Influence of prenatal urinary incontinence and mode of delivery in postnatal urinary incontinence: A systematic review and meta-analysis.

BACKGROUND: It is likely that the pathophysiology of urinary incontinence (UI) differs between women who are incontinent before the first delivery and those whose incontinence occurs after. In this systematic review, we aimed to assess the association between the mode of delivery and the risk of postpartum UI in primiparous women with and without prenatal UI. METHODS: We searched MEDLINE, Cochrane, Web of Science, Embase and CINHAL databases. Prospective studies including primiparous women during their pregnancy with a comparison of the rate of postpartum UI in women who underwent cesarean delivery or vaginal delivery according to continence status before delivery were included. The Risk Ratio (RR) was calculated with a 95% confidence interval (95% CI) using the total number of events and patients extracted from the individual studies. A subgroup comparison analysed the potential influence of women's prenatal continence status. Heterogeneity was estimated using I² statistics. RESULTS: The risk of postpartum UI was significantly higher after vaginal delivery than after cesarean section (RR 1.80, 95% CI 1.48- 2.18). According to the subgroup test, the postpartum UI risk following a vaginal delivery, compared to cesarean section, was significantly higher in the subgroup of continent women during pregnancy (RR 2.57, 95% CI 2.17-3.04) than in the subgroup of incontinent pregnant women (1.56, 95% CI 1.27-1.92). CONCLUSIONS: The effect of a cesarean section in preventing postpartum UI appears controversial, particularly in women with prenatal UI.

[Induced abortions for maternal indications: Retrospective study in Western Normandy between 2010 and 2019]. / Interruptions médicales de grossesse pour indications maternelles : analyse rétrospective en Normandie Occidentale (2010­2019).

INTRODUCTION: Termination of pregnancy for maternal reasons (MTOP) are authorized in France without limit of term when "the continuation of the pregnancy puts in serious danger the health of the woman". The literature on the subject is rare and we wanted to make an inventory in our region. METHODS: Retrospective observational study between 2010 and 2019 at the multidisciplinary center for prenatal diagnosis in Western Normandy. RESULTS: Thirty-one cases of MTOP were included (2.5% of all TOP). At the CHU de Caen, they represented one in 1200 births. Twenty-three percent of MTOP had a psychosocial or psychiatric indication (average term=22 SA) and 29% an obstetric indication due to severe preeclampsia (23 SA). Finally, 48% were linked to a non-obstetric somatic disorder including 46% pre-existing pathologies (average term=11 SA), most often cardiological or nephrological and 54% diagnosed during pregnancy (17 SA) dominated by neoplasias. They were more often (68%) performed in the second trimester. Vaginal births were more frequent (74% against 26% of endouterine aspirations). CONCLUSION: Strict medical contraindications to pregnancy are exceptional. Recourse to the medical termination of pregnancy within the framework of a preexisting pathology must remain rare, by systematizing of the preconception consultation.

DNA damage induced by Strontium-90 exposure at low concentrations in mesenchymal stromal cells: the functional consequences.

90Sr is one of the radionuclides released after nuclear accidents that can significantly impact human health in the long term. 90Sr accumulates mostly in the bones of exposed populations. Previous research has shown that exposure induces changes in bone physiology both in humans and in mice. We hypothesize that, due to its close location with bone marrow stromal cells (BMSCs), 90Sr could induce functional damage to stromal cells that may explain these biological effects due to chronic exposure to 90Sr. The aim of this work was to verify this hypothesis through the use of an in vitro model of MS5 stromal cell lines exposed to 1 and 10 kBq.mL-1 of 90Sr. Results indicated that a 30-minute exposure to 90Sr induced double strand breaks in DNA, followed by DNA repair, senescence and differentiation. After 7 days of exposure, MS5 cells showed a decreased ability to proliferate, changes in cytokine expression, and changes in their ability to support hematopoietic progenitor proliferation and differentiation. These results demonstrate that chronic exposure to a low concentration of 90Sr can induce functional changes in BMSCs that in turn may explain the health effects observed in following chronic 90Sr exposure.

[Pomalidomide for multiple myeloma]. / Le pomalidomide dans le myélome multiple.

