Endometrial biopsy performed before the first in vitro fertilization does not impact the early pregnancy rate.

Endometrial biopsy (EB) has been showed to increase the rate of clinical pregnancy in patients who underwent in vitro fertilization (IVF) failures. The purpose of this work was to assess the impact of an EB performed before the first in IVF on the early pregnancy rate. Be One study is a prospective, single-centre, randomized, open-label study. In this parallel study, patients were evenly split into two groups. In one group, patients underwent an EB between days 17 and 22 of the menstrual cycle that precedes the ovarian stimulation. In the other group (control), no EB was performed. The hCG-positive rate (early pregnancy rate) was evaluated on day 14 after the ovarian puncture. In total, 157 patients were randomized in the EB group and 154 patients were in the control group. The early pregnancy rate was 33.1% (52/157) in the EB group and 29.9% (46/154) in the control group (p = 0.54). Other parameters, including perforation, endometritis, or pain level were reassuring. An EB performed during the luteal phase of the menstrual cycle preceding the stimulation of the first IVF did not increase early pregnancy rate.

Robotic retroperitoneal para-aortic lymphadenectomy via single-site port.

Para-aortic staging is sometimes a standard feature in the management of pelvic cancers. Minimal invasive approach is recommended. Several routes are possible: extra-peritoneal or intraperitoneal depending on the expertise of the surgeon. We performed several extraperitoneal para-aortic lymphadenectomy using the Da Vinci Xi robotic system through single-site incision. We have developed a step-by-step guide from patient installation, installation of the Gelpoint V monotrocar, docking of the robot arms, to surgery, with the aim of performing the most efficient and safest procedure. The surgery does not differ from standard laparoscopic extraperitoneal lymphadenectomy. The advantages of minimally invasive robotic surgery in this indication are comparable to those of the standard laparoscopy approach. But through single-site incision, the Da Vinci Xi robot improves video quality, plus its wristed tools facilitates movements compared to conventional laparoscopy.

Impact of Enhanced Recovery After Surgery (ERAS) program in gynecologic oncology and patient satisfaction.

OBJECTIVE: The primary objective of this study was to compare lengths of stay since ERAS program implementation. We also evaluated ERAS protocol compliance, compared the outpatient rate, the complication rate and the readmission rate within 30 days after surgery and performed a satisfaction study. METHODS: This is a monocentric comparative study with a historical control group, performed in the gynecological surgery department of the University Hospital of Saint-Etienne. We compared a group of patients who underwent surgery in 2016, before the implementation of ERAS program, with a group of patients who underwent surgery from July 2021 to July 2022, for whom ERAS program was applied. RESULTS: 187 patients were included in this study, including 84 patients in the historical group before ERAS and 103 in the group with ERAS. Considering all approaches, the average length of stay decreased by 2 days (p<0.0001). Considering minimally invasive surgery, the outpatient rate increased from 5% to 50% (p<0.0001) and complication rate decreased from 23 to 11% (p = 0,04). The readmissions rate was similar. Satisfaction score for patients managed with ERAS program was 8.9/10. CONCLUSION: The implementation of ERAS program in gynecological oncology surgery allowed a reduction in length of stay, with a high outpatient rate, decreasing complications in case of minimally invasive surgery, without increasing the readmission rate, and was associated with good patient satisfaction.

Role of NLRP7 in Normal and Malignant Trophoblast Cells.

Gestational choriocarcinoma (CC) is an aggressive cancer that develops upon the occurrence of abnormal pregnancies such as Hydatidiform moles (HMs) or upon non-molar pregnancies. CC cells often metastasize in multiple organs and can cause maternal death. Recent studies have established an association between recurrent HMs and mutations in the Nlrp7 gene. NLRP7 is a member of a new family of proteins that contributes to innate immune processes. Depending on its level of expression, NLRP7 can function in an inflammasome-dependent or independent pathway. To date, the role of NLRP7 in normal and in malignant human placentation remains to be elucidated. We have recently demonstrated that NLRP7 is overexpressed in CC trophoblast cells and may contribute to their acquisition of immune tolerance via the regulation of key immune tolerance-associated factors, namely HLA family, ßCG and PD-L1. We have also demonstrated that NLRP7 increases trophoblast proliferation and decreases their differentiation, both in normal and tumor conditions. Actual findings suggest that NLRP7 expression may ensure a strong tolerance of the trophoblast by the maternal immune system during normal pregnancy and may directly affect the behavior and aggressiveness of malignant trophoblast cells. The proposed review summarizes recent advances in the understanding of the significance of NLRP7 overexpression in CC and discusses its multifaceted roles, including its function in an inflammasome-dependent or independent pathways.

Elemental fingerprint of human amniotic fluids and relationship with potential sources of maternal exposure.

