Abstract Skin is a composite material with a complex structure which exhibits a wide range of behaviours such as anisotropy, viscoelasticity, hyperelasticity, plasticity etc. Indeed it remains a ...great challenge to understand its behaviour as it is involved in many consumer and medical applications. In most studies, experiments are performed in situ or in vitro on fresh tissues but most of the time samples are preserved before testing (fridge, freezer, saline solution etc.). In this paper, the impact of samples conservation on the softening behaviour and on the permanent set is studied in order to select the appropriate conservation protocol. Samples are extracted from several pigs' abdomens (direction parallel to spine) and the mechanical testing consists in loading–unloading uniaxial tension tests instrumented with digital image correlation inducing thus reliable strain measurements in a chosen region of interest. The results of this study revealed that preservation conditions must be carefully chosen; conservation in a saline solution and freezing without any caution alter the irreversible part of the global mechanical behaviour of the tissues.
Bacterial vaginosis (BV) is a recurrent disease in women despite treatment by antibiotics. This study investigated the impact of a vaginal probiotic, Lactobacillus crispatus IP174178* (Lc), on the ...rate of recurrence and time to recurrence.
A prospective, multi-centre, double blind, randomised phase III trial in women with at least two documented episodes of BV in the previous year (diagnosis confirmed by presence of three Amsel criteria and a Nugent score≥7), and who had been clinically cured (i.e., no Amsel criteria) after oral metronidazole treatment (1g/day×7 days). The patients were randomised to receive vaginal capsules of either Lc or placebo, once a day, for 14 days over the first two menstrual cycles and another 14 days of the same treatment for the following two menstrual cycles. The primary efficacy endpoint was the number of patients with at least one bacteriologically confirmed recurrence of BV.
Out of 98 assessable patients (mean age 35.7 years), 78 women were evaluated (20 patients had missing data). During the treatment period, 16/39 patients (41%) had at least one recurrence in the placebo group versus 8/39 patients (20.5%) in the Lc group (P=0.0497). The time to recurrence was longer by 28% in the Lc group (3.75±0.16 months) vs. the placebo group (2.93±0.18 months) (P=0.0298). Tolerability and safety were good in both groups.
In women with recurrent BV after antibiotics, treatment with Lc IP 174178 administered over four menstrual cycles, could significantly reduce the rate of recurrence and increase the time to recurrence.
Abstract Prior to testing, soft tissues are usually maintained in different media and additives (solution, air, cryopreservant…) under various environment conditions (temperature, storage ...duration….). In many cases, results from mechanical tests performed on these stored tissues are supposed to be as closed as possible to the fresh ones. In the present work, cyclic tensile tests were performed with increasing values of strain on porcine skin tissues (excised following the Langer’s lines) to enhance tissues mechanical non linearity such as softening behavior and permanent set. Optical methods were used to follow the in-plane strains evolution. These latest values were used as data to simulate the structural behavior of these heterogeneous materials. The numerical simulation is based on the constitutive pseudo-elastic model accounting for the softening behavior as well as the permanent set. As a result, reliable material parameters were extracted from the experiments/model comparison for each storage solution. The result of this study reveals that preservation conditions must be carefully chosen: at low strain the tissues store in fridge in a saline solution during a short time, or in freezer (-80 °C) in water with cryopreservant and the fresh one lead to a similar mechanical response. For larger strain, the freezing (-80 °C) in water with cryopreservant is the only procedure for which the tissue recovers its initial behavior.
BACKGROUND The aim of this study was to estimate the fertility and pregnancy outcomes after successful conservative treatment for placenta accreta. METHODS This retrospective national multicenter ...study included women with a history of conservative management for placenta accreta in French university hospitals from 1993 through 2007. Success of conservative treatment was defined by uterine preservation. Data were retrieved from medical files and telephone interviews. RESULTS Follow-up data were available for 96 (73.3%) of the 131 women included in the study. There were eight women who had severe intrauterine synechiae and were amenorrheic. Of the 27 women who wanted more children, 3 women were attempting to become pregnant (mean duration: 11.7 months, range: 7–14 months), and 24 (88.9% 95% confidence interval (CI), 70.8–97.6%) women had had 34 pregnancies (21 third-trimester deliveries, 1 ectopic pregnancy, 2 elective abortions and 10 miscarriages) with a mean time to conception of 17.3 months (range, 2–48 months). All 21 deliveries had resulted in healthy babies born after 34 weeks of gestation. Placenta accreta recurred in 6 of 21 cases 28.6% (95% CI, 11.3–52.2%) and was associated with placenta previa in 4 cases. Post-partum hemorrhage occurred in four 19.0% (95% CI, 5.4–41.9%) cases, related to placenta accreta in three and to uterine atony in one. CONCLUSIONS Successful conservative treatment for placenta accreta does not appear to compromise the patients' subsequent fertility or obstetrical outcome. Nevertheless, patients should be advised of the high risk that placenta accreta may recur during future pregnancies.
Background. Q fever is a zoonosis caused by Coxiella burnetii. During pregnancy, it may result in obstetric complications, such as spontaneous abortion, intrauterine growth retardation, intrauterine ...fetal death, and premature delivery. Pregnant women are exposed to the risk of chronic Q fever. Methods. We included 53 pregnant women who received a diagnosis of Q fever. We compared the incidence of obstetric and maternal Q fever complications for women who received long-term cotrimoxazole treatment (n = 16) with that for women who did not receive long-term cotrimoxazole treatment (n = 37); long-term cotrimoxazole treatment was defined as oral administration of trimethoprim-sulfamethoxazole during at least 5 weeks of pregnancy. Results. Obstetric complications were observed in 81.1% of pregnant women who did not receive long-term cotrimoxazole therapy: 5 (13.5%) women experienced spontaneous abortions, 10 (27%) experienced intrauterine growth retardation, 10 (27%) experienced intrauterine fetal death, and 10 (27%) experienced premature delivery. Oligoamnios was observed in 4 patients (10.8%). Obstetric complications were found to occur significantly more often in patients infected during their first trimester of pregnancy than in those infected later (P = .032). The outcome of the pregnancy was found to depend on placental infection by C. burnetii (P = .013). Long-term cotrimoxazole treatment protected against maternal chronic Q fever (P = .001), placental infection (P = .038), and obstetric complications (P = .009), especially intrauterine fetal death (P = .018), which was found to be related to placental infection (P = .008). Conclusions. Q fever during pregnancy results in severe obstetric complications, including oligoamnios. Because of its ability to protect against placental infection, intrauterine fetal death, and maternal chronic Q fever, long-term cotrimoxazole treatment should be used to treat pregnant women with Q fever.
Objective
Morbidity in fetuses affected by gastroschisis is mainly the result of bowel ischaemic and inflammatory processes. Experimental studies on animal models show that clearing amniotic fluid ...from the digestive secretions by amnioexchange procedures reduces the inflammatory process. We evaluated the benefit of the amnioexchange procedure for fetal gastroschisis in humans.
Design
Prospective, interventional, randomised study.
Setting
Eight referral centres for fetal medicine.
Population
Pregnant women carrying a fetus with gastroschisis.
Methods
We compared, in utero, amnioexchange with a sham procedure. The protocol included, in both arms, steroid injections at 30 weeks of gestation and the use of postnatal minimal enteral feeding.
Main outcome measures
The primary outcome was a composite variable based on the duration of ventilation and parenteral nutrition. Secondary outcomes were the effectiveness and safety of the amnioexchange procedure, including the rate of perinatal death, time to full enteral feeding, primary closure, and late feeding disorders.
Results
Sixty‐four patients were randomised. There was no difference in the composite criteria between the amnioexchange and control groups. Based on an intention‐to‐treat analysis, there were no significant between‐group differences in pregnancy outcome or complications. When studying the relationship between digestive compounds and amniotic fluid inflammatory markers, a clear correlation was found between bile acid and both ferritin and interleukin 1β (IL1β).
Conclusions
In humans, amnioexchange, as described in our protocol, is not an option for fetal care; however, we provide supplementary proof of the involvement of inflammation in the pathogenicity of gastroschisis and suggest that future research should aim at reducing inflammation. ClinicalTrials.gov: NCT00127946.
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A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans.
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A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans.
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