Surgical Management of Urinary Tract Endometriosis: A 1-year Longitudinal Multicenter Pilot Study at 31 French Hospitals (by the FRIENDS Group).

STUDY OBJECTIVE: To describe the surgical management and risks of postoperative complications of patients with urinary tract endometriosis in France in 2017. DESIGN: Multicenter retrospective cohort pilot study. SETTING: Departments of gynecology at 31 expert endometriosis centers. PATIENTS: All women managed surgically for urinary tract endometriosis from January 1, 2017, to December 31, 2017. We distinguished patients with isolated bladder endometriosis or isolated ureteral endometriosis (IUE) from those with endometriosis in both locations (mixed locations [ML]). INTERVENTIONS: Surgeons belonging to the French Colorectal Infiltrating Endometriosis Study (FRIENDS) group enrolled patients who filled a 24-item questionnaire on the day of the inclusion and 3 months later. Data were collected on operative routes, surgical management, and postoperative complications according to the Clavien-Dindo classification in a single anonymized database. MEASUREMENTS AND MAIN RESULTS: A total of 232 patients from 31 centers were included. Isolated bladder endometriosis was found in 82 patients (35.3%), IUE in 126 patients (54.4%), and ML in 24 patients (10.3%). Surgery was performed by laparoscopy, laparotomy, or robot-assisted laparoscopy in 74.1%, 11.2%, and 14.7% of the cases, respectively. Among the 150 ureteral lesions (IUE and ML), 114 were managed with ureterolysis (76%), 28 with ureteral resection (18.7%), 4 with nephrectomy (2.7%), and 23 with cystectomy (15.3%). Concerning bladder endometriosis, a partial cystectomy was performed in 94.3% of the cases. We reported 61 postoperative complications (26.3%): 44 low-grade complications according to the Clavien-Dindo classification (18%), 16 grade III complications (7%), and 1 grade IV complication (peritonitis). CONCLUSION: The surgical management of ureteral and bladder endometriosis is usually feasible and safe through laparoscopic surgery. Ureteral resection, when necessary, is more strongly associated with laparotomy and with more complications than other procedures. Prospective controlled studies are still mandatory to assess the best surgical management for patients.

Fertility Outcomes After Ablation Using Plasma Energy Versus Cystectomy in Infertile Women With Ovarian Endometrioma: A Multicentric Comparative Study.

STUDY OBJECTIVE: To compare the probability of postoperative pregnancy in infertile women with ovarian endometrioma larger than 3 cm in diameter, managed by either ablation using plasma energy or cystectomy. DESIGN: A multicentric case-control study (Canadian Task Force classification II-2). SETTING: Six surgical departments, affiliated with 4 university hospitals and 2 private facilities. PATIENTS: One hundred four infertile patients with ovarian endometrioma larger than 3 cm. INTERVENTIONS: Endometrioma ablation using plasma energy was performed in 64 patients (61.5%) and cystectomy in 40 patients (38.5%). MEASUREMENTS AND MAIN RESULTS: Patients were enrolled in the CIRENDO prospective cohort database (NCT02294825) from June 2009 to June 2014 and managed in 6 different facilities. The minimum length of follow-up was 1 year. Postoperative probabilities of pregnancy in patietns and control subjects were estimated using the Kaplan-Meier method with 95% confidence intervals (CIs) and compared using the log-rank test. The Cox model was used to assess independent predictive factors for pregnancy. Patients managed by plasma energy were significantly older than patients managed by cystectomy, had significantly higher overall revised American Fertility Society (rAFS) score, and had higher rate of Douglas pouch obliteration, deep endometriosis, and colorectal localizations. After a mean follow-up of 35.3 ± 17.5 months (range, 12-60), fertility outcomes were comparable between the groups. The probability of pregnancy at 24 and 36 months after surgery in plasma energy and cystectomy groups was, respectively, 61.3% (95% CI, 48.2%-74.4%) versus 69.3% (95% CI, 54.5%-83%) and 84.4% (95% CI, 72%-93.4%) versus 78.3% (95% CI, 63.8%-90%). The Cox's model revealed that the type of surgical procedure on ovarian endometrioma had no statistically significant impact on the probability of pregnancy, after adjustment for women's age, bilateral cysts larger than 3 cm, colorectal endometriosis, and rAFS stage of endometriosis. CONCLUSION: Postoperative pregnancy rates were comparable after management of ovarian endometrioma by either ablation using plasma energy or cystectomy despite an overall higher rate of unfavorable fertility predictive factors in women managed by ablation.

