The influence of level of care on admission to neonatal care for babies of low-risk nullipara

in European Journal of Obstetrics & Gynecology & Reproductive Biology (2009), 144

Objective To analyze the risk of admission to neonatal care for newborns of low-risk nullipara and its variation with level of care of the maternity unit. Study design The sample included infants born to ... [more ▼]

Objective To analyze the risk of admission to neonatal care for newborns of low-risk nullipara and its variation with level of care of the maternity unit. Study design The sample included infants born to low-risk nulliparas from the PREMODA study of 138 French maternity units (n = 3652). Medical records of children admitted to neonatal care were reviewed to determine the reasons for admission and the severity of morbidity. The risk factors associated with admission to neonatal care, including maternal, infant and delivery unit characteristics, were studied by univariable analysis, followed by a multivariable analysis using a multilevel logistic model. Results The newborns of 3.5% (n = 129) of the nulliparous mothers at low risk were admitted to neonatal care at birth. The two principal reasons were infections (57%) and respiratory diseases (19%). Babies born in level 2 maternity units were twice as likely to be admitted to neonatal care as those born in level 1 units (ORa = 2.0 [1.1–3.7]) and those born in level 3 units, 1.5 times more often, although this was not statistically significant (ORa = 1.5 [0.8–2.8]). Babies admitted to neonatal care after delivery in level 1 had more severe morbidity (n = 4, 26.7%) than those admitted from level 2 (n = 4, 5.7%) or level 3 (n = 3, 6.8%) facilities (p = 0.046). Conclusion In low-risk populations, the level of care could have an influence on the decision to admit babies to neonatal care at birth. These findings add to the on-going debate about the optimal organization of care for women at low obstetrical risk. [less ▲]

The impact of detailed explanatory leaflets on patient satisfaction with urodynamic consultation: A double-blind randomized controlled trial.

in Neurourology and Urodynamics (2009), 28(5), 374-9

Aims To develop and validate a scale that is applicable in Belgium to investigate the aspects of female patients' satisfaction with urodynamic consultation, and to use it to measure the impact of a ... [more ▼]

Aims To develop and validate a scale that is applicable in Belgium to investigate the aspects of female patients' satisfaction with urodynamic consultation, and to use it to measure the impact of a detailed explanatory leaflet on their satisfaction. Materials and Methods Question items were obtained from a group consensus (Delphi process). Each item was scored on a five-point Likert scale. The satisfaction scale was administered to two groups of patients attending the clinics for urodynamics. One hundred twenty-nine patients were included in the study and randomized in two groups. One group (n = 60) received a detailed explanatory leaflet about urodynamic consultation and the other did not (n = 69). Responses were subjected to a reliability and principal component analysis (PCA) to achieve data reduction and analysis, and to assess the reliability of the new scale. Relevant items were retained to compare both interventions using regression analysis. Results A 15-item scale was derived from the Delphi process. Exploratory factor analysis suggested a single factor solution with 11 meaningful items. No significant difference was noted in global scores of satisfaction between the two groups (P = 0.051). Conclusions A short-form patient satisfaction scale with acceptable validity and reliability was developed and used to measure patient satisfaction with urodynamic consultation in this population of Belgian women. This study did not provide support for the effectiveness of explanatory leaflets in improving satisfaction. [less ▲]

L'endométriose en 2009: place respective du traitement médical et du traitement chirurgical.

in Gunaïkeia (2009), 14(3), 69-73

Les anomalies d'insertion placentaire

in Gunaïkeia (2009), 14(4), 121-123

Soluble HLA-G in IVF/ICSI embryo culture supernatants does not always predict implantation success: a multicentre study.

in Reproductive Biomedicine Online (2009), 18(3), 374-81

Several reports have described an association between the presence of soluble human leukocyte antigen G (sHLA-G) in human embryo culture supernatants (ES) and implantation success. However, not all ... [more ▼]

