[Study of the sexuality of women after a total hysterectomy versus subtotal hysterectomy by laparoscopy in Nantes CHU]

OBJECTIVE

To research the differences in the sexuality and sexual satisfaction for 2 groups of women after a hysterectomy only by laparoscopy for benign pathologies, with or without conservation of the cervix.

METHODS

Retrospective monocentric study, in Nantes CHU, of 46 women divided into two groups. Three validated questionnaires were used (PISQ-12, DSFI, ultra-short Questionnaire of depression).

RESULTS

There is no difference in the scores between the 2 tests in sexuality post-surgically between the 2 groups. But there exists a significant improvement in the postoperative sexuality according to the questionnaire PISQ-12 in the hysterectomy subtotal group, which is not found in the hysterectomy total group. The score of the questions about the orgasm also seems to improve in the hysterectomy subtotal group with some features statistically significant.

CONCLUSION

This study confirms the improvement of the sexual function after hysterectomy. In spite of the absence of proof of interest in the conservation of the cervix in the literature, our study seems to show an improvement on certain criteria in the evaluation of sexuality in the hysterectomy subtotal group, in particular on the orgasm. A proposal for a future study with a more detailed questionnaire on the orgasm would allow to better specify the role of the cervix.

Caffeine consumption and exacerbations of chronic obstructive pulmonary disease: retrospective study

BACKGROUND

The modulation of adenosine receptors has been proposed as new therapeutic target for chronic obstructive pulmonary disease, but studies in humans were negative. Caffeine is widely consumed and acts by non-selective modulation of these receptors, allowing for a non-interventional evaluation of the purinergic effects on COPD. We evaluated the effects of chronic caffeine consumption on the risk for COPD exacerbations.

METHODS

Retrospective study including patients with COPD. The total number of exacerbations during a three-year period and the mean daily caffeine consumption in the last twenty years were evaluated. A univariate and multiple regression analysis were performed for evaluation of the significant predictors of exacerbations.

RESULTS

A total of 90 patients were included. Most were males (82.2%) and had a mean forced expiratory volume in the first second (FEV1) of 57.0±17.1% predicted. The mean daily caffeine consumption was 149.7±140.9mg. There was no correlation between the mean caffeine consumption and exacerbations (p>0.05).

DISCUSSION

Our results suggest that caffeine has no significant effect on the frequency of COPD exacerbations. These conclusions are limited by the sample size and the retrospective nature of the study.

Virtual Kitchen Test. Assessing frontal lobe functions in patients with alcohol dependence syndrome

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation".

BACKGROUND

The ecological validity of paper-and-pencil neuropsychological tests is currently a matter of debate. Arguments in favor of alternatives indicate that paper-and-pencil forms are unable to account for both mental and functional aspects of cognitive functioning.

OBJECTIVES

In this study we developed a new neuropsychological evaluation test - the Virtual Kitchen Test (VKT) - devised to evaluate frontal brain functioning in cognitively impaired individuals. We designed this test according to the rationale of the Trail Making Test (TMT), in order to capture frontal lobe abilities during a more ecologically valid task.

METHODS

Forty-nine participants, 25 from a clinical sample of patients diagnosed with Alcohol Dependence Syndrome, plus 24 healthy participants.

RESULTS

Execution errors and task completion time were significantly higher in the clinical sample. Also, scores on the new VKT showed moderate to high positive correlations with scores on the TMT. Furthermore, the overall discriminant performance of the VKT was high for both of its indicators.

CONCLUSIONS

Overall results support the ability of the VKT to evaluate frontal lobe functions. The best cut-off scores based on this sample are discussed.

Histological and profilometric evaluation of the root surface after instrumentation with a new piezoelectric device - ex vivo study

OBJECTIVES

An ex vivo model was designed to profilometrically and histologically assess root changes resulting from scaling with a new ultrasonic device, designed for bone piezoelectric surgery, in comparison with curettes.

