IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study.

STUDY QUESTION: How does a history of dramatic weight loss linked to bariatric surgery impact IVF outcomes? SUMMARY ANSWER: Women with a history of bariatric surgery who had undergone IVF had a comparable cumulative live birth rate (CLBR) to non-operated patients of the same BMI after the first IVF cycle. WHAT IS KNOWN ALREADY: In the current context of increasing prevalence of obesity in women of reproductive age, weight loss induced by bariatric surgery has been shown to improve spontaneous fertility in obese women. However, little is known on the clinical benefit of bariatric surgery in obese infertile women undergoing IVF. STUDY DESIGN, SIZE, DURATION: This exploratory retrospective multicenter cohort study was conducted in 10 287 IVF/ICSI cycles performed between 2012 and 2016. We compared the outcome of the first IVF cycle in women with a history of bariatric surgery to two age-matched groups composed of non-operated women matched on the post-operative BMI of cases, and non-operated severely obese women. PARTICIPANTS/MATERIALS, SETTING, METHODS: The three exposure groups of age-matched women undergoing their first IVF cycle were compared: Group 1: 83 women with a history of bariatric surgery (exposure, mean BMI 28.9 kg/m2); Group 2: 166 non-operated women (non-exposed to bariatric surgery, mean BMI = 28.8 kg/m2) with a similar BMI to Group 1 at the time of IVF treatment; and Group 3: 83 non-operated severely obese women (non-exposed to bariatric surgery, mean BMI = 37.7 kg/m2). The main outcome measure was the CLBR. Secondary outcomes were the number of mature oocytes retrieved and embryos obtained, implantation and miscarriage rates, live birth rate per transfer as well as birthweight. MAIN RESULTS AND THE ROLE OF CHANCE: No significant difference in CLBR between the operated Group 1 patients and the two non-operated Groups 2 and 3 was observed (22.9%, 25.9%, and 12.0%, in Groups 1, 2 and 3, respectively). No significant difference in average number of mature oocytes and embryos obtained was observed among the three groups. The implantation rates were not different between Groups 1 and 2 (13.8% versus 13.7%), and although lower (6.9%) in obese women of Group 3, this difference was not statistically significant. Miscarriage rates in Groups 1, 2 and 3 were 38.7%, 35.8% and 56.5%, respectively (P = 0.256). Live birth rate per transfer in obese patients was significantly lower compared to the other two groups (20%, 18%, 9.3%, respectively, in Groups 1, 2 and 3, P = 0.0167). Multivariate analysis revealed that a 1-unit lower BMI increased the chances of live birth by 9%. In operated women, a significantly smaller weight for gestational age was observed in newborns of Group 1 compared to Group 3 (P = 0.04). LIMITATIONS, REASONS FOR CAUTION: This study was conducted in France and nearly all patients were Caucasian, questioning the generalizability of the results in other countries and ethnicities. Moreover, 950 women per group would be needed to achieve a properly powered study in order to detect a significant improvement in live birth rate after bariatric surgery as compared to infertile obese women. WIDER IMPLICATIONS OF THE FINDINGS: These data fuel the debate on the importance of pluridisciplinary care of infertile obese women, and advocate for further discussion on whether bariatric surgery should be proposed in severely obese infertile women before IVF. However, in light of the present results, infertile women with a history of bariatric surgery can be reassured that surgery-induced dramatic weight loss has no significant impact on IVF prognosis. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by unrestricted grants from FINOX-Gédéon Richter and FERRING Pharmaceuticals awarded to the ART center of the Clinique Mathilde to fund the data collection and the statistical analysis. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: NCT02884258.

Hydrosurgery as a safe and efficient debridement method in a clinical wound unit.

