Influence of the external cephalic version attempt on the Cesarean section rate: experience of a type 3 maternity hospital in France.

PURPOSE: To define the effects of attempted external cephalic version (ECV) in a low-risk population for breech delivery in a maternity hospital where breech vaginal delivery is widely practiced. MATERIALS AND METHODS: Retrospective exposed-unexposed study including 204 patients presented with a live singleton fetus breech presentation on third-trimester ultrasound and who delivered at Reims University Hospital between January 1st, 2013 and July 1st, 2018. RESULTS: 121 patients received ECV. Cesarean section rate was lower (OR with no adjustment 0.42 [0.24-0.76] p = 0.004) but without significant difference in the exposed patients after adjustment. This difference was significant between exposed and unexposed patients in the subgroup of 51 primiparous (OR = 0.14 [0.04-0.52] p = 0.002) and 51 multiparous (OR = 0.26 [0.08-0.89] p = 0.028) but not in the subgroup of 102 nulliparous. There was no difference in fetal impact other than neonatal management in the delivery room, which is less needed in exposed primiparous women. Attempted ECV significantly decreased the breech rate (72.5 vs 100%, p < 0.001). There were 7 (5.79%) complications. Three factors favored success: high uterine height (p = 0.011), a non-elevated BMI (p = 0.006) and an earlier term at ECV (p = 0.003). CONCLUSION: The attempt of ECV in the Reims University Hospital does not significantly reduce the Cesarean section rate and has no effect on neonatal status.

Gynecology-obstetric resident surgery training: a national evaluation.

OBJECTIVES: The main objective of this study was to evaluate surgery training and evaluation of French gynecology-obstetrics residents. The second objective was to evaluate using simulation during residency. STUDY DESIGN: This national descriptive study, utilized a questionnaire to survey all interns in French gynecology and obstetrics. At the end of a study, 129 responses of residents were analyzed. RESULTS: The participation rate was 12%. The majority of residents were women (84%) and the highest response rate was from the Ile-de-France region (36%). The lowest rate was from the Southern region. The majority of residents were in the eighth semester (20%). Residents reported surgical and obstetric orientations in 53% (n = 68) and 44% (n = 57) of cases, respectively. Registration for cancer oncology was reported by 22% (n = 28) of respondents. Evaluation of oncologic surgery training was mostly considered "good" by the surgical group and "passable" by the obstetrics group. Access to simulators was usually restricted and most often utilized the pelvitrainer. Sessions were typically not mandatory and numbered between zero and five per semester. Three types of simulators were accessible in the Ile-de-France, North-West, West and Rhône-Alpes. The North-East did not have access to animal models, and the South-West did not have access to corpses. Surgical classes were more common in the Rhône-Alpes, North-East, Ile-de-France and North-West regions. To improve their training in oncological surgery, 64% (n = 18) of residents planned to do an inter-university exchange and 54% had completed additional specialized training. Measures that were most expected to improve training were increased training in surgery (96% of respondents, n = 27) and more intensive coaching (96%, n = 27). CONCLUSIONS: Companionship is a pillar of residents training, but its effectiveness is variable. One solution could be to implement better use of simulation methods.

[Evaluation of enhanced recovery for elective cesarean section]. / Évaluation de la mise en place d'un protocole de réhabilitation précoce postcésarienne.

OBJECTIVE: To evaluate the implementation of a protocol of enhanced recovery for elective cesarean section in a level III maternity. METHODS: This is a prospective observational study such as "before/after" on the implementation of a protocol of enhanced recovery for elective cesarean section from January 1st to December 31st, 2015, in a level III obstetrics unit French maternity. Patients were separated in 2 groups: women who benefit from enhanced recovery protocol after the first of July compared to women who underwent the conventional protocol between January 1st and June 30th, 2015. Inclusion criteria included: performing an emergency or scheduled cesarean, in patients with medical history congruent with the possible hospital release at day three. Demographic and obstetrics data were gathered. Items of the protocol, adverse and secondary effects as well as, postoperative complications were collected. RESULTS: From January 1st to December 31st 2015, 408 patients were included in this study, 202 in the conventional arm protocol and 206 in the enhanced recovery protocol. Early rehabilitation protocol has been achieved for 25.7 % patients (n=105) with 18.1 % (n=19) before the establishment of the protocol and 81.9 % (n=86) after creation of the latter. Prevention of PONV by dexamethasone and droperidol was performed before and after creation of the protocol in 5.3 % (n=1) and 51.2 % of cases (n=44) (P<0.05), respectively. There were no significant differences between the 2 groups regarding the removal of the urinary catheter (94.7 % versus 76 %, P=0.14) or the shutter venous catheter SSPI (78.9 % vs 73 %, P=0.82). Administration of drinks H1 and H4 first meal were routinely performed after the creation of the protocol (52.6 % vs 100 %, P<0.05 and 63.1 % vs 100 %, P<0.05). An early rise in the first 12hours was usually performed after the drafting of the protocol (78.9 % versus 92 %, P<0.05). Average hospital stay was shorter after the establishment of early rehabilitation protocol (4 versus 5.5 days, P<0.05). CONCLUSION: Early rehabilitation protocol was applied safely. It resolved in good management of pain, nausea and vomiting in postoperative. It participated in reducing adverse outcomes that could slow recovery and therefore allowed earlier hospital discharge, while maintaining high level of satisfaction with their care.

