[Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) -- Text of the Guidelines (short text)]. / Accouchement normal : accompagnement de la physiologie et interventions médicales. Recommandations de la Haute Autorité de Santé (HAS) avec la collaboration du Collège National des Gynécologues Obstétriciens Français (CNGOF) et du Collège National des Sages-Femmes de France (CNSF) ­ Texte des recommandations (texte court).

OBJECTIVE: The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS: These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS: It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION: These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.

[Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]. / Ressources humaines pour les activités non programmées en gynécologie-obstétrique. Propositions élaborées par le CNGOF, le CARO, le CNSF, la FFRSP, la SFAR, la SFMP et la SFN.

OBJECTIVE: To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology. MATERIALS AND METHODS: Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO). RESULTS: Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%. CONCLUSION: These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.

Iron isotope fingerprints of redox and biogeochemical cycling in the soil-water-rice plant system of a paddy field.

The iron isotope composition was used to investigate dissimilatory iron reduction (DIR) processes in an iron-rich waterlogged paddy soil, the iron uptake strategies of plants and its translocation in the different parts of the rice plant along its growth. Fe concentration and isotope composition (δ56Fe) in irrigation water, precipitates from irrigation water, soil, pore water solution at different depths under the surface water, iron plaque on rice roots, rice roots, stems, leaves and grains were measured. Over the 8.5-10cm of the vertical profiles investigated, the iron pore water concentration (0.01 to 24.3mg·l-1) and δ56Fe (-0.80 to -3.40‰) varied over a large range. The significant linear co-variation between Ln[Fe] and δ56Fe suggests an apparent Rayleigh-type behavior of the DIR processes. An average net fractionation factor between the pore water and the soil substrate of Δ56Fe≈-1.15‰ was obtained, taking the average of all the δ56Fe values weighted by the amount of Fe for each sample. These results provide a robust field study confirmation of the conceptual model of Crosby et al. (2005, 2007) for interpreting the iron isotope fractionation observed during DIR, established from a series of laboratories experiments. In addition, the strong enrichment of heavy Fe isotope measured in the root relative to the soil solution suggest that the iron uptake by roots is more likely supplied by iron from plaque and not from the plant-available iron in the pore water. Opposite to what was previously observed for plants following strategy II for iron uptake from soils, an iron isotope fractionation factor of -0.9‰ was found from the roots to the rice grains, pointing to isotope fractionation during rice plant growth. All these features highlight the insights iron isotope composition provides into the biogeochemical Fe cycling in the soil-water-rice plant systems studied in nature.

[Nicolau syndrome after intramuscular injection]. / Complication d'une injection intramusculaire ou syndrome de Nicolau.

Nicolau syndrome is a rare, potentially severe complication that may occur after any drug injection, particularly after intramuscular injection. It is characterized by the acute onset of cutaneous and soft-tissue aseptic necrosis. Here, we report the case of a 14-year-old boy diagnosed with Nicolau syndrome on the right lower limb, after a benzathine-penicillin intramuscular injection for suspected rheumatic fever. The short-term progression was marked by uncomplicated rhabdomyolysis and the constitution of homolateral testicular torsion. The cutaneous-muscular disorders evolved favorably under symptomatic treatment. We discuss this insufficiently known complication of intramuscular injection, which may motivate reduced use of this route of drug administration in children and strict adherence to the procedure. Furthermore, it is important to note that Nicolau syndrome may evolve to homolateral testicular torsion, as, to the best of our knowledge, is reported for the first time in this case.

Mobility of Cd and Cu in formulated sediments coated with iron hydroxides and/or humic acids: a DGT and DGT-PROFS modeling approach.

The diffusive gradients technique in thin films (DGT) was used to investigate the kinetic resupply of Cd and Cu to pore water from the solid phase. For the sake of simplification, experiments were performed using formulated sediments that differed in the presence or absence of humic acids (HA) and/or of iron hydroxides (i.e., goethite and ferrihydrite). The effects of the time after the contamination of the solid phase (aging effect) on formulated sediments that were coated with goethite and HA and spiked with Cd were also evaluated. Kinetic DGT results were interpreted using the newly developed, multi-compartmental model DGT-PROFS. Due to Cu humate formation, the addition of HA slightly increased the Cu concentration in the pore water independent of the effect of the iron hydroxide coating on the formulated sediments and slightly decreased that of Cd. The impact of 8-190d of aging resulted in a significant decrease in the Cd concentration of the pore water over an increasing incubation time. Modeling our results with DGT-PROFS led to the following conclusions concerning the impact of HA and iron hydroxides on Cd and Cu availability. First, in the presence of HA and absence of iron hydroxides, Cd is associated mainly with weak sites, while Cu is bound to strong sites. Similarly, in the presence of both iron hydroxides and HA, Cu appeared to be more heavily associated with the strong sites than did Cd. When the incubation time increased from 8 to 190d, a proportion of Cd initially adsorbed onto weak sites transferred to the strong sites, suggesting that the adsorption of Cd on sediments is controlled partially by slow kinetic processes.