OBJECTIVE: Hydrosurgical debridement allows removal of non-viable tissue, preserving healthy tissues. This study was designed to analyse whether hydrosurgery, used in a clinical wounds unit, is an effective and safe method that may reduce debridement time. METHODS: Patients' wounds had the following characteristics: wounds with devitalised tissue needing rapid debridement, wounds with cavities, or non-healing wounds. Hydrosurgical debridement uses a pressurised stream of saline (0.9% sodium chloride) and a vacuum around this stream to remove the devitalised tissue of the wound, preserving healthy surrounding tissues. RESULTS: This prospective study comprised of 53 wounds from 39 patients. The wound aetiology included 39.7% arterial insufficiency, 22.6% pressure ulcers (PUs), 15.1% diabetic foot ulcers (DFUs), 9.4% venous leg ulcers (VLUs), and 13.2% from other aetiologies. The percentage of wounds according the size was the following: 32.1% (<10cm2), 43.4% (10-49cm2), 15.1% (50-99cm2), and 9.4% (≥100cm2). Superficial wounds were 43.4% of the total and 56.6% of wounds had cavities. Pain associated with the hydrosurgery was mild to moderate. There were no hydrosurgery-related adverse events. For effective debridement, the required sessions were as follows: one procedure (73.6%), two procedures (18.9%) and three procedures (7.5%). There was a statistical significant direct correlation (r=0.307) between the number of required sessions and wound size. All patients improved in a week (>80% of granulation tissue). CONCLUSION: We demonstrate that hydrosurgery is an effective and rapid debridement method that can be used safely in the outpatient setting.

Factores ambientales relacionados con la duración de la lactancia: estudio de seguimiento a 1 año / Environmental factors related with breastfeeding duration: a one year follow-up study

Objetivo: Estudiar los factores protectores y de riesgo relacionados con la duración de la lactancia materna completa (LMC) y total (LMT) en la Región de Murcia. Material y métodos: Estudio de seguimiento desde el nacimiento hasta el año de vida de 327 recién nacidos y sus familias entre 2009 y 2010. Estudio descriptivo, de supervivencia de la lactancia y regresión de Cox. Resultados: La duración media de la LMC fue de 82 días y la prevalencia a los 6 meses del 15%. La prevalencia de la LMT a los 12 meses fue del 20%. El riesgo relativo (RR) para la LMC a los 6 meses variaba según las diferentes situaciones: madre fumadora (1,79; intervalo de confianza [IC] del 95%: 1,35-2,38), ausencia de «contacto precoz» (1,18; IC del 95%: 1,08-1,28), ingesta de alcohol -al menos una bebida/semana- (1,57; IC del 95%: 1,12-2,21), arrastrar trazas de tóxicos del trabajo a casa -en ropa o zapatos- durante el embarazo (1,43; IC del 95%:1,10-1,87), estudios maternos universitarios (0,48; IC del 95%: 0,33-0,70) y duración de la baja maternal (días) (0,99, IC del 95%: 0,98-0,99). El RR para la LMT a los 12 meses también difería según el tabaquismo materno (cigarros/semana) (1,01; IC del 95%: 1,01-1,02), la duración de las experiencias previas de lactancia materna (semanas) (0,98; IC del 95%: 0,97-0,99) y el tiempo de baja maternal (días) (0,99; IC del 95%: 0,98-0,99). Conclusiones: Los programas enfocados a conseguir una lactancia materna prolongada deberían contemplar un abordaje integral que ayude a crear ambientes más saludables desde la etapa periconcepcional, que incluya eliminar la exposición a drogas legales e ilegales, disminuir la contaminación química del trabajo hacia el hogar, fortalecer el contacto precoz en el paritorio, dedicar más recursos a las mujeres con menos estudios y contemplar mecanismos legales que prolonguen la baja por maternidad (AU)

Objective: To study the risk and protective factors related for the length of breastfeeding and full breastfeeding (FB) in the Region of Murcia, Spain. Methods: Follow-up study from birth until the first year of 327 newborns and their families between 2009 and 2010. We present the descriptive study, survival analysis of breastfeeding and Cox regression model. Results: The median duration of FB was 82 days and 6 months with a prevalence of 15%. The prevalence of breastfeeding at 12 months was 20%. Relative risk (RR) for FB at 6 months: mother smoking (1.79; 95%CI: 1.35-2.38), absence of 'early skin-to-skin contact' -after the first hour- (1.18; 95%CI: 1.08-1.28), alcohol intake (at least one drink/week) (1.57; 95%CI: 1.12-2.21), take-homes exposures (chemicals from the work can come home on clothing and shoes) during pregnancy (1.43; 95%CI: 1.10-1.87), maternal university studies (0.48; 95%CI: 0.33-0.70) and maternity leave length (days) (0.99; 95%CI: 0.98-0.99). The RR for breastfeeding at 12 months: maternal smoking (cigarettes/wk) (1.01; 95%CI: 1.01-1.02), duration of previous breastfeeding experiences (weeks) (0.98; 95%CI: 0.97-0.99) and maternity leave length (days) (0.99; 95%CI: 0.98-0.99). Conclusions: A comprehensive approach that helps create healthier environments from the periconcepcional stage must be considered in the development of programs focused on achieving sustained breastfeeding. Factors to consider in program development include: the elimination of exposure to legal and illegal drugs, reduction of take-homes (para-occupational) exposures, expedite early mother-newborn contact in the delivery room, devote more resources to less educated women, and contemplate legal reforms to extend maternity leave (AU)

Magnetic resonance colonography in severe attacks of ulcerative colitis.

