Neurophysiologic cut off values for safe resection of patients with supratentorial gliomas.

BACKGROUND: Gliomas have infiltrative nature and tumor volume has direct prognostic value. Optimal resection limits delineated by high-frequency monopolar stimulation with multipulse short train technique is still a matter of debate for safe surgery without (or with acceptable) neurological deficits. It is also an enigma whether the same cut-off values are valid for high and low grades. We aimed to analyze the value of motor mapping/monitoring findings on postoperative motor outcome in diffuse glioma surgery. METHODS: Patients who were operated on due to glioma with intraoperative neuromonitorization at our institution between 2017 and 2021 were analyzed. Demographic information, pre- and post-operative neurological deficit, magnetic resonance images, resection rates, and motor evoked potential (MEP) findings were analyzed. RESULTS: Eighty-seven patients of whom 55 had high-grade tumors were included in the study. Total/near-total resection was achieved in 85%. Subcortical motor threshold (ScMTh) from resection cavity to the corticospinal tract was ≤ 2mA in 17; 3 mA in 14; 4 mA in 6; 5 mA in 7, and ≥5mA in 50 patients. On the 6th month examination, six patients (5 with high-grade tumor) had motor deficits. These patients had changes in MEP that exceeded critical threshold during monitoring. Receiver operating characteristic analysis revealed 2.5 mA ScMTh as the cut-off point for limb paresis after awakening and 6 months for the groups. CONCLUSIONS: Subcortical mapping with MEP monitoring helps to achieve safe wider resection. The optimal safe limit for SCMTh was determined as 2.5 mA. Provided that safe threshold values are maintained in MEP, surgeon may force the functional limits by lowering the SCMTh to 1 mA, especially in low-grade gliomas.

[Eclampsia: retrospective study about 16 cases]. / Eclampsie: étude rétrospective de 16 cas.

OBJECTIVE: To determine the etiologic factors, circumstances of diagnosis, obstetrical management and complications of eclampsia and to value the maternal and perinatal outcomes. PATIENTS AND METHODS: We conducted a retrospective descriptive study, from January 1996 to December 2006 in a maternity type IIB. RESULTS: Sixteen cases of eclampsia were studied. The prevalence of eclampsia over the study period was 8.1 per 10,000 births, without annual change in the incidence. The mean age of the patients was 27.8+/-6.7 years. The major risk factor was the primipaternity (87.5%). The eclampsia occurred in ante-, peri- and post-partum in 56, 6 and 38% of the cases, respectively. In cases of eclampsia, 75% of the patients had elevated blood pressure, 93% presented headache, but 62% presented with an atypical form with less than three functional symptoms (headache, visual trouble, hyperreflexia). Various treatments had been started: antihypertensive treatment (75%), antiepileptic treatment (69%) and magnesium sulphate (94%). Eleven patients had developed complications, mainly HELLP syndrome (10 patients). No maternal death was noted. The mean birth weight was 2366+/-818 g, 43.8% of children had birth weight less than the 10th percentile, and 87.5% of children were girls. One fetal and one perinatal death at day 19 had been noted. DISCUSSION AND CONCLUSION: Nowadays, the physiopathology of eclampsia remains misunderstood. It is difficult to establish risk factors, the primipaternity being certainly one of these. Eclampsia may occur in an atypical and unforeseeable form in well followed patients, without risk factor. The diagnosis should be done quickly for an adapted treatment and obstetrical management.

[Postpartum perineal pain: effectiveness of local ropivacaine infiltration]. / Douleur périnéale du post-partum: intérêt de l'infiltration locale de ropivacaïne.