BACKGROUND: The impact of nanoparticles we are increasingly exposed to remains largely unknown. Of particular concern is the exposure of pregnant women and potential impact on fetal development. Indeed, many in vitro and in vivo animal studies have shown that nanoparticles are able to cross the placental barrier and induce toxic effects to the fetus. However, little is known in humans. OBJECTIVE: The aim and originality of this study were to investigate the nanoparticle burden of amniotic fluids in pregnant women. Methods - To that purpose, 100 amniotic fluids collected for clinical purposes were used to determine the nanoparticle quantity and nature by inductively coupled plasma atomic emission spectroscopy (NAMIOTIC, ClinicalTrials.gov Identifier: NCT02720887). Results - The prevalence of patients with a substantial concentration for the essential trace elements Cu, Fe and Zn was high, while that of patients with a substantial concentration of Al, Ag, Be, Co, Cr, Ni, Si, Ti and W was relatively low (under 20 %). It was generally higher in the fraction containing nanoparticles and ions than in the fraction containing micro- and submicroparticles. No correlation was found between the nanoparticle burden and the different potential sources of exposure to nanoparticles (smoking status of the patient, living area, heating source, mode of transport, leisure, use of hygiene products and cosmetics and occupational activities). CONCLUSION: Our results showing low concentrations and low prevalence of most of the assessed elements in amniotic fluids are reassuring. Further research is needed to draw firm conclusions on the developmental toxicity of engineered nanoparticles in humans but the present paper can provide a useful basis for further evaluation of the fetal toxicity of nanoparticles.

Treatment of Gynecomastia by Endoscopic Subcutaneous Mastectomy in Adolescents.

Background: Morbidity of traditional open surgery for the treatment of gynecomastia includes asymmetry, retraction of the nipple, and poor scarring. Other approaches were described to improve the results. Endoscopic subcutaneous mastectomy (ESCM) was reported in adult series, including a few adolescents. This technique was considered as safe with good aesthetic results. The aim of this study was to evaluate the results of ESCM in an adolescent series. Patient and Methods: We treated 19 adolescents with Simon's grade IIB and III gynecomastia between June 2014 and July 2018. They could choose open surgery through the nipple or endoscopic surgery by axillary approach. To perform ESCM, three trocars were placed on the midaxillary line to dissect the gland. The resection was performed leaving 1 cm thickness of gland behind the nipple. The gland was extracted after morcellation through the 10 mm trocar. A drainage tube was placed in the cavity. The patients wore a thoracic belt smoothly compressing the operative areas for 15 days. The result was considered as good when there was no remaining gland, good symmetry, and no nipple retraction or nipple lateral displacement. Results: During the study period, 12 adolescents were treated by ESCM and 7 preferred open surgery. Among the 12 ESCM patients, 7 had bilateral and 5 unilateral gynecomastia. A subcutaneous injection of serum was done in the last 6 patients to facilitate the creation of the work space. A 2- or 3-mm second-degree burn occurred in 4 cases, 2 on the nipple and 2 just above the nipple, with a 2 mm remaining scar above the nipple in 1 case. The postoperative course was uneventful in 11 adolescents. One subcutaneous seroma expanded at 15 days postoperative and resolved after 3 weeks of prolonged compression by thoracic belt. The adolescents had 11 good results and 1 persistent asymmetry; 2 other asymmetries had a spontaneous improvement after 1 or 2 years. Conclusion: ESCM is feasible and safe for the treatment of gynecomastia in adolescents. This technique is challenging but permits to reach good aesthetic results and avoids scars on the anterior wall of the thorax.

Randomized comparison between indocyanine green fluorescence plus 99mtechnetium and 99mtechnetium alone methods for sentinel lymph node biopsy in breast cancer.

Use of both patent blue and a radioisotope to locate, and reduce the risk of sentinel lymph node (SLN) detection failure in breast cancer is recommended, but drawbacks commonly lead to using only a radioisotope. An alternative method would therefore be valuable. This randomized, controlled study in 99 patients compared SLN detection using 99mtechnetium (Tc) alone versus Tc combined with indocyanine green (ICG). The primary endpoint was the SLN identification rate. The primary outcome measure was the number of patients with <2 SLN detected. One SLN was detected in 44.0% of patients in the dual detection group and 40.8% in the 99mTc alone group (RR = 1.08 (95% CI 0.68; 1.72), p = 0.84). A mean (±SD) of 2.14 ± 1.23 SLN were identified in the dual detection group vs. 1.77 ± 0.85 using Tc alone (p = 0.09). Eight-five (78.7%) SLN were both ICG+ and TC+, 15 (13.9%) ICG+ and Tc-, and 7 (6.5%) ICG- and Tc+. SLN detected were ICG-positive in 92.6% of patients and 99mTc-positive in 85.2% with. No adverse event related to ICG injection was recorded. Dual detection of SLN using ICG and radioisotope is reliable and sensitive but was not superior to isotope alone in successfully locating SLN in our pilot randomized trial.

Angiogenic factors for prediction of preeclampsia and intrauterine growth restriction onset in high-risk women: AngioPred study.