OBJECTIVES: To evaluate the ability of MR colonography (MRC) to detect lesions in severe attacks of ulcerative colitis (UC) and to assess its concordance with rectosigmoidoscopy. METHODS: Eighteen patients underwent MRC and rectosigmoidoscopy. MRC consisted of a water-filled colonic procedure followed by T1/T2w images. Image quality was recorded. Inflammatory lesions and the existence of signs of severity were analysed. We calculated MR accuracy in the diagnosis of inflammatory lesions, as well as per segment and per patient concordance depending on the presence or absence of severe lesions. RESULTS: The MR image quality of the 108 segments was satisfactory. Endoscopy was used to study 36 segments (rectum and sigmoid). MRC had a positive predictive value of 100% and a sensitivity of 64% in the diagnosis of inflammatory lesions. Concordance for the diagnosis of severe lesions was excellent for the rectum (k = 0.85) and good for the sigmoid (k = 0.64). MRC diagnosed signs of severity in all patients affected at endoscopy. MRC also disclosed signs of severity located higher in the colon in four patients with nonsevere lesions at rectosigmoidoscopy. CONCLUSIONS: MRC can accurately diagnose inflammatory lesions in severe attacks of UC and significantly correlates with rectosigmoidoscopy in the diagnosis of severe lesions.

[Imaging evaluation of renal function: principles and limitations]. / Mesure de la performance rénale en imagerie: principes et limites.

The kidney performs multiple functions. Glomerular filtration is the most studied of these functions. In clinical practice, the surgical indication for patients with unilateral uropathy is frequently based on the split renal function as demonstrated by scintigraphy. MRI is not yet validated as a technique but nonetheless offers an interesting non-radiating alternative to achieve both morphological and functional renal evaluation. Recent pulse sequences such as diffusion, arterial spin labeling, and blood oxygenation dependent imaging may also provide additional information. CT and US remain of limited value for the evaluation of renal function.

[Laser assisted hatching: Rouen University Hospital outcomes]. / Eclosion embryonnaire assistée: évaluation des indications au CHU de Rouen.

OBJECTIVE: Despite technical progress in In Vitro Fertilisation (IVF) procedure, embryo implantation rate remains low. Assisted hatching has been proposed to facilitate natural embryo hatching and implantation. PATIENTS AND METHODS: Our study has evaluated whether laser assisted hatching improves implantation, pregnancy and live birth rates in different cases. We studied retrospectively 143 IVF cycles concerning more than 38 years old women, 166 IVF cycles after two previous implantation failures and 180 frozen-thawed embryo transfers. RESULTS: Population characteristics were comparable in hatched and control groups. Implantation, pregnancy and live birth rates in women more than 38 years old were comparable with or without assisted hatching. Concerning repeated implantation failures, even if implantation, pregnancy and live birth rates were higher in assisted hatching group (FIV or ICSI), the differences were not significant. After frozen-thawed embryo transfers, implantation rate was significantly better with assisted hatching (19.14% vs 8.84% [p=0.02]). DISCUSSION AND CONCLUSION: Assisted hatching improves embryo implantation rate after frozen-thawed embryo transfer.

Detección de cianobacterias y sus toxinas. Una revisión / Cyanobacteria and toxins detection. A review