Probabilistic multicompartmental model for interpreting DGT kinetics in sediments.

Extensive research has been performed on the use of the DIFS (DGT-Induced Fluxes in Soils and Sediments) model to interpret diffusive gradients in thin-film, or DGT, measurements in soils and sediments. The current report identifies some areas where the DIFS model has been shown to yield poor results and proposes a model to address weaknesses. In particular, two major flaws in the current approaches are considered: (i) many studies of accumulation kinetics in DGT exhibit multiple kinetic stages and (ii) several combinations of the two fitted DIFS parameters can yield identical results, leaving the question of how to select the 'best' combination. Previously, problem (i) has been addressed by separating the experimental data sets into distinct time segments. To overcome these problems, a model considering two types of particulate binding sites is proposed, instead of the DIFS model which assumed one single particulate pool. A probabilistic approach is proposed to fit experimental data and to determine the range of possible physical parameters using Probability Distribution Functions (PDFs), as opposed to single values without any indication of their uncertainty. The new probabilistic model, called DGT-PROFS, was tested on three different formulated sediments which mainly differ in the presence or absence of iron oxides. It was shown that a good fit can be obtained for the complete set of data (instead of DIFS-2D) and that a range of uncertainty values for each modeling parameter can be obtained. The interpretation of parameter PDFs allows one to distinguish between a variety of geochemical behaviors, providing useful information on metal dynamics in sediments.

Reconstructing historical trends of Berre lagoon contamination from surface sediment datasets: influences of industrial regulations and anthropogenic silt inputs.

These last decades, the Berre lagoon (in southeastern France) has been deeply affected since the 1930s by strong inputs of contaminants associated with industrial development and since 1966 by huge inputs of freshwater and silts due to the installation of a hydroelectric power plant. Surveys of the surface sediment contamination have been sparsely performed since 1964 for management and research purposes. These surveys were performed by various laboratories that investigated different chemicals and sampling areas using different analysis protocols. Therefore, the available data are disconnected in time and space and differ in quality. In order to reconstruct coherent time series of sediment contamination from this heterogeneous datasets and to discuss the influences of industrial and hydroelectric discharges we used a statistical approach. This approach is based on Principal Component Analysis (PCA) and Fuzzy clustering analysis on data from one extensive survey realized on surface sediments in 1976. The PCA allowed identifying two geochemical indexes describing the main surface sediment geochemical characteristics. The fuzzy clustering analysis on these indexes allowed identifying sub-areas under the specific influence of industrial or hydroelectric discharges. This allowed us to reconstruct, for each sub-area, a coherent and interpretable long-term time series of sediment contamination from the available database. Reconstructed temporal trends allowed us to estimate: (i) the overall decrease of sediment contamination since the mid-1970 attributed to industrial discharge regulations enacted at this period and (ii) the dilution of the concentrations of sediment bound contaminants induced by the hydroelectric power plant and its associated particulate matter inputs.

Temporal variations in arsenic uptake by rice plants in Bangladesh: the role of iron plaque in paddy fields irrigated with groundwater.

The transfer of arsenic to rice grains is a human health issue of growing relevance in regions of southern Asia where shallow groundwater used for irrigation of paddy fields is elevated in As. In the present study, As and Fe concentrations in soil water and in the roots of rice plants, primarily the Fe plaque surrounding the roots, were monitored during the 4-month growing season at two sites irrigated with groundwater containing approximately 130microgl(-1) As and two control sites irrigated with water containing <15microgl(-1) As. At both sites irrigated with contaminated water, As concentrations in soil water increased from <10microgl(-1) to >1000microgl(-1) during the first five weeks of the growth season and then gradually declined to <10microgl(-1) during the last five weeks. At the two control sites, concentrations of As in soil water never exceeded 40microgl(-1). At both contaminated sites, the As content of roots and Fe plaque rose to 1000-1500mgkg(-1) towards the middle of the growth season. It then declined to approximately 300mgkg(-1) towards the end, a level still well above As concentration of approximately 100mgkg(-1) in roots and plaque measured throughout the growing season at the two control sites. These time series, combined with simple mass balance considerations, demonstrate that the formation of Fe plaque on the roots of rice plants by micro-aeration significantly limits the uptake of As by rice plants grown in paddy fields. Large variations in the As and Fe content of plant stems at two of the sites irrigated with contaminated water and one of the control sites were also recorded. The origin of these variations, particularly during the last month of the growth season, needs to be better understood because they are likely to influence the uptake of As in rice grains.