[Gastroschisis: Prenatal ultrasonography and obstetrical criteria for predicting neonatal outcome]. / Laparoschisis : facteurs échographiques et obstétricaux prédictifs d'une évolution post-natale défavorable.

OBJECTIVE: Prenatal diagnosis of complex laparoschisis is difficult and yet it is associated with a significantly increased morbidity and mortality. The aim of the study was to define ultrasonographic factor and obstetrical criteria to predicting adverse neonatal outcome. METHODS: Retrospective cohort study over 10 years, of 35 gastroschisis cases in CHU of Reims (France). The primary outcome was the neonatal death due to gastroschisis. The sonographic markers was bowel dilatation intra- or extra-abdominale, amniotic fluid, intra-uterin growth. The obstetrical criteria was fetal vitality, fetal heart rate, type of delivery, the weight and the term of birth. RESULTS: There were 28 live births, 16 children with favorable outcome, 8 children with adverse perinatal outcome and 4 deaths. There were any sonographic criteria to predicting adverse neonatal outcome. Only the birth weight less than 2000g was associated with an increase gastrointestinal complications (P=0.049). The type of the delivery was not associated with an adverse prenatal outcome. CONCLUSION: The birth weight less than 2000g seems to be associate with an increase gastrointestinal complications. It is important to fight against prematurity in case of gastroschisis.

[French residents' training in instrumental deliveries: A national survey]. / Évaluation nationale de la formation des internes de gynécologie-obstétrique à l'accouchement instrumental.

OBJECTIVES: To evaluate French residents in Obstetrics and Gynaecology's training in instrumental deliveries in 2015. PATIENTS AND METHODS: We conducted a national descriptive survey among 758 residents between December 2014 and January 2015. Respondents were invited by email to specify their University Hospital, their current university term, the number of instrumental deliveries performed by vacuum extractor, forceps or spatulas, and whether they made systematic ultrasound exams before performing the extraction. RESULTS: Response rate was 34.7 % (n=263). There were important differences between regions in terms of type of instruments used. Vacuum extractor was the most commonly used instrument for instrumental deliveries by French residents (56.9 %), more than forceps (25.2 %) and spatulas (17.9 %). At the end of the residency, all the residents had been trained in instrumental deliveries with at least two instruments. CONCLUSION: The training of difficult techniques as well as their perfect control is required for instrumental deliveries. Yet, we are forced to note that there are substantial differences in the French residents' training in instrumental deliveries depending on their region. So, teaching at least two techniques seems essential as well as improving the training capacities and standardizing practices. A greater systematization of the teaching of the mechanics and obstetric techniques might be a solution to be considered too.

[Training achieves an internal version and a total breech extraction at birth of second twin]. / Formation à la version par manœuvre interne et à la grande extraction lors de l'accouchement du deuxième jumeau.

OBJECTIVES: To evaluate French residents in obstetrics and gynaecology's training to internal version and breech extraction during vaginal delivery of the second twin. METHODS: A national descriptive survey conducted among 1064 residents between July and October 2014. Respondents were invited by email to specify the type of theoretical and practical training they had received, their university hospital obstetrical practices and the number of vaginal internal version and breech extraction of the second twin they had seen and performed. RESULTS: Response rate was 38.7% (n=412). Regarding the type of theoretical training, 39.8% of residents (n=164) had received the obstetrical mechanics and techniques degree; 47.6% (n=196) had got a teaching during special education classes and 29.4% (n=121) a training on mannequin. There were important differences between regions. At the end of residency, 45.6% of residents (n=36) had practiced more than five vaginal internal version and breech extraction of the second twin. CONCLUSION: Internal version and breech extraction are difficult but essential maneuvers for the management of twin delivery. The French residents in obstetrics and gynaecology's training for these maneuvers seems to be insufficient. It is necessary to improve their teaching, this teaching must also be equivalent between regions.

Efficacy of a new combination of fipronil and permethrin (Effitix®) against Phlebotomus perniciosus in dogs.