Réunion Island prepared for possible Zika virus emergence, 2016.

Zika virus (ZIKV) has recently spread widely and turned into a major international public health threat. Réunion appears to offer conditions particularly favourable to its emergence and therefore prepared to face possible introduction of the virus. We designed a scaled surveillance and response system with specific objectives, methods and measures for various epidemiological phases including a potential epidemic. Several tools were developed in order to (i) detect individual cases (including a large information campaign on the disease and suspicion criteria), (ii) monitor an outbreak through several complementary systems allowing to monitor trends in disease occurrence and geographic spread and (iii) detect severe forms of the disease in collaboration with hospital clinicians. We put the emphasis on detecting the first cases in order to contain the spread of the virus as much as possible and try to avoid progress towards an epidemic. Our two main strengths are a powerful vector control team, and a close collaboration between clinicians, virologists, epidemiologists, entomologists and public health authorities. Our planned surveillance system could be relevant to Europe and island settings threatened by Zika virus all over the world.

Measurement and characterisation of radiated underwater sound from a 3.6 MW monopile wind turbine.

This paper describes underwater sound pressure measurements obtained in close proximity (∼50 m) to two individual wind turbines, over a 21-day period, capturing the full range of turbine operating conditions. The sound radiated into the water was characterised by a number of tonal components, which are thought to primarily originate from the gearbox for the bandwidth measured. The main signal associated with the turbine operation had a mean-square sound pressure spectral density level which peaked at 126 dB re 1 µPa2 Hz-1 at 162 Hz. Other tonal components were also present, notably at frequencies between about 20 and 330 Hz, albeit at lower amplitudes. The measured sound characteristics, both in terms of frequency and amplitude, were shown to vary with wind speed. The sound pressure level increased with wind speed up to an average value of 128 dB re 1 µPa at a wind speed of about 10 ms-1, and then showed a general decrease. Overall, differences in the mean-square sound pressure spectral density level of over 20 dB were observed across the operational envelope of the turbine.

A kinematic analysis of the spine during rugby scrummaging on natural and synthetic turfs.

Artificial surfaces are now an established alternative to grass (natural) surfaces in rugby union. Little is known, however, about their potential to reduce injury. This study characterises the spinal kinematics of rugby union hookers during scrummaging on third-generation synthetic (3G) and natural pitches. The spine was sectioned into five segments, with inertial sensors providing three-dimensional kinematic data sampled at 40 Hz/sensor. Twenty-two adult, male community club and university-level hookers were recruited. An equal number were analysed whilst scrummaging on natural or synthetic turf. Players scrummaging on synthetic turf demonstrated less angular velocity in the lower thoracic spine for right and left lateral bending and right rotation. The general reduction in the range of motion and velocities, extrapolated over a prolonged playing career, may mean that the synthetic turf could result in fewer degenerative injuries. It should be noted, however, that this conclusion considers only the scrummaging scenario.

Acousto-optic effect compensation for optical determination of the normal velocity distribution associated with acoustic transducer radiation.

The acousto-optic effect, in which an acoustic wave causes variations in the optical index of refraction, imposes a fundamental limitation on the determination of the normal velocity, or normal displacement, distribution on the surface of an acoustic transducer or optically reflecting pellicle by a scanning heterodyne, or homodyne, laser interferometer. A general method of compensation is developed for a pulsed harmonic pressure field, transmitted by an acoustic transducer, in which the laser beam can transit the transducer nearfield. By representing the pressure field by the Rayleigh integral, the basic equation for the unknown normal velocity on the surface of the transducer or pellicle is transformed into a Fredholm equation of the second kind. A numerical solution is immediate when the scanned points on the surface correspond to those of the surface area discretization. Compensation is also made for oblique angles of incidence by the scanning laser beam. The present compensation method neglects edge waves, or those due to boundary diffraction, as well as effects due to baffles, if present. By allowing measurement in the nearfield of the radiating transducer, the method can enable quantification of edge-wave and baffle effects on transducer radiation. A verification experiment has been designed.