[Bacillus Calmette-Guérin (BCG) vaccine coverage in newborns and infants at risk before and after a change in BCG policy]. / Couverture vaccinale par le BCG ciblé en maternité avant et après la suspension de l'obligation vaccinale.

AIM OF THE STUDY: To evaluate vaccine coverage in at-risk newborns during the maternity hospital stay and at the age of 3 months, before and after the change in the French national Calmette-Guérin Bacillus (BCG) vaccine policy. METHODS: A vaccine program targeting newborns at risk for tuberculosis was implemented in a university maternity hospital in Marseille, France, in 2007. At-risk newborns were mainly defined as those with 1 parent born in an endemic country for tuberculosis, those planning to travel in such a country for at least 1 month in their 1st year of life, or those with previous tuberculosis cases within the family. From February to November 2007, the French BCG policy changed (BCG was no longer mandatory, but only recommended for at-risk children). Parental acceptance of a targeted vaccine delivered during the hospital stay and BCG vaccination during the infant's first 3 months were evaluated before and after the change. RESULTS: A total of 289 newborns at risk of tuberculosis were included. BCG vaccine coverage in the maternity hospital was 72%, significantly higher when BCG was not mandatory (81% versus 66%; p<0.05). At 3 months of age, 90% of the children were BCG vaccinated. Among the infants whose parents refused an early vaccine, the BCG coverage rate at 3 months of age decreased from 78 to 41% (p<0.005) when only a targeted vaccine was recommended. CONCLUSION: Targeted vaccination of newborns at risk for tuberculosis in a maternity hospital is acceptable. When BCG was not mandatory, parental acceptance of an early-targeted vaccine increased, whereas the policy change decreased later vaccination rates within the first 3 months in children whose parents had previously refused. Early BCG vaccination of at-risk newborns in the maternity hospital may prevent a low BCG coverage rate at 3 months and subsequent tuberculosis cases in this population.

[Pediatric Mediterranean spotted fever]. / La fièvre boutonneuse méditerranéenne chez l'enfant.

In France, Mediterranean spotted fever due to Rickettsia conorii is mainly observed in the South-east. Rhipicephalus sanguineus, the brown dog tick, is the vector and the reservoir of the disease. Clinical diagnosis relies on the association of fever, rash and inoculation's scar during summertime. Pathological lesion is a diffuse vasculitis. Severity is often explained by a delay in diagnosis, but prognosis is good in pediatrics. Treatment relies on doxycycline and on macrolids in children under eight.

Probabilistic distribution coefficients (K(d)s) in freshwater for radioisotopes of Ag, Am, Ba, Be, Ce, Co, Cs, I, Mn, Pu, Ra, Ru, Sb, Sr and Th: implications for uncertainty analysis of models simulating the transport of radionuclides in rivers.

The objective of this study was to provide operational probability density functions (PDFs) for distribution coefficients (K(d)s) in freshwater, representing the partition of radionuclides between the particulate and the dissolved phases respectively. Accordingly, the K(d) variability should be considered in uncertainty analysis of transport and risk assessment models. The construction of PDFs for 8 elements (Ag, Am, Co, Cs, I, Mn, Pu and Sr) was established according to the procedure already tested in Durrieu et al. [2006. A weighted bootstrap method for the determination of probability density functions of freshwater distribution coefficients (K(d)s) of Co, Cs, Sr and I radioisotopes. Chemosphere 65 (8), 1308-1320]: (i) construction of a comprehensive database where K(d)s values obtained under various environments and parametric conditions were collected; (ii) scoring procedure to account for the 'quality' of each datapoint (according to several criteria such as the presentation of data (e.g. raw data vs mean with or without replicates), contact time, pH, solid-to-liquid ratio, expert judgement) in the construction of the PDF; (iii) weighted bootstrapping procedure to build the PDFs, in order to give more importance to the most relevant datapoints. Two types of PDFs were constructed: (i) non-conditional, usable when no knowledge about the site of concern is available; (ii) conditional PDFs corresponding to a limited range of parameters such as pH or contact time; conditional PDFs can thus be used when some parametric information is known on the site under study. For 7 other radionuclides (Ba, Be, Ce, Ra, Ru, Sb and Th), a simplified procedure was adopted because of the scarcity of data: only non-conditional PDFs were built, without incorporating a scoring procedure.

