[Dental implant placement in the area of ectopic and impacted teeth]. / Dental'naya implantatsiya v oblasti retenirovannykh i distopirovannykh zubov.

The paper presents two clinical cases demonstrating the effectiveness of using surgical templates for the installation of dental implants in the areas of ectopic and impacted teeth in case of patient's disagreement on their removal or other methods of treatment.

Comparison of neonatal outcomes of cesarean sections performed under primary or secondary general anesthesia: a retrospective study.

BACKGROUND: The conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (secondary GA) vs. that after GA from the outset (primary GA). METHODS: We performed a monocentric retrospective study at the Angers University Hospital (France). All non-elective CSs performed under GA between January 2015 and December 2019 were included. The CSs were classified using a three-color coding system (green for non-urgent delivery, orange for urgent CS, and red for very urgent CS). The primary neonatal outcome was a composite of umbilical artery pH <7.10 or 5-min Apgar score <7. The crude and adjusted odds ratios (OR) for the risk of neonatal morbidity associated with secondary GA were estimated. RESULTS: We included 247 patients, of whom 101 (41.3%) had a secondary GA and 146 (58.7%) had primary GA. In the secondary GA group, 86.1% (87/101) had epidural anesthesia and 13.9% (14/101) had spinal anesthesia. Multivariate analysis showed no difference in neonatal morbidity between the two groups (adjusted odds ratio 1.18, 95% CI 0.56 to 2.51). CONCLUSIONS: Our study found insufficient evidence to identify a difference in neonatal outcomes between secondary compared with primary GA for CS, regardless of the level of emergency. However, our study is underpowered and additional studies are needed to confirm these data.

Assessment of operator performance during oocyte retrievals: residents' learning curve and continuous monitoring of senior physicians.

BACKGROUND: The learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained. After acquisition of the skills, the cumulative summation test (CUSUM test) allows to monitor the maintenance of the required level over time. The LC CUSUM test has been frequently used in the field of Obstetrics and Gynecology (Ob/Gyn) for several procedures, but only once for OR. METHODS: We performed a retrospective study at Angers university hospital between May 2017 and September 2018. Seven Ob/Gyn residents and 5 senior physicians were included, and all OR performed during that time (n = 690) were analyzed. The performance index assessed was the oocyte retrieval rate (ORR), defined as the ratio of oocytes retrieved to follicles aspirated. We used the LC CUSUM test to analyze the learning curves of residents, and the CUSUM test to monitor the performance of senior physicians. An ORR ≥50% in 60% of retrievals was defined as the threshold for clinical proficiency. RESULTS: Six hundred seventy-four oocyte retrieval (OR) were included: 315 were performed by residents, 220 by senior physicians, and 139 by both residents and physicians (mixed retrievals). Four residents (57%) reached the threshold after aspirating 82, 67, 53 and 46 ovaries, respectively. The mean number of ovaries aspirated in order to reach clinical proficiency was 62, and the mean number of weeks needed was 21. The duration of the learning period varied between 26 and 80 days. Two senior physicians (40%) remained proficient across the duration of the study, while two physicians (40%) had one statistically "suboptimal" OR, and one physician (20%) had two suboptimal retrievals. CONCLUSION: There is a large variability in the duration of the learning period and the number of procedures needed for a resident to master OR. Senior physicians maintain an adequate performance.

Surgical treatment of septate uterus in cases of primary infertility and before assisted reproductive technologies.

Septate uterus is the most common congenital uterine malformation in women with infertility. Several criteria are available for the definition of septate uteri, such as the one proposed by the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynecological Endoscopy (ESGE) (ESHRE/ESGE), or by the American Society for Reproductive Medicine (ASRM), with notable differences between the two. Recently, a simplified classification was proposed by the Congenital Uterine Malformations Experts (CUME), where a septum is defined as an internal indentation depth≥10mm. To date, there is no consensus on the management of women with a septate uterus and infertility. We have performed an extensive literature appraisal and reviewed all the available international guidelines in order to propose a management strategy for infertile patients with a uterine septum. Hysteroscopic septum incision seems to improve natural conception rates in the year following surgery. Moreover, it improves in vitro fertilization (IVF) outcomes when performed before the embryo transfer, by improving embryo implantation rates. On the other hand, for patients with an arcuate uterus (indentation<1.5cm according to the ASRM guidelines) and infertility, it seems that assisted reproductive technologies are the most appropriate first line treatment. However, in cases of recurrent implantation failure or recurrent pregnancy loss following IVF, hysteroscopic section could be proposed. Overall, we recommend hysteroscopic septum incision for patients with primary infertility, and for patients undergoing assisted reproductive technologies.