Reliability of an accelerometer-based system for quantifying multiregional spinal range of motion.

OBJECTIVES: The purpose of this study was to investigate the reliability of a novel motion analysis device for measuring the regional breakdown of spinal motion and describing the relative motion of different segments of the thoracolumbar (TL) spine. METHODS: Two protocols were applied to 18 healthy participants. In protocol 1, 2 sensors were placed on the forehead and T1 to measure cervical range of motion (ROM). In protocol 2, 6 sensors were placed on the spinous processes of T1, T4, T8, T12, L3, and S1 to measure TL regional ROM. Intraclass correlation coefficients were used to evaluate the repeatability of movement, whereas SEM was used to define the extent of error. Ranges of motion were demonstrated in flexion extension, right-left lateral flexion, and right-left rotation of the head-cervical, upper thoracic, middle thoracic, lower thoracic, upper lumbar, and lower lumbar. RESULTS: The intraclass correlation coefficient values, for all regions, were found to be high, ranging from 0.88 to 0.99 for all movements, and regions of the spine and SEM values ranged from 0.4° to 5.2°. Multiregional spine ROM ranged from 3° in the upper thoracic and mid-thoracic during flexion and 80° at head cervical during right rotation. CONCLUSION: The described methodology was reliable for assessing regional spinal ROM across multiple spinal regions while providing the relative motions of different segments of the TL spine.

Correlation of lumbar-hip kinematics between trunk flexion and other functional tasks.

OBJECTIVE: The purpose of this study was to explore the relationship between the kinematic profiles of flexion of the upper lumbar and lower lumbar (LL) spine and hip and 3 sagittally dominant functional tasks (lifting, stand-to-sit, and sit-to-stand). METHODS: Fifty-three participants were recruited for this study. Four sensors were attached to the skin over the S1, L3, T12, and lateral thigh. Relative angles between adjacent sensors were used to quantify the motion for the hip, LL, and upper lumbar spine. Pearson correlation coefficients were used to explore the relationship between the movements and more functional tasks. One-way analysis of variance was used to determine the significance of differences between the variables. RESULTS: Flexion resulted in a greater or similar range of motion (ROM) to the other tasks investigated for both spinal regions but less ROM for the hip. Strong correlations for ROM are reported between forward flexion tasks and lifting for the LL spine (r = 0.83) and all regions during stand-to-sit and sit-to-stand (r = 0.70-0.73). No tasks were strongly correlated for velocity (r = 0.03-0.55). CONCLUSION: Strong correlations were only evident for the LL spine ROM between lifting and flexion; all other tasks afforded moderate or weak correlations. This study suggests that sagittal tasks use different lumbar-hip kinematics and place different demands on the lumbar spine and hip.

Cystocele repair with single-incision, trocarless mesh system.

INTRODUCTION AND HYPOTHESIS: The use of mesh at the time of anterior vaginal wall repair reduced the risk of recurrent anterior vaginal wall prolapse. The aim of our video is to demonstrate our dissection technique focusing on the main anatomical landmarks in the pelvis and present an overall safer system to correct pelvic floor prolapse. METHODS: The video demonstrates correction of cystocele with the EndoFast Reliant™ system (IBI Israel Biomedical Innovations, Caesarea Industrial Park South, Israel). The surgical technique is described. RESULTS: Twenty-nine patients were treated with the system. Mean follow-up was 10 (range, 6-30) months. At latest follow-up, favorable anatomical results were obtained for 26 of 29 patients (89.6 %); three patients presented stage 1 nonsymptomatic prolapse. Three cases (13 %) of de novo stress urinary incontinence (SUI) and two cases of de novo urgency (6.9 %) were diagnosed and treated. Postoperative voiding difficulties, dyspareunia, or pain were not observed. CONCLUSION: The operation with the trocarless system was found to be safe, easy to learn and implement, and have the potential for reducing intra- and postoperative complications, with very satisfactory functional and anatomical results.

[Prevalence of menorrhagia among women in Reunion Island]. / Prévalence des ménorragies chez les femmes à la Réunion.