[Utility of interferon gamma assays for diagnosis of tuberculosis in children]. / Que faut-il penser des tests sanguins in vitro pour le diagnostic de la tuberculose en pédiatrie?

In vitro assays that measure the interferon gamma production by T cells incubated with specific antigen of Mycobacterium tuberculosis may be useful in the diagnosis of tuberculosis in children. Compared to Mantoux test, these tests are easier to perform and have a greater specificity, especially because they do not cross-react with BCG vaccine and with most of environmental Mycobacteria. However, their sensitivity is not well evaluated in children. To date in pediatrics, they can be associated with Mantoux test for the diagnosis of active tuberculosis. In the diagnosis of latent tuberculosis infection, larger studies with commercial kits are required.

Combination of 13C/ 113Cd NMR, potentiometry, and voltammetry in characterizing the interactions between Cd and two models of the main components of soil organic matter.

This work allowed the characterization of the Cd-binding sites of two compounds taken as models for exudates, the main components of soil organic matter (SOM). The studied compounds were exopolysaccharides (EPS), specifically exudates of roots (polygalacturonic acid) and of soil bacteria (Phytagel). Potentiometric acid-base titrations were performed and fitting of the obtained results indicated the presence of two main classes of acidic sites, defined by their pKa values, for both EPS but of a different nature when comparing the two compounds. The two studied exopolysaccharides presented different acidic/basic site ratios: 0.15 for Phytagel and 0.76 for polygalacturonic acid. Spectroscopic techniques (13C/113Cd NMR, FTIR) distinguished different Cd surroundings for each of the studied EPS, which is in agreement with the titration results. Furthermore, these analyses indicated the presence of -COOH and -OH groups in various proportions for each exopolysaccharide, which should be linked to their reactivity towards cadmium. Cadmium titrations (voltammetric measurements) also differentiated different binding sites for each compound and allowed the determination of the strength of the Cd-binding site of the EPS. Fitting of the results of such voltammetric measurements was performed using PROSECE (Programme d'Optimisation et de Speciation Chimique dans l'Environnement), a software coupling chemical speciation calculation and binding parameter optimization. The fitting, taking into account the Cd2+/H+ competition towards exopolysaccharides, confirmed the acid-base titrations and spectroscopic analyses by revealing two classes of binding sites: (i) one defined as a strong complexant regarding its Cd2+-EPS association (logK = 9-10.4) and with basic functionality regarding H+-EPS association (pKa = 11.3-11.7), and (ii) one defined as a weak complexant (logK = 7.1-8.2) and with acidic functionality (pKa = 3.7-4.0). Therefore the combination of spectroscopic analyses, voltammetry, and fitting allowed the precise characterization of the binding sites of the studied exopolysaccharides, mimicking the main SOM components. Furthermore, the binding parameters obtained by fitting can be used in biogeochemical models to better define the role of key SOM compounds like exudates of roots and of soil bacteria on trace metal transport or assimilation.

[Treatment of visceral leishmaniasis in children]. / Le traitement de la leishmaniose viscérale infantile.

Visceral Leishmania infantum leishmaniasis is endemic in the south of France. For many years the mainstay for treatment of infected children was pentavalent antimony: meglumine antimoniate (Glucantime) or sodium stibogluconate (Pentostam). However these drugs are poorly tolerated and resistance similar to that observed in the treatment of Indian visceral Leishmania donovani leishmaniasis has been reported. Currently liposomal amphotericin B is being used instead of antimony for treatment of visceral leishmaniasis in children in France. In addition to being well tolerated, liposomal amphotericin B is almost 100% effective. It can be administered in six intravenous injections of 3-4 mg/kg each (days 1 to 5 then day 10). A two-day protocol (10 mg/kg/d) that would reduce overall cost by shortening the duration of hospitalization is now being studied. Another oral drug, i.e., miltefosine, has been successfully used for treatment of visceral leishmaniasis in India. However it has not been evaluated for treatment of Mediterranean visceral leishmaniasis.