[Training of medical students for pelvic examination: Benefits of teaching on anatomic models]. / Formation des externes à l'examen gynécologique : intérêt de l'enseignement sur modèles anatomiques.

OBJECTIVES: To evaluate the benefits of training sessions for pelvic examination using anatomic models. MATERIAL AND METHODS: The medical students (MS) registered in their 5th year of medical studies at Angers University Hospital had to complete two anonymous questionnaires; one at the beginning of the workshop and one at the end. Every procedure which included pelvic exam (PE), vaginal sample (VS), smear test (ST), insertion of a speculum and insertion of intra-uterine device (IUD) was evaluated. RESULTS: Seventy-one MS answered both questionnaires. They were very satisfied or satisfied with the outcomes of the workshop in 91 % of the cases. At the beginning of the workshop, 28 %, 52 %, 30 %, 25 % and 3 % reported a low level of difficulty to carry out, respectively, a PE, VS, ST, insertion of a speculum, insertion of an IUD. At the end of the session, there were respectively 55 %, 83 %, 76 %, 66 % and 16 % of MS to report a low level of difficulty of these same procedures. For all of these procedures, there were a significant (P<0.05) number of MS who estimated the procedure's level of difficulty as being low at the end of the session. CONCLUSION: The level of technical difficulty of all procedures was significantly decreased at the end of the workshop.

HBx triggers either cellular senescence or cell proliferation depending on cellular phenotype.

Replicative senescence is a hallmark of chronic liver diseases including chronic hepatitis B virus (HBV) infection, whereas HBV-encoded oncoproteins HBx and preS2 have been found to overcome senescence. HBx possesses a C-terminal truncation mainly in hepatocellular carcinomas but also in noncancerous liver tissues. Here, by cell counting, BrdU incorporation, MTT proliferation assay, cell cycle analysis, SA-ßgal staining and Western blotting in primary and malignant cells, we investigated the effect of HBx C-terminal mutants on cellular senescence. HBx C-terminal mutants were found to trigger cellular senescence in primary MRC5 cells, and malignant liver cells Huh7, and SK-Hep1. In contrast, these mutants promoted the proliferation of HepG2 malignant liver cells. The pro-senescent effect of HBx relied on an increased p16(INK4a) and p21(Waf1/Cip1) expression, and a decreased phosphorylation of Rb. Together, these results suggest that the two main variants of HBx present in HBV-infected liver possess opposite effects on cellular senescence that depend on the phenotype of infected cells.

[The influence of exogenous LH/hCG activity on serum progesterone levels on the day of hCG administration in in vitro fertilization]. / Influence de l'activité LH/hCG exogène sur le taux sérique de progestérone le jour de l'hCG en fécondation in vitro.

OBJECTIVES: Clarifying whether the addition of recombinant LH (rLH) to recombinant FSH (rFSH) leads to progesterone (P4) levels on dhCG comparable to those obtained with stimulation with FSH and hCG (HP-hMG) MATERIALS AND METHODS: Pituitary-desensitized patients, matched for age and follicle reserve, received rFSH+LH (n=729) or HP-hMG (n=729). In the rFSH+rLH group, rLH (75 UI/day) was started at day 6. To control for the influence of ovarian response on P4, we divided serum P4 levels by the number of growing follicles (13-22 mm; "per follicle" P4 levels) and performed a multivariate analysis. RESULTS: Serum P4 levels on dHCG were lower in the HP-hMG (median: 0.63 ng/mL, max-min: 0.10-2.97) than in the rFSH+rLH group (0.91 ng/mL; 0.10-4.65, P<0.0001), as well as "per-follicle" P4 levels (0.055 ng/mL/growing follicle, 0.006-0.284 vs 0.077 ng/mL/growing follicle, 0.003-0.336; P<0.0001). CONCLUSIONS: HP-hMG led to lower P4 levels on day hCG than rFSH+rLH irrespective of the intensity of the ovarian response and the adjunction of rLH (75 IU/day from day 6 onward).

[Awareness and knowledge about risks of drinking during pregnancy in pregnant Lebanese women]. / Les conduites d'alcoolisation des femmes enceintes libanaises et leurs connaissances sur les risques et répercussions sur l'enfant à naître.