METHODS

Three groups of 10 periodontal hopeless teeth were each subjected to different root instrumentation: Gracey curettes (CUR); ultrasonic piezoelectric device, Perio 100% setting, level 8 (P100); and ultrasonic piezoelectric device Surg 50% setting, level 1 (S50). After extraction, all teeth were photographed to visually assess the presence of dental calculus. The treated root surfaces were profilometrically evaluated (Ra, Rz, Rmax). Undecalcified histological sections were prepared to assess qualitative changes in cementum thickness. Statistical analysis was carried out using one-way anova test with a significance level of 95%.

RESULTS

Both instruments proved to be effective in the complete removal of calculus. The CUR group presented the lowest Ra [2.28 μm (±0.58)] and S50 the highest [3.01 μm (±0.61)]. No statistically significant differences were detected among the three groups, for Ra, Rz and Rmax. Histologically, there was a cementum thickness reduction in all groups, being higher and more irregular in S50 group.

CONCLUSIONS

Within the limits of this study, there were no statistically significant differences in roughness parameters analyzed between curettes and the ultrasonic piezoelectric unit. This new instrument removes a smaller amount of cementum, mainly at the Perio 100% power setting, which appears to be the least damaging. The ultrasonic device is effective in calculus removal, proving to be as effective as curettes.

Effects of cyclosporine and sirolimus on insulin-stimulated glucose transport and glucose tolerance in a rat model

Cyclosporine (CsA) and sirolimus (SRL) have been associated with undesirable side effects, including posttransplantation diabetes and hyperlipidemia, but the molecular mechanisms underlying these effects remain to be elucidated. Animal studies focusing on clinically relevant doses are advised. This study sought to compare the metabolic effects on isolated rat adipocytes treated with either CsA or SRL ex vivo and after long-term in vivo treatment in Wistar rats. We assessed the ex vivo effects of CsA (0.5-30 μmol/L) and SRL (1-250 μmol/L) on insulin-stimulated (14)C-glucose uptake in epididymal adipocytes (n = 6-9). In parallel, rats (n = 12) were treated with either vehicle, CsA (5 mg/kg/d) or SRL (1 mg/kg/d) for either 3 or 9 weeks. At the end of the treatment, glucose tolerance test (GTT) and insulin-stimulated (14)C-glucose uptake as well as biochemical parameters were analyzed. A significant reduction in the insulin-stimulated glucose uptake over basal was observed among isolated adipocytes, whether exposed ex vivo or in vivo to CsA or SRL treatment. Furthermore, the SRL group showed significantly lighter fat pads and smaller adipocytes at 3 weeks with a smaller gain in body weight throughout the study compared with either the vehicle or CsA cohorts. Glucose intolerance was observed after a GTT, at the end of the treatment with either drug. Additionally, at 9 weeks serum triglycerides were increased by CsA compared with vehicle or SRL treatment. Interestingly, although SRL-treated animals presented higher fed and fasted insulin levels compared with either group, suggesting insulin resistance, the CsA group presented lower fed and fasted insulin values, suggesting a defect in insulin secretion at 9 weeks. These results suggested that either ex vivo treatment of fat cells or in vivo treatment of rats with CsA or SRL impaired insulin-stimulated glucose uptake by adipocytes. Both drugs caused glucose intolerance, which altogether could be responsible for the development of posttransplantation diabetes.

[The postnatal contraception: upon 600 patients of whom 129 were postnatal controlled]

OBJECTIVE

To draw a parallel between the contraceptive methods prescribed in the post-natal ward and the contraceptive methods taken by patients during their postnatal visit.

PATIENTS AND METHODS

This piece of work draws information from a prospective 10 weeks study at a University Teaching Hospital post-natal ward on the contraception that is prescribed upon leaving the maternity ward and also at the time of the post-natal visit.