La creciente eutrofización de los ambientes acuáticos favorece el crecimiento masivo (blooms) de algas, y poblaciones de cianobacterias, capaces de producir potentes toxinas con graves repercusiones en la salud públicas y en la sanidad animal. Más del 50 por ciento de las proliferaciones masivas de cianobacterias son tóxicas. Dentro de una misma especie de cianobacteria, existen cepas que producen toxinas y otras que no las producen. Se hace necesario disponer de métodos que permitan detectar y cuantificar cianobacterias y sus toxinas. Los tradicionales bioensayos en ratón para conocer la toxicidad de una muestra sospechosa, se van sustituyendo por otros bioensayos y diversos métodos in vitro que están demostrando ser eficaces. El avance experimentado en las técnicas inmunológicas y enzimáticas ha facilitado la detección rápida de toxinas mediante el empleo de kits comerciales y no comerciales. Uno de los campos más prometedores de investigación, consiste en la determinación de las secuencias genéticas que diferencian géneros incluso cepas tóxicas, así como otras que codifican para la síntesis de toxinas; métodos que permitirán prever el desarrollo de cianobacterias o sus toxinas. El control y seguimiento de los desarrollos masivos de cianobacterias, es muy importante para gatantizar la calidad del agua. El reconocimiento de los factores ambientales que influyen o desencadenan la aparición de blooms, es otro factor fundamental para la prevención y el control (AU)

Hypertension and combinations of cardiovascular risk factors. An epidemiologic case-control study in an adult population in Guadeloupe (FWI).

Our aim was to quantify the association between hypertension and four well-known cardiovascular risk factors (obesity, dyslipidemia, high blood glucose, smoking) and to determine the extent of their combinations in hypertensive subjects in an adult population in Guadeloupe (FWI). A case-control study was conducted in 1999. Odds ratios (ORs) and 95% confidence interval (95% CI) of hypertension according to cardiovascular risk factors were calculated by a logistic regression model. In all, 4210 subjects were included in the study: 2105 hypertensives and 2105 age and sex matched non-hypertensive controls. In the hypertensives, obesity (30%) was the most frequent risk factor followed by dyslipidemia (23.2%), current smoking (11.5%) and high blood glucose (8.2%). But, prevalence of current smokers was higher in normotensives (13.9 vs. 11.5%, p < 0.01). Among cases, 44.5% had no risk factor other than hypertension. The proportion of subjects with multiple risks factors (< or = 2) was higher in hypertensives than in controls (55.5 vs. 6.5%,p < 0.001) and higher in women than in men in cases (58.1 vs. 51.8%, p = 0.005). The adjusted ORs (95% CI) of hypertension were 2.41 (2.02-2.88) for obesity, 1.39 (1.16-1.66) for dyslipidemia and 1.67 (1.20-2.32) for high blood glucose. Our study documents the high prevalence of combinations of cardiovascular risk factors in hypertensive subjects in Guadeloupe and confirms the need of a global risk approach in prevention and treatment of hypertension.

Ecotoxicological evaluation of pig slurry.

Swine sewage could be source of nutrients and pollutants. This work estimates the environmental risk in nine samples from different farm treatment systems based on the evaluation of their effects in Daphnia magna acute test, and on the assessment of Cu, Zn and ammonia as main contributors. NH3 and Cu were responsible for LC50 results (1-5% of dilution). Organic compounds were quantified through several extraction methods (SPMDs, SPE and solvent extraction). A more exhaustive extraction was performed in an additional sample, which showed indole and phenol recoveries much higher than the previous ones. This method also includes PCBs (430 ppb) and fatty acids (approximately =150 ppm) quantification.

Ensayo de ecotoxicidad miniaturizado en Chlorella vulgaris utilizando diferentes parámetros de expresión / Miniaturized ecotoxicity assay with Chlorella vulgaris using differents endpoints

La exigencia actual de valoraciones medioambientales, requiere la utilización de métodos con relación coste/beneficio adecuado. En este trabajo presentamos el desarrollo y utilización de la Fluorescencia como medida de la inhibición del crecimiento, utilizando un monocultivo de Chlorella vulgaris var. Viridis. Se estimó las CI50 48 h de los siguientes compuestos: Glifosato, Amitrol, paraquat, Sulfato de Cobre, 3,4-Dicloroanilina y Cloruro de Cadmio, utilizando la Fluorescencia, la Densidad Celular y la Absorbancia, como parámetros de expresión. Los resultados aportan información sobre efectos fitotóxicos para los herbicidas Glifosato, Amitrol y Paraquat, con CI50 48 h de 100,85, 13, 82 y 0,04 mg/mL respectivamente, que ofrecen CI50 48 h en el mismo orden de magnitud, en cada uno de los compuestos ensayados para Densidad Celular, Absorbancia y Fluorescencia. Se discuten las ventajas que la Fluorescencia tendría frente a los otros parámetros de expresión, en ensayos de ecotoxicidad (AU)

GAPO syndrome: a new case of this rare syndrome and a review of the relative importance of different phenotypic features in diagnosis.