Once characterized by a very poor outcome, multiple myeloma (MM) now has a significantly prolonged survival, with major improvements allowed by the use of "novel agents": proteasome inhibitors (first-in-class bortezomib) and immunomodulatory compounds (IMiDs; first-in-class thalidomide and lenalidomide). However, the vast majority - if not all - of patients with MM ultimately end up being refractory to all existing drugs, including these efficient novel agents. There is a clear unmet medical need in this situation, which warrants the development of the next generation of proteasome inhibitors and IMiDs, as well as new drug classes. This review focuses on pomalidomide, the next generation IMiD, recently approved by the US FDA and the EMA for patients with relapsed or refractory MM who have received at least two prior therapies, including lenalidomide and bortezomib, and have demonstrated disease progression on their last therapy.

Advantages of susceptibility-weighted magnetic resonance sequences in the visualization of intravascular thrombi in acute ischemic stroke.

BACKGROUND: In gradient echo magnetic resonance imaging (MRI), intravascular thrombi (IT) can appear as vascular susceptibility artifacts, linked to local presence of intra-arterial deoxyhaemoglobin, and called susceptibility vessel signs (SVS). AIMS: Our objectives were to evaluate the sensitivity of susceptibility-weighted sequences, such as T2* weighted angiography (SWAN) in the visualization of SVS compared with T2*, to consider whether it enabled a better understanding of the importance of SVS, and to compare cerebral circulation regulation profiles according to the localization of the SVS (i.e. proximal or distal). METHODS: We prospectively studied the clinical and imaging data of 78 consecutive patients admitted for acute cerebral ischemia to the stroke unit of Besançon University Hospital between 1 April 2009 and 31 January 2010. RESULTS: An SVS was visualized in 44/78 (56%) patients using SWAN and in 13/78 (16%) patients using T2*. All the SVS visible using T2* were also visible on the SWAN. The inter-observer kappa score was 0·72 [CI (0·53-0·91)] for T2*, 0·72 [CI (0·57-0·87)] for SWAN, and weighted kappa was 0·77 [CI (0·61-0·92)] for both T2* and SWAN. When an MCA occlusion was visible on MRA imaging (22/78 patients), a SVS was visualized in 7/22 cases (31·8%) using T2* and in 20/22 cases (91%) using SWAN. When the occlusion was visible in the M1 or M2 segments (17/78 patients), an SVS was visualized in 6/17 cases (35·3%) using T2* and in 15/17 cases (88·2%) using SWAN. When the occlusion was visible in the M3 segment (5/78 patients), an SVS was visualized in 1/5 cases (20%) using T2* and in 5/5 cases (100%) using SWAN. Presence of SVS was not associated with cardioembolic etiology of the stroke. CONCLUSIONS: SWAN was more sensitive than T2* in the visualization of SVS in the intracranial arteries during the acute phase of ischemic stroke. Our study shows that the low number of SVS visualized using T2* in previous studies is probably related to a lack of sensitivity of the sequence, rather than to the nature or age of the thrombus. The greater sensitivity of SWAN seems to be linked to the visualization of SVS in cases of small thrombi.

Cephalic morphological variation in freshwater silversides Odontesthes hatcheri and Odontesthes bonariensis in Patagonia: introgression and ecological relationships.

Based on geometric morphometrics and discriminant analysis, the percentage of silverside Odontesthes hatcheri and Odontesthes bonariensis individuals identified by a taxonomic key and misclassified by discriminant analysis was obtained and a negative correlation between the percentage of misclassified individuals of O. hatcheri and the distance to the nearest hatchery stocking silversides was found, suggesting a genetic introgression. Morphological analyses between species, between populations and within populations pointed to the same anatomical structures, suggesting a nested variation related to environmental cues such as availability of littoral shelter. The dependence between the cephalic morphology of O. hatcheri and body size would be in agreement with the trophic niche shifts of the species. Introgression adds a new threat to the already observed decline of populations of O. hatcheri and suggests that this species deserves particular consideration in terms of conservation guidelines.

A biologically inspired meta-control navigation system for the Psikharpax rat robot.