GOAL: To assess efficiency of local ropivacaine infiltration in perineal pain after episiotomy and perineal tear during the first 24 h after vaginal delivery. MATERIALS AND METHODS: Case control survey, including 62 consecutive patients with episiotomy and/or perineal tear during two consecutive periods: the ropivacaine group from February 2, 2008 to March 27, 2008 (n=31) and the control group from December 27, 2007 to January 1, 2008 (n=31). In the ropivacaine group, patients received 10 ml of ropivacaine 7,5mg/ml as a local infiltration along the perineal damage. In the control group no injection was done. A numerical pain rating scale (0-10) at four (H4), eight (H8), 12 (H12) and 24 h (H24) was used to evaluate patients post-partum perineal pain. A numerical rating scale was used to evaluate patients satisfaction (0: no satisfied, 5: very satisfied). RESULTS: Numerical pain rating scale for perineal pain evaluation was significantly lower in the ropivacaine group than in the control group at H4 (1.9+/-0.3 versus 3.6+/-0.5, p=0.006), H8 (3.3+/-0.4 versus 5.2+/-0.4, p=0.003), H12 (2.8+/-0.4 versus 5.2+/-0.4, p=0.0001) and H24 (2.6+/-0.4 versus 4.3+/-0.4, p=0.006). Numerical rating scale for satisfaction evaluation was significantly higher in the ropivacaine group (4.2+/-0.2 versus 3.5+/-0.2, p=0.004). CONCLUSION: Local ropivacaine infiltration in episiotomy and/or perineal tear reduce post-partum perineal pain within the first 24 h.

Endometriosis mimicking hernia recurrence.

Endometriosis is a common gynecologic condition and has been described in several locations, mostly in the pelvis. Extragenital endometriosis may appear as a painful nodule evoking an inguinal hernia. Scar endometriosis after inguinal hernia repair seems to be a rare occurrence. We report an unusual case of a 28-year-old woman who developed a scar endometriosis 2 years after an inguinal hernia repair. This case highlights that the presence of a painless inguinal mass similar to a recurrent hernia, with possible swelling related to the menstrual cycle, may evoke endometriosis, especially after a previous hernia repair and should lead to prompt diagnosis, wide excision, and gynecological advice.

Obstetric outcome following laparoscopic adjustable gastric banding.

OBJECTIVE: To evaluate obstetric outcomes following laparoscopic adjustable gastric banding (LAGB) in obese women. METHODS: Obstetric outcomes were compared in a retrospective case-control study with 427 obese women, 13 who underwent LABG and 414 who did not. RESULTS: The mean weight gain during pregnancy was significantly lower in the LABG group than among controls (5.5 kg vs. 7.1 kg; P<0.05). The incidence of pre-eclampsia, gestational diabetes mellitus, low birth weight, and fetal macrosomia was less in the LABG group (P<0.05), and the incidence of cesarean deliveries during labor was half in the LAGB group (15.3% vs. 34.4%; P<0.01). Neonatal outcomes were not significantly different in the 2 groups. CONCLUSIONS: Among obese women, the incidence of adverse obstetric outcomes was less in those who underwent LABG than in those who did not. These results suggest that obese women who wish to become pregnant would decrease their risk of obstetric complications if they first underwent LAGB.

[Psychosomatical approach to Hyperemesis gravidarum]. / Approche psychosomatique des vomissements incoercibles du premier trimestre.

Vomiting of pregnancy is a physiological symptom of the first trimester and is a frequent reason for consultation in emergency as well as hospitalization in the severe forms (Hyperemesis gravidarum). Though strong the aversion usually developed against the hospitalized patients for H. gravidarum may be, it is important to understand the distress of these women with a symptom difficult to endure, which often reflects a psychical conflict with respect to their pregnancy. The gynecologist must be the somatic doctor who deals with the symptom and its sometimes disastrous clinical consequences, whereas the psychologist or the psychiatrist plays a fundamental role in this pathology. Indeed, he will lead the patient to work on how she feels her pregnancy, to give it a place in her personal history and to understand her contradictory feelings with regard to this pregnancy.

[Pregnancy in obese patients: which risks is it necessary to fear?]. / Grossesse des patientes obèses: quels risques faut-il craindre?

OBJECTIVE: To evaluate the deleterious effects of maternal obesity on obstetrical complications and neonatal outcomes. PATIENTS AND METHODS: Historical cohort study including all patients delivered in our maternity between 1st January 2002 and 31st December 2004. Intra uterine death and fetal loss before 22 weeks were excluded. Women were categorized by the Body Mass Index: less than 25, between 25 and 30, and more than 30. Maternal data, obstetrical complications, labor and its complications, and neonatal outcomes were studied. RESULTS: During these 3 years, 23.5% (1336/5686) of patients were overweight and 7.5% (425/5686) were obese. Obstetrical pathologies (gestational diabetes mellitus, hypertension, preeclampsia and fetal macrosomia) and labour induction were more significantly frequent in obese patients (P < 0.01). We noted twice more caesarean sections during labour in obese patients. The rate of artificial placental delivery was significantly higher in obese patients (P < 0.01). Obese patients with prior caesarean sections had a rate of vaginal delivery significantly lower than non obese patients with prior C-sections (23.6 vs 43.8%; P < 0.01). Mean children birth weight was significantly higher in obese patients (3305 vs 3181 g; P < 0.01) with no impact on Apgar score. DISCUSSION AND CONCLUSION: Our study confirms that obesity is responsible for major obstetrical complications, for what should no doubt be considered as high risk pregnancies. Our practices must take these complications into account by ensuring an adapted and early management in order to improve maternal and neonatal issues.