The case of GAPO syndrome reported here is the 24th recorded case, 23 cases having been published previously. The 29-year-old male under discussion presents all the typical features of the syndrome, having short stature, dysmorphic craniofacial features, total alopecia and pseudoanodontia. Orally, the erupted primary dentition was extremely worn and on radiographic examination, the second mandibular molars were found to be unerupted, together with the entire permanent dentition. Cephalometry revealed the absence of facial pneumatisation, a deficient cranial base with diminished upper face height and maxillary and mandibular hypoplasia with a prognathic skeletal pattern. Histological examination of an extracted primary incisor and its surrounding root bone revealed extensive ankylosis. This paper describes in detail the clinical findings and reviews, and discusses previously published cases in relation to the present one. As with prior cases, parental consanguinity was present in the pedigree.

[Predictive factors of drug prescription: profile of the overprescribing physician]. / Factores predictivos de la prescripción farmacéutica: perfil del médico hiperprescriptor.

Because of increasing pharmaceutical costs, several programs aimed at optimizing physician's prescription have been set up in the last years. However, factors determining prescription volume are not well known yet. The aim of study is to determine which the characteristics of the practitioner (GP) or the working place are related with a higher amount of drug prescription. With data obtained from PE-29, PE-20, and the managing center Human Resources Department databases, concerning the whole GP staff (N = 293), via a multiple regression model, we were able to determine the following factors predicting higher prescription:rural work place, longer distance to reference specialty center, care to children, lack of postgraduate education, short term work contract, and part time staff.

Risk stratification for dissemination of tuberculosis in HIV-infected patients.

The location of tuberculosis (TB) early in the course of HIV-induced immunosuppression was located, and an attempt was made to determine the correlation between the degree of immune suppression and prognostic variables to stratify the risk for dissemination of TB in HIV-infected patients. Clinical and laboratory characteristics were reviewed in 73 HIV-infected patients with TB admitted between 1984 and 1990. The presence of Mycobacterium tuberculosis was investigated in different clinical samples to verify the diagnostic yield of different sources. TB was extrapulmonary in 46.6 per cent of patients in whom it was their first opportunistic infection, and in 46.7 per cent of patients with previously diagnosed AIDS (p = NS). TB was frequently associated with other opportunistic infections, particularly oesophageal candidiasis (p = 0.006). Patients with localized extrapulmonary or disseminated TB presented more often with cytopenias, hypoalbuminaemia and oral thrush. The existence of extrapulmonary TB or another opportunistic coinfection allowed AIDS to be diagnosed in the same admission in 30 patients and a mean of 8.4 months later in another eight. Extrapulmonary TB was found to be as common in early HIV infection as in patients with established AIDS. Haematological derangements were common in these patients, and cytopenias, hypoalbuminaemia and oral thrush were useful predictors of TB dissemination. The location of TB and its dissemination were not significantly linked to a more advanced CDC stage of HIV infection or a more profound fall in CD4 count.(ABSTRACT TRUNCATED AT 250 WORDS)

[Progress in the early diagnosis of cancer of the colon and rectum]. / Progresos en el diagnóstico precoz del cáncer de colon y recto.

Our experience with the air contrast examination in the cancer of colon and rectum diagnoses is showed. The colaboration among radiologist, endoscopist, pathologist and surgeon is important. In the large bowel tumors diagnosis, the radiologic and endoscopic prodedures should be evaluated together. The double colonic contrast has showed in our experience, better results than with the barium enema. Over 31 patients with both studies, we obtained 13 false negatives (with barium enema, doing then the double colonic contrast became positive 12 (92.4%).

[Cimetidine in the treatment of the active duodenal ulcer]. / Cimetidina en el tratamiento de la úlcera duodenal activa.

Thirty six patients with active duodenal ulcers were studied in this double blind work. 19 received placebo and 17 Cimetidine: 1 gr./day. The endoscopic control after 21 days, showed healing in 81,2% of the cases treated with Cimetidine and in 22,2% of those with placebo. After 42 days of continous treatment with Cimetidine the healing of duodenal ulcers was 82,3% against 50% with placebo; the difference being highly statestically significant; p less than 0.01. The symptoms improved with Cimetidine revealing less diurnal and nocturnal pain complete disappearance of nausea and vomit and a significant decreased ingestion of alkali tablets.