A biologically inspired navigation system for the mobile rat-like robot named Psikharpax is presented, allowing for self-localization and autonomous navigation in an initially unknown environment. The ability of parts of the model (e.g. the strategy selection mechanism) to reproduce rat behavioral data in various maze tasks has been validated before in simulations. But the capacity of the model to work on a real robot platform had not been tested. This paper presents our work on the implementation on the Psikharpax robot of two independent navigation strategies (a place-based planning strategy and a cue-guided taxon strategy) and a strategy selection meta-controller. We show how our robot can memorize which was the optimal strategy in each situation, by means of a reinforcement learning algorithm. Moreover, a context detector enables the controller to quickly adapt to changes in the environment-recognized as new contexts-and to restore previously acquired strategy preferences when a previously experienced context is recognized. This produces adaptivity closer to rat behavioral performance and constitutes a computational proposition of the role of the rat prefrontal cortex in strategy shifting. Moreover, such a brain-inspired meta-controller may provide an advancement for learning architectures in robotics.

Contamination of woody habitat soils around a former lead smelter in the North of France.

The contamination of the topsoil of 262 woody habitats around a former lead smelter in the North of France was assessed. In this urbanized and industrialized area, these kinds of habitats comprise of hedges, groves, small woods, anthropogenic creations and one large forest. Except for the latter, which is 3 km away, these woody habitat soils often present a high anthropization degree (a significant amount of pebbles and stones related to human activities) with a high metal contamination. In the studied woody habitat topsoils, Cd, Pb and Zn concentrations largely exceeded those of agricultural topsoils located in the same environmental context. Therefore, atmospheric emissions from the smelter are not the only cause of the high contamination of the woody habitat soils. This last one is related to the nature and the contamination level of deposit in relation with human activities (rubbles, slag, soils, etc). With regard to the results obtained with chemical extractions, the mobility of Cd, Pb and Zn in these soils is also greater than in agricultural soils. In the forest, pollutant solubility is increased by soil acidic pH. The variability of the physico-chemical parameters and the high metal contamination of the topsoils are the main characteristics of the woody habitats located around the former smelter. Although never taken into account during risk assessment, the disturbance of these environmental components could have important biogeochemical impacts (nutrients and metal cycles). Moreover, any modification of the soils' use could potentially cause mobilization and transfer of the pollutants to the biosphere. Six years after the closure of the smelter, and as social and economic pressures considerably increase in this area, the study of these peculiar ecosystems is necessary to understand and predict the bioavailability, transfer, bioaccumulation and effects of pollutants in food chains.

Solving XOR.

Three experiments examined the way in which exclusive-or (XOR) problems are solved by rats. All rats first received food-rewarded positive and negative patterning problems with two stimulus sets: either A+, B+, AB- and C-, D-, CD+, or A-, B-, AB + and C+, D +, and CD-. Subsequently, rats received revaluation trials in which A was paired with shock and C was not, prior to generalization test trials with B, D, AB, and CD (Experiments 1 & 2); or received A-->shock trials prior to tests with B and CD (Experiment 3). There was greater generalized fear to B than to either D (Experiments 1 & 2) or AB (Experiment 2) and CD (Experiments 2 & 3). These results are inconsistent with configural, connectionist models, but are consistent with an alternative connectionist model that can represent the logical structure of XOR problems.

The role of similarity in human associative learning.

In 2 experiments, humans received sequences of patterns that were similar (AX-->BX, AY-->BY, AZ-->BZ) or dissimilar (CX-->DY, CY-->DZ, CZ-->DX). The patterns were portrayed as bugs that could be eliminated with 2 insecticide sprays (red or blue). Either spray eliminated bugs with Features A and C, and participants learned by trial and error to use one spray (e.g., red) to eliminate bugs with Feature B and the other spray (e.g., blue) to eliminate those with Feature D. In Experiment 1, participants' spray choice for bugs with Feature A came to match that used to eliminate bugs with Feature B, but there was no such associative transfer between Features C and D. That is, similarity promoted associative transfer of responding between paired patterns when the features used to manipulate similarity (i.e., X, Y, and Z) were irrelevant. In Experiment 2, in which X, Y, and Z were relevant to the solution of configural discrimination, similarity hindered such associative transfer. These results complement those found in pigeons (R. A. Rescorla & D. J. Gillan, 1980) and indicate that similarity should not be accorded independent status as a principle of associative learning.