[Vasa previa: one case]. / Vasa praevia: à propos d'un cas.

Vasa previa is a rare condition (1/2000 to 1/5000) in which the rupture of membranes may result in fetal haemorrhage (Benckiser's haemorrhage). We report one unusual case of delayed Benckiser's haemorrhage 12 hours after rupture of membranes. We point out the risk situations in which prenatal diagnosis should particularly be sought: low-lying placenta at routine second trimester ultrasound screening, bilobate or succenturiate placenta, velamentous insertion of the umbilical cord, in vitro fertilization. A universal screening, as proposed by certain authors, is also discussed.

[Surgical management of stress urinary incontinence: a questionnaire-based survey amongst members of the Société de Chirurgie Gynécologique et Pelvienne (SCGP)]. / Prise en charge chirurgicale de l'incontinence urinaire d'effort : résultat d'une enquête par questionnaire parmi les membres de la Société de chirurgie gynécologique et pelvienne (SCGP).

OBJECTIVE: To evaluate by voluntary and anonymous declaration the current surgical practice for female stress urinary incontinence (SUI) in France. POPULATION AND METHODS: A postal survey, anonymous, sealed, and validated by the Scientific Committee of the Société de chirurgie gynécologie et pelvienne (SCGP), was conducted among all members. The questionnaire was also available online, on the SCGP website. RESULTS: One hundred and three (18%) members responded. The respondents (87%; n=90) were performing less than 10 incontinence procedures in a month. Suburethral slings represent the choice technique for SUI, prior by transobturator approach (87%; n=90). Other practices are exceptional. Urodynamics study was routinely performed prior to surgery in 69% of cases. Surgical treatment was performed using prior regional anaesthesia in retropubic approach (58%; n=40 in 68 respondents); either loco-regional (47%; n=48 in 102 respondents) or general anaesthesia (50%; n=51 in 102 respondents) were used in transobturator approach. No transobturator route was privileged. The postoperative urethral catheter was being left for 24h or less in case of retropubic or transobturator approach (70%; n=37 in 53 respondents and 68%; n=52 in 76 respondents, respectively). The patient's hospital stay was one night (83%; n=54 in 65 respondents and 85%; n=87 in 102 respondents, respectively). A postoperative audit was not done by 19% of respondents. DISCUSSION AND CONCLUSION: Suburethral tape placement is nowadays the main surgical treatment for female stress urinary incontinence amongst members of SCGP. The transobturator approach is preferred.

[Pregnancy in a patient with Gitelman syndrome: a case report and review of literature]. / Syndrome de Gitelman et grossesse: à propos d'un cas et revue de la littérature.

Gitelman syndrome (GS) is a tubulopathy characterized by hypokaliemia, hypomagnesiemia, metabolic alkalosis and hypocalciuria. We report a case of a 33-year-old pregnant woman with Gitelman Syndrome. Oral potassium chloride and magnesium citrate were prescribed and the course of the pregnancy was uneventful with vaginal delivery at term. The impact of GS on the physiologic adaptations to pregnancy is not well-known, with few reports to date. Monitoring of serum potassium and magnesium levels with supplementation, amniotic fluid and fetal growth is required to prevent obstetrical and fetal complications in a patient with GS.

Expression of highly toxic genes in E. coli: special strategies and genetic tools.