OBJECTIVES: To estimate the prevalence of menorrhagia in women in Reunion Island using the Higham score, to evaluate self-reporting as an alternative diagnostic method, and to study women's level of knowledge about menorrhagia and its impact on their quality of life. METHODS: This was a descriptive, cross-sectional observational study involving 185 adult women with menstrual periods living in Reunion Island. Women volunteered to answer an online self-questionnaire proposed by healthcare professionals from January to May 2023 in Reunion Island. They completed a general information questionnaire, the Higham score, a menorrhagia knowledge questionnaire and a menstrual quality of life questionnaire. RESULTS: The prevalence of menorrhagia in the sample was 48.1% using the Higham score and 46.5% using self-report. Women's level of knowledge about menorrhagia is still insufficient, given the significant impact on quality of life during menstruation among those suffering from this symptom. CONCLUSION: The prevalence of menorrhagia in our sample of women on Reunion Island is high. Measures need to be taken to break the taboos surrounding menstruation, promote menstrual education and foster a better understanding by women of menstrual pathologies, particularly menorrhagia. Early detection of this symptom would enable faster treatment and avoid complications and adverse effects on quality of life.

Single port laparoscopic sacrohysteropexy in a young patient presenting with grade III uterine prolapse and rectocele.

INTRODUCTION: Uterine preservation in patients with uterine prolapse is a common practice in the last decade and the reconstructive pelvic operation can be done either by vaginal, abdominal or laparoscopic approach. In young patients, uterine preservation is a legitimate option and one of the proposed operations is sacro-hystero-pexy. Single Port Laparoscopy (SPL) is a relatively new technique. This is a case of a young patient presented with grade III uterine prolapse and rectocele. METHODS: The video presents the surgical technique of sacro-hystero-pexy as was described in 2001 by von Theobald, adapted specifically for the SPL technique. CONCLUSIONS: The Single Port laparoscopy is an advanced laparoscopic technique. This video demonstrate that scaro-hystero-pexy can be done safely and efficacy with Single Port Laparoscopy without prolonging the operation time significantly.

Development of a methodology for the standardisation and improvement of 'Smartphone' photography of patterned bruises and other cutaneous injuries.

Human bite-mark analyses can play a prominent role in forensic case investigations, including those involving sexual assault. High-quality photographs routinely secure a link between a bite-mark and an individual's dentition. Access to around the clock forensic photography, however, is often limited, resulting in delay and/or missed opportunities to record valuable evidence. The emergence of Smartphone high-quality photographic technology now provides a previously unimagined opportunity to gather timely forensic photographic evidence. Problems can arise, however, due to the relatively poor quality of the photographs, as a result of many of those taking photographs having received little or no forensic photography training. This study compares unassisted photography with assisted photography, by a specifically developed camera application (App), to provide a standardised method for taking forensic photographs. An App, written in Java, was hosted on the Google Android Operating System, on a Samsung Galaxy SII Smartphone. Twenty-four volunteers participated in a study to photograph a pseudo bite-mark using three methods, (1) unassisted (as a control), (2) assisted by an ABFO No.2 right-angled photographic reference scale and (3) assisted by the App. The App, method (3), was shown to consistently outperform methods (1) and (2), demonstrating greater standardisation and precision (p<0.001). Analysis of the data showed the extent to which acquiring an accurate photograph depends on the image being orthogonal to the camera. It appears likely that the relatively inaccurate photographs acquired by methods (1) and (2), were as a result of deviation from the plane, orthogonal to the bite-mark. Therefore, the App was successful in ensuring that the camera was both orthogonal and at an appropriate distance, relative to the bite-mark. Thus, the App enhanced the abilities of non-experts to acquire more accurate photographs and created the potential to significantly improve the quality of forensic photographs.

Quantifying the microstructural and biomechanical changes in the porcine ventricles during growth and remodelling.