OBJECTIVE: To assess the awareness and knowledge of pregnant Lebanese women about the risks of drinking during pregnancy and the factors that influence their drinking patterns. MATERIALS AND METHODS: A prospective study was conducted on a sample of 107 women consulting the gynecology outpatient department of Hôtel-Dieu de France in Beirut, Lebanon, who completed the T-ACE screening test included in a 21 multiple choice questionnaire which examine knowledge and beliefs about alcohol use during pregnancy, drinking patterns and awareness of fetal alcohol exposure. RESULTS: The 107 women of our sample were all married, between 20 and 41 years old and had mostly a high educational level (86%). Most of the women (47%) were at their first pregnancy. Of the 20 women who self-reported drinking during pregnancy, 60% obtained a positive score on the T-ACE questionnaire, which indicates that more than 11% of the women engaged with potentially high risk drinking for the baby. There is not a significant difference between the different age categories or educational levels. This proportion is lower than that found in international publications. However, the rate of excessive drinking (4 drinks or more on any one occasion in females) was higher and one woman in five reported excessive drinking in the previous year. There is a high level of knowledge that alcohol use during pregnancy is harmful to the child, and the more consumption the more harmful and likely the effects, but there is confusion about the safety of small amounts of alcohol. Women (37%) think that there is a safe level of drinking during pregnancy; 29% tolerate up to one drink a month, 9% tolerate up to one drink a week and one woman thinks having one drink a day is safe. Women who actually drink during pregnancy are more likely to think that alcohol consumption to a certain level is safe. Women (31%) think that beer and/or wine are safe alcohols to a certain level during pregnancy. When asked about the source of this belief, 22% mention a gynecologist but the majority (61%) says it is a personal belief. Women (65%) in our sample are aware that alcohol use during pregnancy can lead to life-long disabilities in a child, such as delayed development (36%), birth defects/deformities (35%) and mental retardation (32%). However, up to 33% of the respondents report having no information about the effects of alcohol on the fetus and two women believe alcohol is not harmful at all. Women with lower levels of education are somewhat less knowledgeable about the risks of alcohol use during pregnancy than those with higher levels of education. There is no association between the drinking patterns of the women with their age, their professional habits and the alcohol consumption of their husbands. The women in our sample seem to be more aware of the necessity to stop smoking rather than stop drinking during pregnancy. CONCLUSION: Lebanese women are not fully aware of the recommendations and risks related to drinking during pregnancy. This is the reason why action must be taken to ensure better diffusion of these recommendations and better assessment of alcohol intake during prenatal visits.

[Collagenous colitis and small intestinal villous atrophy: manifestations of the same disorder?]. / Colitis colágena y atrofia vellositaria del intestino delgado: manifestaciones de una misma enfermedad?

We describe the case of a 64-year-old woman with a previous diagnosis of celiac sprue and no clinical or histological response to gluten withdrawal. The patient presented a history of longstanding recurrent watery diarrhea and was found to have collagenous colitis after further investigation of her diarrhea. Immunological study was incompatible with celiac disease and no other cause of villous atrophy was found. We suggest that this patient may have a separate disease entity unrelated to celiac sprue and consisting of a pan-intestinal inflammatory disorder characterized by the combination of a chronic inflammatory infiltrate in the small and lower bowel together with a subepithelial collagenous band in the colon.

Nephrotic syndrome with mesangial proliferative glomerulonephritis induced by multiple wasp stings.

We report the case of a young male who developed severe nephrotic syndrome within 2-3 weeks after being stung by 3 wasps. A percutaneous kidney biopsy specimen revealed mesangioproliferative glomerulonephritis with occasional subepithelial deposits suggestive of early membranous nephropathy. The patient was treated with oral prednisone 60 mg/day with no significant clinical response after 4 weeks, at which point he was started on oral cyclophosphamide, 100 mg/day, while the prednisone dose was tapered to 20 mg every other day over a 2-week period. Six months after initiation of cyclophosphamide, he still has severe nephrotic syndrome. We also briefly review the literature on Hymenoptera sting associated nephrotic syndrome.

Idiopathic granulomatous vasculitis: response to immunosuppressive therapy.

A case of idiopathic granulomatous vasculitis (disseminated visceral giant cell arteritis) is described in an old woman, the seventh case of this rare disorder reported to date. The main organ affected was the liver and, to our knowledge, this is the first patient to be diagnosed while still alive and the only case to have received medical treatment. It is also the first time that muscular involvement has been documented in this condition. Cyclophosphamide treatment resulted in disappearance of symptoms and increase in weight. The patient died of an unrelated condition.