Escherichia coli (E. coli) remains the most efficient widely-used host for recombinant protein production. Well-known genetics, high transformation efficiency, cultivation simplicity, rapidity and inexpensiveness are the main factors that contribute to the selection of this host. With the advent of the post-genomic era has come the need to express in this bacterium a growing number of genes originating from different organisms. Unfortunately, many of these genes severely interfere with the survival of E. coli cells. They lead to bacteria death or cause significant defects in bacteria growth that dramatically decrease expression capabilities. In this paper, we review special strategies and genetics tools successfully used to express, in E. coli, highly toxic genes. Suppression of basal expression from leaky inducible promoters, suppression of read-through transcription from cryptic promoters, tight control of plasmids copy numbers and proteins production as inactive (but reversible) forms are among the solutions presented and discussed. Special expression vectors and modified E. coli strains are listed and their effectiveness illustrated with key examples, some of which are related to our study of the highly toxic phage T4 restriction endoribonuclease RegB. We mainly selected those strategies and tools that permit E. coli normal growth until the very moment of highly toxic gene induction. Expression then occurs efficiently before cells die. Because they do not target a particular toxic effect, these strategies and tools can be used to express a wide variety of highly toxic genes.

Universal rather than selective screening for gestational diabetes mellitus may improve fetal outcomes.

AIM: The benefit of treating gestational diabetes mellitus (GDM) has recently been shown. The aim of this study was to compare offspring and maternal health benefits from selective or universal screening for GDM. METHODS: The incidence of outcomes was compared in three series of pregnant women: 1) the 159 consecutive women with GDM out of the 1909 women who delivered between October 2000 and September 2001: during this period screening for GDM was based on risk factors (risk factor-GDM); 2) the 265 consecutive women with GDM out of the 2111 women who delivered during the year 2002: during this period screening for GDM was universal (universal-GDM); 3) 1255 women with no GDM during year 2002 (controls). RESULTS: After adjustment for age, pregravid body mass index, parity, and ethnicity, the risk of large for gestational age (Odds ratio 2.19[95% confidence interval 1.36-3.54], P < 10(-3)), delivery before 37 weeks of gestation (OR 2.44 [95CI 1.32-4.51], P = 0.004), jaundice (OR 3.31[95CI 1.58-6.93], P = 0.002), hospitalization in the department of pediatrics (OR 2.35 [95CI 1.53-3.61], P < 10(-3)) was higher in the GDM-risk factor group than in the control group, whereas it was similar in the universal-GDM group and the control group. Compared with the control group, the risk of anticipated delivery and hospital stay > 4 days after delivery was increased in the GDM-risk factor group (OR 2.69[1.88-3.84], P < 10(-3); and OR 2.6 [1.82-3.71], P < 10(-3) respectively) and the universal-GDM group (OR 1.54 [1.15-2.07] P = 0.004; and OR 1.49 [1.13-1.97], P = 0.005 respectively). CONCLUSION: This observational study suggests that universal rather than selective screening for GDM may improve outcomes. Universal screening might reduce delay of diagnosis and care.

[Preeclampsia and antiphospholipid syndrome. Uterine artery Doppler evaluation]. / Prééclampsie et syndrome des antiphospholipides. Intérêt du Doppler utéroplacentaire.

INTRODUCTION: Women with persistently high resistance in uterine arteries have an increased risk of the subsequent development of preeclampsia. Doppler investigation provides a non-invasive method for the study of the uteroplacental blood flow. In pregnant women the antiphospholipid syndrome is associated to an increased risk of preeclampsia and complications related to uteroplacental insufficiency, and the role of uterine artery Doppler is discussed. CURRENT KNOWLEDGE AND KEY POINTS: In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. In women with preeclampsia or related complications, the abnormal persistence of high resistance to flow in the uterine arteries correlates with maternal and neonatal outcome. In one study including patients with antiphospholipid syndrome, a high resistance index in the uterine arteries at 22-24 weeks gestation strongly predicted the subsequent development of preeclampsia. In another study including patients with lupus anticoagulant, persistent bilateral notches at 22-24 weeks gestation may identify preeclampsia and fetal growth restriction with a high sensitivity, specificity, positive and negative predictive value. The treatment may improve the uteroplacental blood flow and is a possible confounding factor which needs further evaluation. FUTURE PROSPECTS AND PROJECTS; In patients with antiphospholipid antibodies a higher impedance has been observed in the uterine artery, suggesting a possible vascular dysfunction precluding to impaired trophoblastic invasion and placental thrombosis, as probable mechanisms in the complications. If confirmed, these findings might have important implications for the management of these patients.

[Maternal cannabis use and intra-uterine growth restriction]. / Consommation maternelle de cannabis et retard de croissance intra-utérin.