Several reports have described an association between the presence of soluble human leukocyte antigen G (sHLA-G) in human embryo culture supernatants (ES) and implantation success. However, not all studies agree with these findings. To further document this debate, a multicentre blinded study was performed to investigate, on a large number of IVF ES and ICSI ES, whether sHLA-G is a useful criterion for embryo selection before transfer. A total of 1405 ES from 355 patients were collected from three assisted reproductive technique (ART) centres and evaluated for their sHLA-G content in a single laboratory, using a chemiluminescence enzyme-linked immunosorbent assay. In only one centre was a significant association between sHLA-G-positive ES and successful implantation established (P = 0.0379), whereas no such association was observed in the other centres. It was found that the percentages and concentrations of sHLA-G-positive ES varied between centres, depending on culture media and ART conditions. The percentage of sHLA-G-positive ES was significantly higher in IVF ES than ICSI ES (P < 0.001 and P < 0.01 for two centres). These data demonstrate that substantial variations of sHLA-G content in ES occur between different ART centres, highlighting the influence of several technical parameters that differ from one centre to another. [less ▲]

Gynaecological uses of a new class of steroids: the selective progesterone receptor modulators

in Gynecological Endocrinology : The Official Journal of the International Society of Gynecological Endocrinology (2009), 25(2), 67-73

Selective progesterone receptor modulators (SPRM) represent a new class of synthetic steroids, which can interact with the progesterone receptor (PR) and can exert agonist, antagonist or mixed effects on ... [more ▼]

Selective progesterone receptor modulators (SPRM) represent a new class of synthetic steroids, which can interact with the progesterone receptor (PR) and can exert agonist, antagonist or mixed effects on various progesterone target tissues in vivo. This review evaluates the actual and potential usefulness of SPRMs in gynaecology [less ▲]

Absence of aromatase protein and mRNA expression in endometriosis.

in Human Reproduction (2009), 24(9), 2133-41

BACKGROUND: Aromatase has been reported to be involved in estrogen biosynthesis and expressed in eutopic and ectopic endometrium of endometriosis patients. The objective of the present study was to ... [more ▼]

BACKGROUND: Aromatase has been reported to be involved in estrogen biosynthesis and expressed in eutopic and ectopic endometrium of endometriosis patients. The objective of the present study was to investigate its expression and localization in three distinct types of endometriosis. METHODS: Human peritoneal, ovarian and rectovaginal endometriotic lesions and matched eutopic endometrium were collected from patients during laparoscopy. Aromatase protein localization (immunohistochemistry, n = 63) and mRNA expression [quantitative polymerase chain reaction (Q-PCR), n = 64] were assessed. RESULTS: No aromatase protein was detected by immunohistochemistry in either the glandular or stromal compartment of endometriotic lesions or eutopic endometrium, while it was strong in placental syncytiotrophoblasts, granulosa and internal theca cells from pre-ovulatory follicles, and luteal cells from corpus luteum. By Q-PCR, low but discernible levels of aromatase expression were found in endometriomas, probably due to follicular expression. Transcripts for aromatase were barely detectable in only a few peritoneal and rectovaginal endometriotic lesions, and a few eutopic endometrium samples, probably due to contaminating surrounding tissues (adipose tissue, intact peritoneum). CONCLUSIONS: Unlike previous studies, we observed no aromatase protein in any of the endometriosis types, and barely detectable aromatase mRNA expression, suggesting that locally produced aromatase (within endometriotic lesions) may be less implicated in endometriosis development than previously postulated. Potential factors responsible for these discrepancies are discussed. [less ▲]

Biomarker discovery in asthma-related inflammation and remodeling.

in Proteomics (2009), 9(8), 2163-70

Asthma is a complex inflammatory disease of airways. A network of reciprocal interactions between inflammatory cells, peptidic mediators, extracellular matrix components, and proteases is thought to be ... [more ▼]