Cardiac tissue growth and remodelling (G & R) occur in response to the changing physiological demands of the heart after birth. The early shift to pulmonary circulation produces an immediate increase in ventricular workload, causing microstructural and biomechanical changes that serve to maintain overall physiological homoeostasis. Such cardiac G & R continues throughout life. Quantifying the tissue's mechanical and microstructural changes because of G & R is of increasing interest, dovetailing with the emerging fields of personalised and precision solutions. This study aimed to determine equibiaxial, and non-equibiaxial extension, stress-relaxation, and the underlying microstructure of the passive porcine ventricles tissue at four time points spanning from neonatal to adulthood. The three-dimensional microstructure was investigated via two-photon excited fluorescence and second-harmonic generation microscopy on optically cleared tissues, describing the 3D orientation, rotation and dispersion of the cardiomyocytes and collagen fibrils. The results revealed that during biomechanical testing, myocardial ventricular tissue possessed non-linear, anisotropic, and viscoelastic behaviour. An increase in stiffness and viscoelasticity was noted for the left and right ventricular free walls from neonatal to adulthood. Microstructural analyses revealed concomitant increases in cardiomyocyte rotation and dispersion. This study provides baseline data, describing the biomechanical and microstructural changes in the left and right ventricular myocardial tissue during G & R, which should prove valuable to researchers in developing age-specific, constitutive models for more accurate computational simulations. STATEMENT OF SIGNIFICANCE: There is a dearth of experimental data describing the growth and remodelling of left and right ventricular tissue. The published literature is fragmented, with data reported via different experimental techniques using tissues harvested from a variety of animals, with different gender and ages. This prevents developing a continuum of data spanning birth to death, so limiting the potential that can be leveraged to aid computational modelling and simulations. In this study, equibiaxial, non-equibiaxial, and stress-relaxation data are presented, describing directional-dependent material responses. The biomechanical data is consolidated with equivalent microstructural data, an important element for the development of future material models. Combined, these data describe microstructural and biomechanical changes in the ventricles, spanning G &R from neonatal to adulthood.

Towards using a multi-material, pellet-fed additive manufacturing platform to fabricate novel imaging phantoms.

The design freedom afforded by additive manufacturing (AM) is now being leveraged across multiple applications, including many in the fields of imaging for personalised medicine. This study utilises a pellet-fed, multi-material AM machine as a route to fabricating new imaging phantoms, used for developing and refining algorithms for the detection of subtle soft tissue anomalies. Traditionally comprising homogeneous materials, higher-resolution scanning now allows for heterogeneous, multi-material phantoms. Polylactic acid (PLA), a thermoplastic urethane (TPU) and a thermoplastic elastomer (TPE) were investigated as potential materials. Manufacturing accuracy and precision were assessed relative to the digital design file, whilst the potential to achieve structural heterogeneity was evaluated by quantifying infill density via micro-computed tomography. Hounsfield units (HU) were also captured via a clinical scanner. The PLA builds were consistently too small, by 0.2 - 0.3%. Conversely, TPE parts were consistently larger than the digital file, though by only 0.1%. The TPU components had negligible differences relative to the specified sizes. The accuracy and precision of material infill were inferior, with PLA exhibiting greater and lower densities relative to the digital file, across the 3 builds. Both TPU and TPE produced infills that were too dense. The PLA material produced repeatable HU values, with poorer precision across TPU and TPE. All HU values tended towards, and some exceeded, the reference value for water (0 HU) with increasing infill density. These data have demonstrated that pellet-fed AM can produce accurate and precise structures, with the potential to include multiple materials providing an opportunity for more realistic and advanced phantom designs. In doing so, this will enable clinical scientists to develop more sensitive applications aimed at detecting ever more subtle variations in tissue, confident that their calibration models reflect their intended designs.

Trocarless system for mesh attachment in pelvic organ prolapse repair--1-year evaluation.

INTRODUCTION AND HYPOTHESIS: EndoFast Reliant system is a novel technology for pelvic organ prolapse (POP) repair that attaches mesh directly with metal fasteners. METHODS: This was a prospective multicenter study in 20 women who underwent vaginal POP repair to evaluate safety and efficacy. The patients were followed for 12 months, using POP-Q measures, questionnaires on symptoms (PFDI), and sexual function (FSFI). RESULTS: No intraoperative complications occurred. Prolapse has been anatomically resolved (< stage 2) in 85% at 1-year follow-up (17/20 patients). Pelvic Floor Distress Inventory (PFDI) scores showed significant improvement for 1 year in symptoms related to prolapse (4.1-0.7, p < 0.001) and bladder (1.4-0.7, p = 0.06) but not to rectum. Female Sexual Function Index (FSFI) scores did not change significantly. One case of mesh exposure was found (5%) and treated conservatively. No migration of fasteners was observed on X-ray. CONCLUSIONS: The EndoFast Reliant system was found safe and efficacious. Future studies are needed to evaluate its advantages over techniques using trocars.