11 Beta-hydroxysteroid dehydrogenase type 1 is induced in human monocytes upon differentiation to macrophages.

11beta-hydroxysteroid dehydrogenases (11beta-HSD) perform prereceptor metabolism of glucocorticoids through interconversion of the active glucocorticoid, cortisol, with inactive cortisone. Although the immunosuppressive and anti-inflammatory activities of glucocorticoids are well documented, the expression of 11beta-HSD enzymes in immune cells is not well understood. Here we demonstrate that 11beta-HSD1, which converts cortisone to cortisol, is expressed only upon differentiation of human monocytes to macrophages. 11beta-HSD1 expression is concomitant with the emergence of peroxisome proliferator activating receptor gamma, which was used as a surrogate marker of monocyte differentiation. The type 2 enzyme, 11beta-HSD2, which converts cortisol to cortisone, was not detectable in either monocytes or cultured macrophages. Incubation of monocytes with IL-4 or IL-13 induced 11beta-HSD1 activity by up to 10-fold. IFN-gamma, a known functional antagonist of IL-4 and IL-13, suppressed the induction of 11beta-HSD1 by these cytokines. THP-1 cells, a human macrophage-like cell line, expressed 11beta-HSD1 and low levels of 11beta-HSD2. The expression of 11beta-HSD1 in these cells is up-regulated 4-fold by LPS. In summary, we have shown strong expression of 11beta-HSD1 in cultured human macrophages and THP-1 cells. The presence of the enzyme in these cells suggests that it may play a role in regulating the immune function of these cells.

Activation of peroxisome proliferator-activated receptor gamma does not inhibit IL-6 or TNF-alpha responses of macrophages to lipopolysaccharide in vitro or in vivo.

We have investigated the potential use of peroxisome proliferator-activated receptor gamma (PPARgamma) agonists as anti-inflammatory agents in cell-based assays and in a mouse model of endotoxemia. Human peripheral blood monocytes were treated with LPS or PMA and a variety of PPARgamma agonists. Although 15-deoxy-Delta12,14-prostaglandin J2 (15d-PGJ2) at micromolar concentrations significantly inhibited the production of TNF-alpha and IL-6, four other high affinity PPARgamma ligands failed to affect cytokine production. Similar results were obtained when the monocytes were allowed to differentiate in culture into macrophages that expressed significantly higher levels of PPARgamma or when the murine macrophage cell line RAW 264.7 was used. Furthermore, saturating concentrations of a potent PPARgamma ligand not only failed to block cytokine production, but also were unable to block the inhibitory activity of 15d-PGJ2. Thus, activation of PPARgamma does not appear to inhibit the production of cytokines by either monocytes or macrophages, and the inhibitory effect observed with 15d-PGJ2 is most likely mediated by a PPARgamma-independent mechanism. To examine the anti-inflammatory activity of PPARgamma agonists in vivo, db/db mice were treated with a potent thiazolidinedione that lowered their elevated blood glucose and triglyceride levels as expected. When thiazolidinedione-treated mice were challenged with LPS, they displayed no suppression of cytokine production. Rather, their blood levels of TNF-alpha and IL-6 were elevated beyond the levels observed in control db/db mice challenged with LPS. Comparable results were obtained with the corresponding lean mice. Our data suggest that compounds capable of activating PPARgamma in leukocytes will not be useful for the treatment of acute inflammation.

A valid ELISPOT assay for enumeration of ex vivo, antigen-specific, IFNgamma-producing T cells.

We describe an ELISPOT technique for the detection of antigen specific IFNgamma-producing T cells. The technique is performed on spleen cells plated directly ex vivo into ELISPOT trays without an in vitro pre-culture step. Thus, the assay is likely to reflect the in vivo activity of the cells. We have found that very high cell densities (at least 10(6) cells/well) are required for optimal detection of spot forming cells, and only at a high density of cells is the number of spots detected linearly related to the number of primed cells plated. If lower numbers of antigen primed cells are used, then unprimed spleen cells from syngeneic mice can be added to the well to increase the cell density. Under these conditions, we find that the number of spots is linearly proportional to the number of primed cells plated, even if these are well below a million cells/well. Experiments with MHC congenic mice indicate that the high density of spleen cells required to obtain optimal spot formation reflects a requirement for an MHC restricted function, probably efficient antigen presentation to T cells. The formation of IFNgamma spots is antigen dependent and abrogated by depleting the antigen primed cells of T cells. We conclude that this linear assay can be used to efficiently detect ex vivo antigen-specific IFNgamma-producing T cells.

Characterisation of the cytotoxic alloresponse of cord blood.