RESULTS

From the 600 cases studied, the analysis is about 129 patients reviewed in the post-natal visit. The percentage of loss was 78.5%. A hormonal contraceptive pill was prescribed to 73.5% of women (441 patients) after birth in which 63.5% had microprogestative pills. At the earliest, the IUD was given at about 5.4 weeks postpartum. At the time of the postnatal visit, compliance was bad for one third of women with either estrogen plus progestin methods, microprogestative or natural methods. Women who chose a barrier method were only 45.5% to follow this choice, the others left without contraception.

DISCUSSION AND CONCLUSION

The prescription of postpartum contraception was followed by only 66.6% of women. In order to prescribe a more effective contraceptive method, we must improve the prescriber's timing in sharing contraceptive information and completeness of the contraceptive methods offered.

The MSH2 c.388_389del mutation shows a founder effect in Portuguese Lynch syndrome families

The MSH2 c.388_389del mutation has occasionally been described in Lynch families worldwide. At the Portuguese Oncology Institute in Porto, Portugal, we have identified 16 seemingly unrelated families with this germline mutation. To evaluate if this alteration is a founder or a recurrent mutation we performed haplotype analysis in the 16 Portuguese index cases and 55 relatives, as well as in four index cases and 13 relatives reported from Germany, Scotland, England, and Argentina. In the Portuguese families we observed a shared haplotype of approximately 10 Mb and all were originated from the north of Portugal. These results suggest that this alteration is a founder mutation in Portugal with a relatively recent origin. In the reported families outside Portugal with this mutation different haplotype backgrounds were observed, supporting the hypothesis that it occurred de novo on multiple occasions. We also conclude that the high proportion of families with the MSH2 c.388_389del mutation indicates that screening for this alteration as a first step may be cost-effective in the genetic testing of Lynch syndrome suspects of Portuguese ancestry, especially those originating from the north of Portugal.

[Menopause and oncologic risks]

Since the Women's health Initiative (WHI) study published in 2002, hormonal replacement therapy (HRT) prescription is discussed, especially concerning the risk of cancer, and breast cancer in particular. This calling into question led France to publish in 2004 ANAES and AFFAPS recommendations. From recent literature data published by the EMAS, the North American Society and CNGOF, this study aim to discuss cancer risk under HRT. The relative risk (RR) of breast cancer varies from 1.26 in the WHI study to 1.66 in the Million Women Study, with different results according to the interval between menopause and starting hormone therapy and the modalities of HRT (different data for estrogen-only hormone therapy, or within the type of progestogen used). However, impact of breast cancer decreases since 2004, in which role of HRT is difficult to specify. Part of HRT in ovarian cancer is controversial, data being discordant in recent studies and mainly involving estrogen-only hormone therapy. Regarding protective property in endometrial cancer, the dose and duration of progestogen therapy seem to be the main factors. At last, there is no evidence as regards the role of HRT in drop of colon cancer incidence or increased mortality by pulmonary cancer. These updates data must be part of patient information before introducing HRT, in order to get the best evaluation of individual risk and benefit of this treatment.

Physical exercise reduces cardiac defects in type 2 spinal muscular atrophy-like mice

Spinal muscular atrophy (SMA), the leading genetic cause of death in infants worldwide, is due to the misexpression of the survival of motor neuron protein, causing death of motor neurons. Several clinical symptoms suggested that, in addition to motor neurons, the autonomic nervous systems could be implicated in the cardiac function alterations observed in patienst with SMA. These alterations were also found in a severe SMA mouse model, including bradycardia and a reduction of sympathetic innervation, both associated with autonomic imbalance. In the present study, we investigate the extent of autonomic dysfunction and the effects of a running-based exercise on the altered cardiorespiratory function in type 2 SMA-like mice. We observed that the SMA induced: (1) a dramatic alteration of intrinsic cardiac conduction associated with bradycardia; (2) a severe cardiomyopathy associated with extensive ventricular fibrosis; and (3) a delay in cardiac muscle maturation associated with contractile protein expression defects. Furthermore, our data indicate that the sympathetic system is not only functioning, but also likely contributes to alleviate the bradycardia and the arrhythmia in SMA-like mice. Moreover, physical exercise provides many benefits, including the reduction of cardiac protein expression defect, the reduction of fibrosis, the increase in cardiac electrical conduction velocity, and the drastic reduction in bradycardia and arrhythmias resulting in the partial restoration of the cardiac function in these mice. Thus, modulating the cardiorespiratory function in SMA could represent a new target for improving supportive care and for developing new pharmacological and non-pharmacological interventions that would most certainly include physical exercise.