Satisfaction of patients in pain management delivering in Reunion Island with or without neuraxial analgesia.

BACKGROUND: Neuraxial analgesia (NA) rate during labour in Reunion Island is below the average rate in continental France. Our study objective was to know if the patients that deliver with or without NA were satisfied. We also wanted to identify the reasons of this lower rate. METHOD: This was a multicentre prospective observational study led in the seven Reunion Island maternity hospitals including all patients who delivered after 24 weeks of gestation onwards during two weeks in 2019 and excluding scheduled caesarean sections. Included patients received a satisfaction questionnaire the day after delivery and returned it before leaving. RESULTS: Of the 497 patients who met the inclusion criteria, 303 questionnaires were analysable. 216 patients had NA (71.3 %) and 87 patients (28.7 %) delivered without. A total of 88.0 % of patients with NA were satisfied with pain management compared to 83.9 % without. There was no significant difference between the groups (p=0.68). Among patients who delivered without NA, it was their choice in 55.2 % of cases. They wanted the most natural birth possible in 87.5 % of cases. Birth without NA in opposition to their wish was related to too rapid dilation in 90.0 % of lowerecases. DISCUSSION: No significant difference in satisfaction between women who delivered with or without NA was found. The lower regional NA rate seems to be linked to a choice to give birth as naturally as possible and to too fast dilation at the time of requesting NA.

Extremely and Very Preterm Deliveries in a Maternity Unit of Inappropriate Level: Analysis of Socio-Residential Factors.

PURPOSE: To analyze the socio-residential factors associated with extremely and very preterm deliveries occurring in non-level 3 maternity units in France. MATERIALS AND METHODS: This is a population-based observational retrospective study using national hospital data from 2012 to 2014. A generalized estimating equations regression model was used to study the characteristics of women who delivered very preterm and the socio-residential risk factors for not delivering in a level 3 maternity unit at 24-31+6d weeks of gestation. RESULTS: Among deliveries resulting in live births and without contraindication to in-utero transfer, we identified 9198 extremely or very preterm deliveries; 2122 (23.1%) of these were managed in a non-level 3 unit. Our study showed that young maternal age (women under 20 years at delivery) was associated with the risk of giving birth prematurely in a non-level 3 maternity, and particularly in a level 1 maternity unit (adjusted relative risk, 1.53; 95% CI 1.09-2.16). Living more than 30 minutes away from the closest level 3 unit increased the risk of delivering very preterm in a level 1 or 2 unit. Living in an urban area or urban periphery increased the risk of giving birth in a level 2 maternity unit (adjusted relative risk, 1.53; 95% CI 1.28-1.83 and 1.42; 95% CI 1.17-1.71, respectively). CONCLUSION: This study shows that young pregnant women living more than 30 minutes from a level 3 hospital have an increased risk of delivering in a maternity unit that is not equipped to deal with premature births. The risk also increases with an urban place of residence when the delivery occurs in a level 2 unit. A clearer understanding of the population at risk of delivering prematurely in a non-level 3 maternity could lead to improvements in structuring healthcare to encourage earlier management and better support.

Cystocele repair by transobturator four arms mesh: monocentric experience of first 123 patients.

INTRODUCTION AND HYPOTHESIS: The aims of the study were to evaluate the per- and post-operative complications and outcomes after cystocele repair with transobturator mesh. METHODS: A retrospective continuous series study was conducted over a period of 3 years. Clinical evaluation was up to 1 year with additional telephonic interview performed after 34 months on average. When stress urinary incontinence (SUI) was associated with the cystocele, it was treated with the same mesh. RESULTS: One hundred twenty-three patients were treated for cystocele. Per-operative complications occurred in six patients. After 1 year, erosion rate was 6.5%, and only three cystoceles recurred. After treatment of SUI with the same mesh, 87.7% restored continence. Overall patient's satisfaction rate was 93.5%. CONCLUSIONS: Treatment of cystocele using transobturator four arms mesh appears to reduce the risk of recurrence at 1 year, along with high rate of patient's satisfaction. The transobturator path of the prosthesis arms seems devoid of serious per- and post-operative risks and allows restoring continence when SUI is present.