Marijuana is the most commonly used illegal drug, especially among young women in Western societies. The effects of cannabis use during pregnancy have been studied for many years. The vast majority of studies have shown a link between maternal consumption of cannabis and foetal development. Foetal growth restriction seems to be the major complication of cannabis exposure. Nevertheless, all these studies have suffered from several methodological biases. The maternal marijuana use should be first and foremost detected in pregnant women for a specific addiction management and pregnancy follow-up.

[Comparison of two routine screening strategies for gestational diabetes mellitus: the experience of Jean-Verdier Hospital]. / Comparaison de deux politiques de dépistage du diabète gestationnel: expérience de l'hôpital Jean-Verdier.

OBJECTIVE: Screening strategies for gestational diabetes mellitus are controversial. Thus, we sought to determine the benefits of universal screening. PATIENTS AND METHODS: Prospective study with 2121 women involved but 1610 really screened (75.9%). According to WHO's recommendations, the strategy implemented was one-step, universal screening with a 75g oral glucose tolerance test. Screening was performed between 24 and 28 weeks of gestation or earlier if risk factors were identified. Results were compared to previous year (2001) then only a selective screening was done. RESULTS: Application of universal screening increased the prevalence of gestational diabetes mellitus (8.39% to 15.65%). Out of the 252 patients with gestational diabetes, 66 did not display any identified risk factor (26.19%). Some new risk factors have been identified: age>30, Asian, Indian or Pakistan ethnies. If these new risk factors were applied, this super selective screening would have a sensibility of 96%. DISCUSSION AND CONCLUSION: Universal screening seems to be the most appropriate routine screening strategy because it is difficult to know exactly the specific risk factors of a population to do a super selective screening.

[Efavirenz (Sustiva) in pregnancy: a study about 12 HIV patients]. / Grossesse sous efavirenz (Sustiva): à propos de 12 cas de patientes positives pour le VIH.

OBJECTIVE: In developed countries, where the mother-to-child transmission rate of HIV is low (1 to 1,5%), a major medical concern is the safety of new therapies during pregnancy. Teratogenicity has been described with an NNRTI, efavirenz (Sustiva), in animal model, regarding neural tube defects. PATIENTS AND METHODS: We have made a retrospective study of pregnancies starting with efavirenz with a special focus on foetal and infant abnormalities. RESULTS: Three abnormalities were notified no one linked to a neural tube defect. DISCUSSION AND CONCLUSION: In the English literature published, although the prevalence of abnormalities in human is low (1,7%) during pregnancy, due to the potent teratogenicity, efavirenz is contraindicated in the first trimester and should be used with caution in women of childbearing potential.

[Interest of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: A case-control study]. / Intérêt du gel d'acide hyaluronique dans la prévention des synéchies intra-utérines après hystéroscopie opératoire: étude cas-témoin.

OBJECTIVES: To evaluate the efficacy of auto-cross-linked hyaluronic acid gel in the prevention of adhesions after operative hysteroscopy using a case-control study. MATERIALS AND METHODS: Fifty-four patients with an intrauterine lesion (myoma, polyp, uterine septa and adhesions) undergoing hysteroscopic surgery were divided into two groups: group A (30 patients) with intrauterine application of hyaluronic acid gel at the end of the surgical procedure and group B, which was considered as control (24 patients). The rate of adhesion formation, the score and the adhesion severity were estimated for each group using American Fertility Society (AFS) classification, by diagnostic hysteroscopy two months after surgery. No other treatment was associated. RESULTS: Age, weight, parity, hysterometry were comparable in the two groups. Surgery indications were polyp(s), myoma(s), uterine septa, and adhesions (11, 8, 1, and 10 patients in group A and 6, 6, 4, and 8 patients in group B, respectively). No difference was observed in intrauterine adhesion formation between the two groups (33.3% for group A and B; p = NS). The median adhesion scores using AFS were comparable in the two groups (1.30+/-2.35 vs 1.42+/-2.47; respectively, p = NS). The severity of the adhesions showed no significant difference between the two (70% stage I, mild adhesions; 20% stage II, moderate adhesions; 10% stage III, severe adhesions and 62.5% stage I; 25% stage II; 12.5% stage III in the group A and B, respectively). No adverse effect with the ACP gel was detected. CONCLUSION: ACP gel does not reduce the incidence and the severity of intrauterine adhesions after hysteroscopic surgery.