High density lipoprotein3 binding sites are related to DNA biosynthesis in the adenocarcinoma cell line A549.

The effect of high density (apoE-depleted HDL3) on cell growth of a human tumor cell line (A549) was studied and related to its binding on the plasma membrane. HDL3 were shown to stimulate the incorporation of [3H]thymidine into DNA and cell proliferation; these effects were dose-dependent. As HDL3, apoA-I and apoA-I-liposomes complexes (but not apoA-II) were able to stimulate DNA synthesis in serum-free conditions. This effect was maximum for 15-30 micrograms HDL3 protein/ml concentration. Binding of HDL3 on whole cells occurred by two mechanisms: the first was specific for HDL3; the second, of lower affinity, was phospholipid-dependent and was inhibited by low density lipoprotein or by phospholipid particles. Internalization and degradation of bound HDL3 were not observed. The specific sites (27.9 +/- 2.2 ng HDL3 protein/ng cell protein) accounted for only 2.5% of total (specific+phospholipid) binding sites and they bound HDL3 with a dissociation constant (KD) of 2.47 +/- 0.46 microgram HDL3 protein/ml (2.6 +/- 0.5 x 10(-8) M). The apparent KD value of total binding sites (specific+phospholipid) was eightfold higher (20.4 +/- 6.1 micrograms HDL3 protein/ml). Analysis of the membrane specific binding sites by ligand blotting with 125I-labeled HDL3 showed a single protein with an apparent molecular mass of 110 kDa. When HDL3 binding on phospholipid sites was inhibited by rigid phospholipid particles, the stimulation of [3H]thymidine incorporation related to HDL3 concentration did not show a maximum peak as previously observed but reached a plateau at a concentration as low as 5 micrograms HDL3 protein/ml. This low concentration also nearly saturated the specific binding sites with HDL3. When binding on specific protein sites was suppressed by tetranitromethane, DNA synthesis was not stimulated but, in contrast, inhibited. The stimulating effect of HDL3 on DNA biosynthesis is therefore likely dependent on HDL3 occupying specific binding sites.

Evidence for up-regulated low density lipoprotein receptor in human lung adenocarcinoma cell line A549.

Human lung adenocarcinoma cell line A549 was studied with respect to the metabolism of human low density lipoprotein (LDL) and 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGR) activity. After incubation in medium containing lipoprotein-deficient serum (LPDS) for 24 h, the A549 cell line expresses a single class of high affinity LDL binding sites (KD at 37 degrees C of 15.1 +/- 0.7 nM and capacity of 118 +/- 2.8 ng/mg cell protein) and an HMGR activity of 111.4 +/- 7 pmol/min/mg cell protein. After binding, the LDLs were internalized and degraded by a common saturable process. The HMGR activity was higher in A549 cells than in fibroblasts but LDL affinity and binding capacity were similar in both cell types. However, in the presence of lipoproteins, A549 cells showed a two-fold higher binding capacity than fibroblasts. When the cells were deprived of cholesterol, the amount of LDLR sites increased but the extent of stimulation was lower in A549 than in fibroblast cells (2.5-fold versus six-fold respectively). This increase was accompanied by a similar increase in the specific LDLR mRNA cellular levels (two-fold versus six-fold respectively). When cells were deprived of exogenous and endogenous cholesterol (biosynthesis blocked by compactin), the binding capacity and the LDLR mRNA levels were yet again increased in A549 cells but not in fibroblasts. Taken together these results suggest that the level of expression of the LDLR is up-regulated in A549 cells compared to fibroblasts.

A sensitive immunochemiluminescence assay for human serum amyloid A protein.

We describe an immunochemiluminescence assay for human plasma serum amyloid A protein (SAA) in which specific rabbit polyclonal antibodies against synthetic peptides are used. The detection of the antigen-antibody reaction at 425 nm is based on a brief emission of light by a luminophor component (signal) in response to chemical energy. The working range of the assay covers plasma SAA concentrations from 5 to 100 micrograms/L. The lower detection limit is 5 micrograms/L, the within- and between-assay CVs are less than 12%. Bilirubin, cholesterol and triglyceride in final concentrations of up to 220 mumol/L, 8.1 mmol/L and 2.68 mmol/L, respectively, do not interfere with the assay. Results were correlated with those obtained by the enzyme-linked immunosorbent assay using the same antibodies (r = 0.95; p less than 0.001; n = 50). This method is inexpensive, simple and easily automated.