Two controlled clinical trials were carried out to assess the anti-feeding and adulticidal effects of a spot-on combining fipronil and permethrin (Effitix(®), Virbac, Carros, France) against Phlebotomus perniciosus in dogs. The first study (Exp. A) was a dose-determination study in which 3 doses of permethrin (30 mg/kg, 60 mg/kg and 120 mg/kg) were compared. The second study (Exp. B) was an efficacy study using commercial dose of permethrin contained in Effitix(®) (the minimum dose of permethrin applied to dogs was 60 mg/kg). Twenty four and twelve Beagle dogs with equal sensitivity to sandflies were included in Exp. A and in Exp. B, respectively. Dogs were challenged with female sandflies (50 per dogs in Exp. A and 80 in Exp. B) for 60±5 min on Days - 7, 1, 7, 14, 21 and 28 (Day 0 being treatment day). Counts and engorgement determination of dead and alive sandflies were performed after each exposure to treated and untreated dogs. Dead sandflies were also counted 24 h after exposure. In Exp. A, the repellency induced by an administration of 30 mg/kg of permethrin to dogs was above 91% for the first two weeks and then dropped to 82.2, 83.1 and 81.1% on Days 14, 21 and 28, respectively. For dogs receiving 60 mg/kg of permethrin, the repellency was a bit higher with 95.8, 97.6, 92.1, 91.4, and 86.8%, for Days 1, 7, 14, 21 and 28, respectively. The repellency induced by 120 mg/kg of permethrin was significantly higher than that induced by 60 mg/kg of permethrin on Day 14 only. In Exp. B the anti-feeding effect of the spot-on formulation was 94.1, 97.8, 96.3, 90.8 and 87% on Days 1, 7, 14, 21 and 28, respectively. The mortality effect was 98.9, 99.1, 99.8, 97.0 and 89.7% on Days 1, 7, 14, 21 and 28, respectively. At each challenge point, the mortality and anti-feeding effects on sandflies were significantly different between control and treatment group (p<0.05). The results indicate that a monthly administration of this new combination of permethrin and fipronil could be used as an effective sandfly control strategy in dogs and therefore recommended for use in an integrated leishmaniosis prevention program.

[Myoma and pregnancy: when medical treatment is not sufficient]. / Fibrome et grossesse: quand le traitement médical ne suffit pas.

The leiomyoma is the most common benign uterine tumor in population of childbearing age women. We report a patient case with uterine myomas threatening the pregnancy continuation and causing a real problem of maternal tolerance. In presence of a 22 cm subserosal fibroma which is responsible of a severe abdominal pain syndrome resistant to level 3 analgesics, the use of surgical treatment was considered, even if current recommendations are for an optimal medical management. Myomectomy by laparotomy has been performed after 13 weeks of gestation.

Therapeutic efficacy of topical hydrocortisone aceponate in experimental flea-allergy dermatitis in dogs.

OBJECTIVE: To evaluate the treatment efficacy of a topical spray containing hydrocortisone aceponate (HCA) on dogs with flea-allergy dermatitis (FAD). DESIGN: A controlled clinical study was conducted on dogs with experimentally induced FAD. Sixteen laboratory beagles with mild to moderate clinical signs were divided into two groups. The test group received HCA by topical spray once daily for 7 days, while the control group did not. Pruritic events (time and frequency) were videotaped and then scored. Clinical signs (erythema, papules, excoriation and alopecia) present on four anatomical regions were monitored and their severity directly assessed. RESULTS: After 2 days, pruritus was reduced by 94% in the treatment group and by 24% in the control group (P = 0.014) in cumulative time, and by 86% versus 34% (P = 0.034) in frequency. The HCA spray also resulted in significant improvements in overall clinical signs: 23% versus 0% in the control group (P = 0.0006) on day 3 and 43% versus 15% in the control group (P = 0.0006) on day 7. During the 7-day trial, no drug-related adverse effects were observed. CONCLUSIONS: Topical treatment with HCA showed a rapid and potent antipruritic effect on dogs with FAD. HCA also demonstrated significant overall therapeutic effects on FAD-associated skin lesions.

[Persistence and recurrence of in situ cervical adenocarcinoma after primary treatment. About 121 cases]. / Persistance et récidive des adénocarcinomes in situ après traitement: à propos d'une série rétrospective multicentrique de 121 cas.