Asthma is a complex inflammatory disease of airways. A network of reciprocal interactions between inflammatory cells, peptidic mediators, extracellular matrix components, and proteases is thought to be involved in the installation and maintenance of asthma-related airway inflammation and remodeling. To date, new proteic mediators displaying significant activity in the pathophysiology of asthma are still to be unveiled. The main objective of this study was to uncover potential target proteins by using surface-enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS) on lung samples from mouse models of allergen-induced airway inflammation and remodeling. In this model, we pointed out several protein or peptide peaks that were preferentially expressed in diseased mice as compared to controls. We report the identification of different five proteins: found inflammatory zone 1 or RELM alpha (FIZZ-1), calcyclin (S100A6), clara cell secretory protein 10 (CC10), Ubiquitin, and Histone H4. [less ▲]

Dysregulation of anti-angiogenic agents (sFlt-1, PLGF, and sEndoglin) in preeclampsia--a step forward but not the definitive answer

in Journal of Reproductive Immunology (2009), 82(2), 106-11

Preeclampsia (PE) is a pregnancy-specific syndrome characterized by hypertension, proteinuria and edema, which resolves on placental delivery. It is thought to be the consequence of impaired placentation ... [more ▼]

Preeclampsia (PE) is a pregnancy-specific syndrome characterized by hypertension, proteinuria and edema, which resolves on placental delivery. It is thought to be the consequence of impaired placentation due to inadequate trophoblastic invasion of the maternal spiral arteries. In PE the maternal plasma concentration of free vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) is decreased whereas the concentration of soluble fms-like tyrosine kinase-1 (sFlt-1) and of soluble endoglin (sEng) is increased. These soluble receptors may bind VEGF, PLGF and TGFβ1 and TGFβ3 in the maternal circulation, causing endothelial dysfunction in many maternal tissues. Hence there is a view that the pathogenesis is more or less clarified. According to the vascular theory, poor placentation leads to poor uteroplacental perfusion and hypoxia, which stimulates sFlt-1 and sEng production causing the maternal syndrome. This assumption has been recently challenged. The role of hypoxia as the main stimulus for release of sFlt-1 has been questioned and the role of inflammatory mechanisms has been emphasized. According to this inflammatory theory, poor placentation may predispose more to placental oxidative stress than hypoxia and endothelial dysfunction may be part of a broader disorder of systemic inflammation. Finally, the recent demonstration of activating auto-antibodies to the angiotensin 1 receptor that experimentally play a major pathogenic role in PE further suggests a pleiotropism of aetiologies for this condition. The purpose of this review is to critically evaluate the recent hypotheses and their possible insights on early diagnosis, prevention and treatment. [less ▲]

PAI-1 Regulates the Invasive Phenotype in Human Cutaneous Squamous Cell Carcinoma

in Journal of Oncology Management : The Official Journal of the American College of Oncology Administrators (2009)

The emergence of highly aggressive subtypes of human cutaneous squamous cell carcinoma (SCC) often reflects increased autocrine/paracrine TGF-β synthesis and epidermal growth factor receptor (EGFR ... [more ▼]

The emergence of highly aggressive subtypes of human cutaneous squamous cell carcinoma (SCC) often reflects increased autocrine/paracrine TGF-β synthesis and epidermal growth factor receptor (EGFR) amplification. Cooperative TGF-β/EGFR signaling promotes cell migration and induces expression of both proteases and protease inhibitors that regulate stromal remodeling resulting in the acquisition of an invasive phenotype. In one physiologically relevant model of human cutaneous SCC progression, TGF-β1+EGF stimulation increases the production of several matrix metalloproteinases (MMPs), among the most prominent of which is MMP-10—an MMP known to be elevated in SCC in situ. Activation of stromal plasminogen appears to be critical in triggering downstream MMP activity. Paradoxically, PAI-1, the major physiological inhibitor of plasmin generation, is also upregulated under these conditions and is an early event in progression of incipient epidermal SCC. One testable hypothesis proposes that TGF-β1+EGF-dependent MMP-10 elevation directs focalized matrix remodeling events that promote epithelial cell plasticity and tissue invasion. Increased PAI-1 expression serves to temporally and spatially modulate plasmin-initiated pericellular proteolysis, further facilitating epithelial invasive potential. Defining the complex signaling and transcriptional mechanisms that maintain this delicate balance is critical to developing targeted therapeutics for the treatment of human cutaneous malignancies. [less ▲]