Hyperphosphatasemia related to three intestinal alkaline phosphatase isoforms: biochemical study.

An unexplained hyperphosphatasemia was noted in a healthy 47-year-old woman. The electrophoretic pattern on agarose gel with and without wheat germ lectin of the serum of this patient showed the presence of three isoforms which have been characterised as being of intestinal origin: their biochemical (neuraminidase, phenylalanine) and thermodenaturation properties are similar to those of intestinal tissue extract. The pI and pH optima of these isoforms agree with an intestinal origin. Our results suggest the existence of different allelozymes of intestinal alkaline phosphatase.

Evidence for qualitative abnormalities in high-density lipoproteins from myeloma patients: the presence of amyloid A protein could explain HDL modifications.

HDL apolipoproteins (apo) from normal subjects and patients with multiple myeloma were studied by isoelectric focusing (IEF) and by two-dimensional gel electrophoresis. Qualitative abnormalities were detected in myeloma HDL apolipoproteins. We observed two new bands not previously described in this disease. As determined by IEF and two-dimensional gel electrophoresis, the relative molecular weight of these two proteins was 12,600, with pI = 6.04 and 6.36, respectively. They correspond to two isoforms of serum amyloid A protein (SAA), as confirmed by western blot assay against specific antiserum to SAA. The high sensitivity of this assay revealed also other SAA isoforms. Our data are consistent with the hypothesis that major apolipoproteins of normal HDL, apo A-I and apo A-II, could be displaced by SAA isoproteins in myeloma HDL. This could lead structural changes in HDL.

Quantitative abnormalities of lipoprotein particles in multiple myeloma.

Serum concentrations of total cholesterol and lipoprotein cholesterol, of apolipoproteins A I and A II and of apolipoprotein A I in lipoprotein particles (Lp A I and Lp A) were determined in 43 patients with multiple myeloma. There were striking alterations in the plasma levels of these analytes relative to normal subjects. We observed a decrease of cholesterol levels in LDL, HDL and HDL3 fractions, and of apolipoproteins A I and A II compared with normal subjects. The HDL2 cholesterol was increased. The decrease of apolipoprotein A II was more prominent than apolipoprotein A I. The decrease of apolipoprotein A I concerns only the A I (Lp A), while the A I (Lp A I) was increased. Most of these modifications were correlated with the monoclonal Ig levels.

Serum apolipoproteins A-I, A-II and B in hepatic metastases. Comparison with other liver diseases: hepatomas and cirrhosis.

Serum concentrations of lipids and apolipoprotein A-I, A-II and B were determined in patients with hepatic metastases of colorectal cancer, with primary liver cancer and with cirrhosis. In all three liver diseases, the HDL fraction and apolipoproteins A-I and A-II showed significantly low values, while apolipoprotein B was only increased in hepatic metastases. The decrease of apolipoprotein A-II levels was more prominent in cirrhosis, thereby enhancing the A-I/A-II ratio. This ratio is decreased in metastasis and normal in hepatomas. In patients with hepatic metastases a correlation was observed between alkaline phosphatase and apolipoprotein A-II (p less than 0.05), and between gamma-glutamyltransferase and the A-I/A-II ratio (p less than 0.05). The present work suggests that determination of apolipoproteins and lipids of the HDL fraction offers a new approach to the study of liver diseases.

Automated immunoturbidimetric assay of serum apolipoprotein A-II using the Cobas-Bio centrifugal analyser: influence of hyperlipoproteinemia.

A quantitative automated immunoturbidimetric procedure for the analysis of apolipoprotein A-II (Apo A-II) in human serum is described. Dilution of antibody with a 5% solution of PEG 6000 enhanced the quantification. The within- and between-assay coefficients of variation were less than 5%. Results correlated well with those obtained by classic electroimmunodiffusion and immunonephelometry. No extraction of samples with organic solvent was necessary, whatever the triglyceride concentration. Large lipoproteins such as VLDL and immunocomplexes did not affect the method, nor was there interference from icteric or hemolyzed serum or from serum with excessive hyperlipemia. Physiological values of Apo A-II were determined in a normal population. Concentrations were found to be age-dependent, and higher in women than in men. The procedure is very suitable for the rapid, precise, reproducible and inexpensive assay of Apo A-II.