OBJECTIVE: The study aimed to compare the level of two angiogenic factors, soluble fms-like tyrosine kinase-1 (sFlt1) and soluble endoglin (sEng), for the prediction of preeclampsia and intrauterine growth restriction in high-risk pregnant women. METHODS: A prospective multicenter cohort study of 200 pregnant patients was conducted between June 2008 and October 2010. sFlt1 and sEng were measured by enzyme-linked immunosorbent assay. RESULTS: Forty-five patients developed a placenta-mediated adverse pregnancy outcome. Plasma levels of sFlt1 and sEng were higher in patients who will experience a preeclampsia at 28, 32, and 36 weeks compared with patients with no complication. The same results were observed for intrauterine growth restriction. Plasma levels of sFlt1 and sEng were not significantly different for patients with preeclampsia compare to patients with intrauterine growth restriction. Patients with early pre-eclampsia (PE) had very high rates of angiogenic factors at 20, 24, and 28 weeks. Patients with late PE and early and late intrauterine growth retardation (IUGR) had high rates at 32 and 36 weeks. CONCLUSION: In high-risk women, angiogenic factors are disturbed before the onset of preeclampsia and this is true for intrauterine growth restriction.

Accuracy of antenatal ultrasound signs in predicting the risk for bowel atresia in patients with gastroschisis.

OBJECTIVE: Evaluate accuracy of prenatal ultrasound findings in predicting the risk of bowel atresia in patients with gastroschisis. METHODS: A retrospective study was conducted on 18 fetuses with a prenatal diagnostic of gastroschisis treated at University hospital of Saint Etienne France between 2002 and 2012. Ultrasound abnormalities were used to classify them into three groups: no ultrasound abnormality (n=4), oligohydramnios (n=9), intra-abdominal bowel dilatation ≥20.5mm (n=5). Postnatal outcomes were compared between groups. The threshold value of 20.5mm for the prediction of atresia was determined through the receiver operator characteristics curve. RESULTS: In the group with oligohydramnios, intra uterine growth restriction were significantly more frequent (p=0.015) and three newborns had serositis including two with secondary complications after the initial surgery. In the group with major intra-abdominal bowel dilatation, all had a narrow defect <10mm significantly more than other fetuses (p=0.002). Intra-abdominal bowel dilatation reaching 20.5mm started at a mean gestational age significantly lower than that of the other fetuses (23.3 versus 29.7 weeks p=0.02). On the five fetuses presented intra-abdominal bowel dilatation ≥20.5mm, four showed atresia and no other newborn has this complication (p=0.0016). The threshold value of 20.5mm has a sensitivity of 100% and a specificity of 92.9%. The area under the curve was equal to 96.4%. CONCLUSION: Intra-abdominal bowel dilatation ≥20.5mm seems to be associated with the risk of postnatal atresia. MRI could help to clarify a complicated or uncertain ultrasound aspect.

[Place of indocyanine green coupled with fluorescence imaging in research of breast cancer sentinel node]. / Place du vert d'indocyanine couplée à l'imagerie par fluorescence dans la recherche du ganglion sentinelle du cancer du sein.

The sentinel node has a fundamental role in the management of early breast cancer. Currently, the double detection of blue and radioisotope is recommended. But in common practice, many centers use a single method. However, with a single detection, the risk of false negatives and the identification failure rate increase to a significant extent and the number of sentinel lymph node detected and removed is not enough. Furthermore, the tracers used until now show inconveniences. The purpose of this work is to present a new method of detection, using the green of indocyanine coupled with fluorescence imaging, and to compare it with the already existing methods. The method combined by fluorescence and isotopic is reliable, sure, of fast learning and could constitute a good strategy of detection. The major interest is to obtain a satisfactory number of sentinel nodes. The profit could be even more important for overweight patients. The fluorescence used alone is at the moment not possible. Wide ranging studies are necessary. The FLUOTECH, randomized study of 100 patients, comparing the isotopic method of double isotope technique and fluorescence, is underway to confirm these data.

OSNA (one-step nucleic acid amplification) sentinel lymph node intraoperative molecular analysis in breast cancer: a cost-benefit analysis.

The aim of the study was to analyze the medical and economic interest of OSNA molecular technique, compared to conventional postoperative histopathologic evaluation for sentinel lymph node exploration in breast cancer patients. This retrospective cost-benefit study was conducted in the French Universitary Hospital of Saint Etienne on patients who received sentinel lymph node exploration between July 1, 2007 and December 31, 2009. Lymph nodes were analyzed by conventional postoperative histological evaluation in group 1 (82 patients) and OSNA in group 2 (86 patients). Costs were analyzed in three different ways: surgery cost, hospitalization cost and histopathologic cost. Average operating time was slightly shorter for group 1 (histology) [71.9 vs. 76.8 min for group 2 (OSNA)]. Time and operating costs were not significantly different (p = 0.293). The average cost of pathological examination was significantly higher in group 2 (35.04 euros per node in group 1 vs. 291.84 euros per node in group 2 p < 10(-3)). The average length of hospital stay was significantly longer in group 1 (5.4 days in group 1 vs. 4.2 days in group 2, p = 0.0065). The total costs were not significantly different between both groups (3,774.6 euros in group 1 vs. 3,393.9 euros in group 2 p = 0.055). The sentinel lymph node analysis with OSNA technique does not lead to higher expenses. It also avoids another surgery for 20% of patients. A prospective multicentric medico-economic study made with a larger effective would probably confirm these results.