Post-transcriptional controls in bacteriophage T4: roles of the sequence-specific endoribonuclease RegB.

Gene regB of bacteriophage T4 encodes a sequence-specific endoribonuclease which introduces cuts in early phage messenger RNAs. In most cases, cutting takes place in the middle of the tetranucleotide GGAG. Efficient cleavages occur in the motifs located in intergenic regions, some of them being Shine-Dalgarno sequences. When located in a coding sequence, this tetranucleotide is poorly recognized or not at all. In this article, we have reviewed the properties of the RegB endoribonuclease, with emphasis on its possible roles in T4 development. We show that the nuclease RegB plays at least two roles: (i) it inactivates a sub-class of early mRNA by cleaving Shine-Dalgarno sequences, and (ii) it is necessary for the degradation of early mRNAs, but not of middle and late mRNAs. Accordingly, we found that middle and late mRNAs avoid processing by RegB, probably for different reasons. Most of the middle mRNAs (mRNAs initiated at MotA-dependent promoters) do not contain the motif GGAG in their intergenic regions, whereas about one-third of the late genes have this motif as Shine-Dalgarno sequence. It is not yet known whether the RNase is inactivated early in the phage cycle, or whether it remains active but cannot recognize late mRNAs as substrates.

Dual role of the sequence-specific bacteriophage T4 endoribonuclease RegB. mRNA inactivation and mRNA destabilization.

Gene regB of bacteriophage T4 encodes a sequence-specific endoribonuclease that introduces cuts in early phage messenger RNAs. Cutting takes place specifically in the middle of the tetranucleotide GGAG, as soon as the first minute of infection. Out of the 20 processing sites so far identified, seven are in Shine-Dalgarno sequences. The others are localized in intercistronic regions or within coding sequences. In the latter case, cutting efficiency is much lower. regB-dependent cleavages can occur within AU-rich sequences downstream of processed GGAG motifs that are not in effective translation initiation sites. We looked for possible consequences of regB-dependent cuts on gene expression in two early regions of the T4 chromosome. In the comC alpha region, none of the three major RegB cleavage sites is in a Shine-Dalgarno sequence, and in the motA region the unique regB-dependent processing site is found within the Shine-Dalgarno sequence of the gene. We find that in the region of gene comC alpha, RegB decreases two- to threefold the chemical half-life of early transcripts, but does not change the functional half-life of mRNAs coding for protein ComC alpha. The amount of MotA protein synthesized by the wild-type is half that obtained in a regB mutant infection. We show that this is a direct consequence of mRNA processing by RegB at the Shine-Dalgarno sequence of motA. This regB-mediated translation inhibition is not accompanied by an important modification in motA mRNA chemical half-life. We show that rapid shut-off of MotA protein synthesis that occurs soon after infection results both from RegB processing within the translation initiation region of motA and from early transcription inhibition followed by regB-independent breakdown of the motA mRNA.

Endoribonuclease RegB from bacteriophage T4 is necessary for the degradation of early but not middle or late mRNAs.

The RegB endoribonuclease from bacteriophage T4 cleaves early mRNAs specifically in the middle of the sequence GGAG. We show here that RegB is required for the degradation of bulk T4 early mRNA. In the absence of RegB, the chemical half-life of early transcripts is increased nearly fourfold, whereas their functional half-life is increased twofold. RegB also regulates the translation of several prereplicative genes. The synthesis of several early proteins is down-regulated, probably as a consequence of RegB cleavages in the Shine-Dalgarno sequence of these genes. The synthesis of several other proteins is up-regulated, suggesting that processing by RegB might improve translation by changing the conformation of a transcript. In contrast, RegB does not affect the average half-life of middle and late mRNA. An analysis of the susceptibility to RegB of many GGAG motifs carried by these mRNA species showed that most middle and all late GGAG-carrying mRNAs escape RegB processing in spite of the fact that the enzyme is acting at least until ten minutes post-infection. The sensitivity or resistance to RegB observed during phage infection could be reproduced in uninfected Escherichia coli cells and in vitro. This shows that the GGAG-carrying RNAs that are uncut during T4 infection are not substrates, whatever the period of the T4 cycle when the transcripts are made.