As compared to bone marrow, transplantation with cord blood (CB) is associated with a lower risk of GVHD. Although some cases of GVHD III have been reported, usually the grade of GVHD remains low, even when donor and recipient are not fully HLA matched. To investigate whether this is due to an intrinsic property of CB T cells, we studied the conditions under which CB CD8+ cells would be able to generate an alloresponse. In addition, we measured the cytokines secreted by the alloreactive cytotoxic T lymphocyte (CTL) clones generated. We show that: (1) the capacity of CB cells to generate alloreactive CTLs in vitro is diminished as compared to adult cells (AB); (2) in the presence of exogenous IL-2, CB cells do generate a normal alloreactive response; (3) although CB-derived CD8+ allospecific clones showed the same T1/T0 cytokine profile as the clones from AB, they secreted a lower amount of IFN-gamma; and (4) in addition, cloned CD4+ CB cells are mainly T2/T0 type, whereas AB CD4+ T cells were mainly of T1/T0 type. These data suggest that the reduced GVHD observed after transplantation with CB might be the result of the naiveness of CB T cells. After allostimulation, CB cytotoxic T cells differ from AB T cells by a higher activation threshold, a lower secretion of IFN-gamma by both CD4+ and CD8+ CB cells and their bias towards a T2 type CD4 response.

[French language pharmaceutical publications in 1995. I. Assessment and analysis of French language pharmaceutical periodicals]. / La presse pharmaceutique francophone en 1995. I. Recensement et anlyse des Péruiduqes pharmaceutique francophones.

Periodicals constitute a vital source of information and an invaluable continuing education medium to pharmacists. The aim of the present study was to compile the list of the 83 pharmacy-related periodicals published in French as at 1995 with a view to establishing their main characteristics. The first part focuses on the definition of the concept of "French language pharmaceutical periodicals" selected for the survey needed a) to be in circulation in 1995 and published at least two times a year, b) published by pharmacists or non-pharmacists but must carry articles intended to help, inform, or retrain pharmacists irrespective of their specialties (community, hospital, biological or industrial pharmacy) as well as their closest collaborators (assistants, technicians, etc.) and c) published in French. The second section presents the methodology of the survey, which consisted essentially in consulting publisher and library catalogs and direct interviews with embassies and Pharmacy Associations in French-speaking countries. Questionnaires were also sent out to editors of periodicals and the information gathered was analysed by computer. The following section reproduces the results of the the survey: These were classified into three categories: scientific, professional, and continuing education periodicals. The last section concentrates on their readership (national, international), frequency, modalities of publication, date of creation, indexing in bibliographic databases.

Magnetic resonance angiography of intravascular endoprostheses: investigation of three devices.

PURPOSE: To assess the value of magnetic resonance angiography (MRA) in the evaluation of vascular patency after intravascular endoprosthesis placement. METHODS: Three different metallic stents (Wallstent, Strecker, Palmaz) were studied in vitro, and in vivo in six patients with spin-echo (SE) and gradient-echo (GRE) MR imaging. Time-of-flight, two-dimensional (2D) gadolinium-enhanced MRA was performed with GRE and flow-compensation technique, and reconstructed with a maximum-intensity projection (MIP) algorithm. MRA was compared to digital angiograms. RESULTS: In vitro studies demonstrated that the signal intensity (SI) within the stent differed according to the device employed, the lowest SI being observed within the Palmaz stent (p = .001). There was no difference in SI or apparent diameter of the stent according to the sequence (SE vs GRE) or length of echo time (TE). In patients, the endoprostheses recorded as a well-defined area of signal void or drop-out (p = 0.004), whereas vessels above and below the stent displayed high signal intensities. CONCLUSION: MRA does not seem as yet to be well suited for evaluating vascular patency after endoprosthesis placement, even if the Strecker and Wallstent endoprostheses provide fewer artifacts than the Palmaz stent.

[Tuberculous lymphadenopathy revealed by polyneuropathy. Causal relation or simple coincidence?]. / Tuberculose ganglionnaire révélée par une polyneuropathie. Relation causale ou simple coïncidence?

We report a case of cervical and mediastinal lymphadenopathy revealed by a sensory-motor polyneuropathy of the lower limbs. A search for a cause was unsuccessful; the improvement following antituberculous treatment posed a question as to whether the polyneuropathy was tuberculous in origin or simply a coincidence.