associated with the respect of the latent phase and the determinants which influence the management of a non-progressive labor before 6 centimeters. Among low risk nulliparous women with spontaneous onset of labor, comparison of the maternal and neonatal outcomes with or without latent phase respect.Methods: unicenter retrospective study of the non-exposed/exposed type realized at Port-Royal from 09/01/2014 to 08/31/2015. The exposed group "respecting latent phase", defined by the absence of intervention (amniotomy or oxytocin), and the non-exposed group defined as patients who had no intervention (amniotomy or oxytocin), following more than 2 hours of non-progressive labor.Results: The study population consisted of 247 patients, including 114 in the exposed group and 133 in the not exposed group.The results obtained with this study showed that the respect of the latent phase seems to be associated with a reduction in the rate of instrumental deliveries or with maneuver or cesarean delivery (36,1% versus 18,4% avec p=0, 0003), a reduction in the rate of Postpartum haemorrhage (14,3% vs 5,3% p = 0,015) and a minor rate of neonatal resuscitation.Conclusion: These results suggest that compliance with the latent phase would have beneficial effects on labor and would not be significantly associated with increased maternal and neonatal risks. This encourages the setting up of additional research.Objectif : Évaluer les issues materno-fœtales associées au respect de la phase de latence ainsi que les déterminants influençant la prise en charge d’une stagnation de la dilatation cervicale avant 6 centimètres. Chez les primipares à bas risque en travail spontané avec stagnation de la dilatation avant 6 cm, comparaison issues materno fœtales avec ou sans respect de la phase de latence.Matériel et méthode : Étude rétrospective mono centrique de type exposé/ non exposé réalisée à Port Royal (type 3) entre le 1/09/2014 et le 31/08/2015. Le groupe exposé, « respect de la phase de latence » est défini par l’absence d’intervention (ocytocine ou rupture artificielle des membranes), le groupe non-exposé correspond aux patientes ayant eu une intervention (rupture artificielle des membranes ou mise en place d’une perfusion d’ocytocine), suite à la stagnation de la dilatation de plus de 2 heures.Résultats : La population de l’étude était composée de 247 patientes, dont 114 dans le groupe exposé et 133 dans le groupe non exposé.Les résultats de notre étude ont montré que le respect de la phase de latence semblait associée à une diminution du taux de voie basse instrumentale, avec manœuvre ou de césarienne (36,1% versus 18,4% avec p=0,0003), une diminution des taux d’hémorragies du post partum (14,3% vs 5,3% p = 0,015) ainsi qu’un moindre taux de réanimation néonatale (12,8% vs 5,3% p = 0,043).Conclusion : Ces résultats suggèrent que le respect de la phase de latence soit associé à des effets positifs sur le travail et non associé significativement à un sur risque materno-foetal. Cela encourage la mise en place d’études plus puissantes

Maternal Leisure-time Physical Activity and Risk of Preterm Birth: A Systematic Review of the Literature

Background: Preterm birth is a leading cause of infant death and regular physical activity may reduce the risk for preterm birth because of its beneficial effects on pregnancy complications such as preeclampsia, excessive weight gain, and gestational diabetes. On average, however, pregnant women report lower levels of physical activity compared with those who are not pregnant. This systematic review examined low, moderate and vigorous leisure-time physical activity (LTPA) during pregnancy and the outcome of preterm birth. Methods: Key words related to preterm birth and physical activity were used to search relevant databases (Medline, Cochrane, CINAHL, Sports Discuss and Scopus). Studies were excluded if they did not measure physical activity as an exposure in pregnant women, did not provide information on gestational age at delivery, and were not published in English. All study designs and sample sizes were considered. Results: The search generated 1472 studies. There were 27 studies included in this review of which 23 received high quality reporting scores. A total of 13 studies reported a significant protective effect of LTPA on the risk of preterm birth. Physical activity of both moderate and vigorous levels was associated with a lower risk of preterm birth in a number of studies, with relative risk estimates ranging from 0.08 to 0.90. Low-intensity activity was also significantly associated with a lower odds of preterm birth, provided the duration of such activity was ≥8hr/day at weeks 23-26 (OR=0.56, 95% CI=0.36, 0.87) or \u3e20min/day during the second trimester (aOR=0.36, 95% CI=0.16, 0.78). Fourteen studies reported null findings, while only two studies detected a significantly higher risk of preterm birth with LTPA during pregnancy. Conclusion: This review of literature up to 2014 provides evidence to support the assertion that healthy pregnant women can engage in low, moderate, and even some vigorous levels of LTPA without risk for preterm bi

Characteristics of Incident Liver Cancer Cases in the District of Columbia Metropolitan Area

The District of Columbia (D.C.) has the highest liver cancer incidence in the United States (U.S.), but the reasons for this are not fully known. We examined socio-demographic, clinical and behavioral characteristics of incident liver cancer cases in D.C., Maryland (MD) and Virginia (VA) to identify potential risk factors.We obtained data from D.C., MD and VA cancer registries for individuals diagnosed with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC) between 2013 and 2016. We estimated age-adjusted incidence rates and conducted descriptive analyses stratified by state/territory, sex, stage at diagnosis, and race/ethnicity. 5,928 incidents HCC/ICC cases occurred between 2013-2016. Age-adjusted incidence rates (per 100,000) for HCC/ICC were highest in D.C. (12.2, 95% CI=10.9, 13.5), for males (12.6, 95% CI=12.2, 12.9), and non-Hispanic Blacks (11.3, 95% CI=10.8, 11.8) and Asian/Pacific Islanders (APIs) (10.8, 95% CI=9.7, 11.9). Racial disparities in HCC/ICC incidence were widest in D.C. A substantial proportion of cases were missing data on country of birth and behavioral risk factors. Mean age at diagnosis, marital status, country of birth, insurance status, and alcohol and tobacco use history varied across analytic sub-groups. Non-Hispanic Blacks, APIs and males experience a high burden of liver cancer in the D.C. metropolitan area. There are several socio-demographic disparities by state/territory, sex, and race/ethnicity. More data on country of birth, behavioral risk factors, and comorbidities are urgently needed to understand their contribution to the burden of liver cancer in the D.C. metropolitan area.

Cancer-Specific Mortality, Cure Fraction, and Noncancer Causes of Death Among Diffuse Large B-cell Lymphoma Patients in the Immunochemotherapy Era.

BACKGROUND Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown. METHODS Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs). RESULTS Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years. CONCLUSIONS Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017. © 2017 American Cancer Society

Plasma S-adenosylmethionine, DNMT polymorphisms, and peripheral blood LINE-1 methylation among healthy Chinese adults in Singapore

10.1186/1471-2407-13-389BMC Cancer13-BCMA

Association between class III obesity (BMI of 40-59 kg/m2) and mortality: A pooled analysis of 20 prospective studies

Background The prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity. Methods and Findings In a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19–83 y at baseline, classified as obese class III (BMI 40.0–59.9 kg/m2) compared with those classified as normal weight (BMI 18.5–24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976–2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences = 238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences = 36.7 and 62.3 in men and women, respectively) and diabetes (rate differences = 51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40–44.9, 45–49.9, 50–54.9, and 55–59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7–7.3), 8.9 (95% CI: 7.4–10.4), 9.8 (95% CI: 7.4–12.2), and 13.7 (95% CI: 10.5–16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report. Conclusions Class III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight