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.
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.
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.
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.
Abstract Fighting against risk factors for disability and dependency throughout the whole life process and – more specifically relevant to this paper – during the second part of life, needs to become ...a core focus of adult public health actions. In order to engage positive actions towards this goal, it is important to identify and target modifiable risk factors. One would imagine that it is always possible to positively modify “intermediate” risk factors, such as health habits (sedentary lifestyle and diet), health behaviours (alcohol consumption, smoking or other addictions…), as well as living and working conditions, and access to healthcare. However, the simplest interventions of all could target “proximal” risk factors that closely relate to disease and disability, such as hypertension, metabolic disorders (malnutrition and diabetes), mood and cognitive impairments, musculoskeletal disorders, inappropriate drug prescriptions and frailty. A careful review of the world literature allows to identify the most effective and efficient medical interventions allowing to prevent or delay these disabling clinical conditions and allow to reach the WHO goal of “healthy ageing”, which is developing and maintaining the functional ability that enables well-being in older age.
The epidermal growth factor receptor is a member of type-I growth factor receptor family with tyrosine kinase activity that is activated following the binding of multiple cognate ligands. Several ...members of the EGF family of ligands are expressed by cells involved in atherogenesis. EGF receptor mediated processes have been well characterised within epithelial, smooth muscle and tumour cell lines in vitro, and the EGF receptor has been identified immunocytochemically on intimal smooth muscle cells within atherosclerotic plaques. There is also limited evidence for the expression of the EGF receptor family on leukocytes, although their function has yet to be clarified. In this review, we will discuss the biological functions of this receptor and its ligands and their potential to modulate the function of cells involved in the atherosclerotic process.
A screening of fasting blood glucose and lipids disorders, presumely linked to premature atherosclerosis namely affecting Coronary arteries, has been performed among 599 adolescents of both sexes ...with the goal of establishing the actual prevalence of these disorders in French population recruited through different areas of the country. All of them were between ages of 16 and 19–20 years old, and invited to give, in total gratuity, their blood samples to private and accreditable laboratories close to their living habitation. After 262 exclusions due to either previous screening not signaled before or present use of contraceptive pill in girls, only 202 boys and 135 girls remained eligible for such a prevalence study. Using plasma enzymatic dosages of CT, HDL C, (calculated) LDLC, TG, and blood glucose, cut off points for each of these parameters, were analysed as well as calculated international index of CT/HDLC and CT minus HDLC. But the first one index was shown the best tool for the final estimation of the frequency of lipid disorders, which requires primary prevention. Indeed, despite of a rather high frequency of overlaps of CT and LDLC respectively found at 16.3 and 22.5% for boys, and 27.3 and 27.5% for girls, the still higher increase of frequency of HDL C at 31% for boys and 28.1% for girls has shown a very significant compensation of these previous increases. In such a way as the authentic prevalence of atherogenic lipid disorders is found reduced in boys to 8.4% and in girls to 7.4% for CT/HDLC
≥
4.5 ratio, and to 5.4% in boys and 5.2% in girls for CT less HDLC. A Familial Dominant Hypercholesterolemia was discovered only two times in two girls 16 years old. Other abnormal lipid profiles were rather those of Mixed H., type IV, chiefly mild Hypercholesterolemia, and some rare cases of HypoHDLemia. The only greater linked cardiovascular risk factor was direct parental C.V. heredity, round 30% among lipid disorders. Obesity remained rare, as well as Metabolic Syndrome in the present recruitment. Contraceptive pill increases significantly all lipid parameters and atherogenic index: chiefly CT minus HDLC which reaches almost the double of frequency (15%) versus that of girls without pill. But 53% of boys with proatherogenic lipid disorders are smokers, while only 10% of these dyslipidemic girls smoke.
Un dépistage à jeun de la glycémie et des désordres lipidiques, présumés liés à l'athérosclérose prématurée affectant principalement les artères coronaires, a été réalisé chez 599 adolescents des deux sexes, dans le but d'établir la prévalence actuelle de ces désordres, dans la population des différentes régions du territoire français. Tous sont âgés de 16 à 19–20 ans et invités à donner un échantillon sanguin, gratuitement prélevé par des laboratoires privés proches de leur domicile et accrédités au plan national. Après 262 exclusions, dues à un dépistage préalable non signalé ni communiqué ou en cas de pilule contraceptive chez les filles, seulement 202 garçons et 135 filles sont restés éligibles pour cette étude de prévalence. L'utilisation de dosages plasmatiques enzymatiques de CT, HDLC, LDLC calculé, TG et glycémie, de valeurs seuils pour chacun de ces paramètres, est complétée par celle en index international calculé de CT/HDLC et de CT moins HDLC (CT
–
HDLC). Ceux-ci sont démontrés comme étant les meilleurs instruments pour une estimation finale de prévalence des désordres lipidiques exigeant une prévention primaire. En dépit d'une fréquence plus élevée des dépassements de CT et LDLC, respectivement trouvés à 16,3 et 22,5
% chez les garçons, 27,3 et 27,5
% chez les filles, l'élévation encore supérieure de fréquence de HDLC à 31
% chez les garçons et 28,1
% chez les filles montre une compensation très significative des élévations précédentes. De telle manière qu'une authentique prévalence de désordres lipidiques proathérogéniques est trouvée réduite à 8,4
% chez les garçons et 7,4
% chez les filles, sur le ratio CT/HDLC supérieur ou égal à 4,5, et à 5,4
% pour les garçons et 5,2
% chez les filles pour l'index du CT
–
HDLC. Une hypercholestérolémie familiale dominante est découverte seulement chez deux filles âgées de 16 ans. Les autres profils lipidiques anormaux recouvrent plutôt
: d'abord les hypercholestérolémies pures modérées, puis les hyperlipidémies mixtes ou combinées, les hyperglycéridémies endogènes de type IV, enfin quelques rares cas d'hypoHDLémie. Le plus saillant des facteurs de risque cardiovasculaire ajoutés est l'hérédité parentale cardiovasculaire directe, autour de 30
% chez les sujets dépistés anormaux. L'obésité est restée rare comme le syndrome métabolique, dans la présente cohorte. Cependant, 53
% des garçons retenus à risques lipidiques fument contre 10
% seulement des filles à mêmes risques. La pilule contraceptive augmente significativement tous les paramètres lipidiques et l'index d'athérogénicité, principalement celui du CT
–
HDLC dont la fréquence double (15
%) en comparaison avec celle des filles hors pilule.
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.
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