OBJECTIVE: The aim of this study is to assess the results of conservative management of adenocarcinoma in situ (AIS) of the uterine cervix. PATIENTS AND METHODS: Retrospective multicentric study with 121 cases. Patients with cervical invasive lesions were excluded. General characteristics of population, diagnosis circumstances, treatment, histology and evolution were studied. RESULTS: Conservative treatment was performed in 98.3% of cases with 64% of negative margins. In the positive margins group, 80% of conservative treatments were performed by electrosurgical loop. Length of cone resection is significantly higher for conization with negative margins (p<0.001). The rate of residual lesion was 18% in negative margins group and 46% in positive margins group. Two noninvasive and one invasive recurrence were deplored. DISCUSSION AND CONCLUSION: Conservative surgery for patients with AIS could be considered in young patients but several conditions should be respected: careful follow-up after conservative treatment; cold knife conization; length of cone specimen greater than 25 mm and negative margins.

2D arrays device for calcaneus bone transmission: an alternative technological solution using crossed beam forming.

In the context of manned space flight with the European Space Agency, a quantitative ultrasound device for transmission imaging through the calcaneus bone has been developed. It includes two matrix transducers of 576 elements each in order to electronically perform the scanning and the focusing of the 500 kHz ultrasonic beam. This device called the BEAM scanner, provides two parametric images of attenuation (BUA, broadband ultrasonic attenuation) and velocity (SOS, speed of sound) of the investigated skeletal site. The cost and complexity of such a device has motivated the study of an alternative solution, less demanding in terms of technology, based on a crossed beam former [H. Ermert et al., A new concept for a real-time ultrasound transmission camera, in: IEEE Ultrasonics Symposium Proceedings, 2000, pp. 1611-1614]. It consists in forming two perpendicular cylindrically focused planes, one in emission, one in reception, instead of two spherically focused apertures. The crossing line of the two planes replaces the focused beam. The 2D beam forming technological challenge is moved to a 1D simpler and cheaper architecture. In this work the two solutions have been compared for in vivo measurements. Data sets have been acquired using all spatial combinations of emission and reception single elements of the matrix. Then signals have been processed using either the cylindrical or the spherical focussing mode. For cylindrical focussing, the increased level of the side lobes caused severe artefacts. Several apodization techniques have been implemented to reduce these artefacts, resulting in encouraging results. After a brief description of this new ultrasonic method for bone quantitative assessment, several reconstructed images using both processing schemes are presented. Corresponding statistical results obtained in 29 subjects are also provided.

Influence of the adipate and dissolved oxygen concentrations on the beta-lactam production during continuous cultivations of a Penicillium chrysogenum strain expressing the expandase gene from Streptomyces clavuligerus.

The influence of adipate concentration and dissolved oxygen on production of adipoyl-7-aminodeacetoxycephalosporanic acid (ad-7-ADCA) by a recombinant strain of Penicillium chrysogenum expressing the expandase gene from Streptomyces clavuligerus was studied in glucose-limited continuous cultures. Operating conditions were maintained constant but the adipate and dissolved oxygen concentrations (DOC) were varied separately in a range from 1 to 37.5gl(-1) and from 2% to 125% air saturation (%AS), respectively. The total beta-lactams specific productivity, r(ptotal), was not significantly changed for adipate concentrations from 5 to 25gl(-1), but the flux towards an unknown by-product decreased as the adipate concentration increased. Investigations at different DOC showed that r(ptotal) was stable around 18 micro molgDW(-1)h(-1) for DOC being in the range from 15 to 125%AS. When DOC was decreased from 15 to 7%AS, r(ptotal) increased to 25 micro molgDW(-1)h(-1), mainly due to a two-fold increase in the adipoyl-6-aminopenicillanic acid (ad-6-APA) specific productivity.

Genetic characterization of the major lactococcal aromatic aminotransferase and its involvement in conversion of amino acids to aroma compounds.

In lactococci, transamination is the first step of the enzymatic conversion of aromatic and branched-chain amino acids to aroma compounds. In previous work we purified and biochemically characterized the major aromatic aminotransferase (AraT) of a Lactococcus lactis subsp. cremoris strain. Here we characterized the corresponding gene and evaluated the role of AraT in the biosynthesis of amino acids and in the conversion of amino acids to aroma compounds. Amino acid sequence homologies with other aminotransferases showed that the enzyme belongs to a new subclass of the aminotransferase I subfamily gamma; AraT is the best-characterized representative of this new aromatic-amino-acid-specific subclass. We demonstrated that AraT plays a major role in the conversion of aromatic amino acids to aroma compounds, since gene inactivation almost completely prevented the degradation of these amino acids. It is also highly involved in methionine and leucine conversion. AraT also has a major physiological role in the biosynthesis of phenylalanine and tyrosine, since gene inactivation weakly slowed down growth on medium without phenylalanine and highly affected growth on every medium without tyrosine. However, another biosynthesis aromatic aminotransferase is induced in the absence of phenylalanine in the culture medium.