Properties and osteoblast cytocompatibility of self-curing acrylic cements modified by glass fillers

Materials filled with a silicate glass (MSi) and a borate glass (MB) were developed and compared in terms of their in vitro behavior. The effect of filler composition and concentration (0, 30, 40 and 50 wt%) on the curing parameters, residual monomer, water uptake, weight loss, bioactivity, mechanical properties (bending and compression) and osteoblast cytocompatibility was evaluated. The addition of bioactive glass filler significantly improved the cements curing parameters and the mechanical properties. The most relevant results were obtained for the lower filler concentration (30 t%) a maximum flexural strength of 40.4 Pa for MB3 and a maximum compressive strength of 95.7 MPa for MSi3. In vitro bioactivity in acellular media was enhanced by the higher glass contents in the cements. Regarding the biological assessment, the incorporation of the silicate glass significantly improved osteoblast cytocompatibility, whereas the presence of the borate glass resulted in a poor cell response. Nevertheless it was shown that the surviving cells on the MB surface were in a more differentiated stage compared to those growing over non-filled poly(methyl methacrylate). Results suggest that the developed formulations offer a high range of properties that might be interesting for their use as self-curing cements.

Changes in cardiac tone regulation with fatigue after supra-maximal running exercise

To investigate the effects of fatigue and metabolite accumulation on the postexercicse parasympathetic reactivation, 11 long-sprint runners performed on an outdoor track an exhaustive 400 m long sprint event and a 300 m with the same 400 m pacing strategy. Time constant of heart rate recovery (HRRτ), time (RMSSD), and frequency (HF, and LF) varying vagal-related heart rate variability indexes were assessed during the 7 min period immediately following exercise. Biochemical parameters (blood lactate, pH, PO₂, PCO₂, SaO₂, and HCO₃⁻) were measured at 1, 4 and 7 min after exercise. Time to perform 300 m was not significantly different between both running trials. HHRτ measured after the 400 m running exercise was longer compared to 300 m running bouts (183.7 ± 11.6 versus 132.1 ± 9.8 s, P < 0.01). Absolute power density in the LF and HF bands was also lower after 400 m compared to the 300 m trial (P < 0.05). No correlation was found between biochemical and cardiac recovery responses except for the PO₂ values which were significantly correlated with HF levels measured 4 min after both bouts. Thus, it appears that fatigue rather than metabolic stresses occurring during a supramaximal exercise could explain the delayed postexercise parasympathetic reactivation in longer sprint runs.

Isolation and characterization of α,β-unsaturated γ-lactono-hydrazides from Streptomyces sp

Two novel α,β-unsaturated γ-lactono-hydrazides, geralcin A (2) and geralcin B (3), were isolated from Streptomyces sp. LMA-545. This unusual scaffold consists of the condensation of alkyl-hydrazide with an α,β-unsaturated γ-lactone, 3-(5-oxo-2H-furan-4-yl)propanoic acid (1), which was isolated from the same broth culture. Amberlite XAD-16 solid-phase extraction was used during the cultivation step, and the trapped compounds (1-3) were eluted from the resin with methanol. The structures were elucidated using (1)H, (13)C, and (15)N NMR spectroscopic analysis and high-resolution mass spectrometry. Geralcin B (3) was cytotoxic against MDA231 breast cancer cells with an IC(50) of 5 μM.