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Our aim was to identify factors associated with shoulder dystocia following an attempted operative vaginal delivery (aOVD) in a prospective cohort study and to evaluate whether these factors can be used to accurately predict shoulder dystocia by building a score of shoulder dystocia risk. This was a planned secondary analysis of a prospective cohort study of deliveries with aOVD at term from 2008–2013. Cases were defined as women with shoulder dystocia following an aOVD defined as a delivery that requires additional obstetric maneuvers following failure of gentle downward traction on the fetal head to effect delivery of the shoulders. Multivariate logistic regression analyses were performed to determine risk factors for shoulder dystocia. Shoulder dystocia occurred in 57 (2.7%) of the 2118 women included. In the whole cohort, women with shoulder dystocia more often had a history of shoulder dystocia (3.5% vs. 0.2%, p = 0.01), and there was a significant interaction between aOVD and gestational age and the duration of the second stage of labor: women with shoulder dystocia more often had a gestational age > 40 weeks and a second stage of labor longer than 3 h specifically for midpelvic aOVD. In multivariable analysis, a history of shoulder dystocia was the only factor independently associated with shoulder dystocia following aOVD (aOR 27.00, 95% CI 4.10–178.00). The AUC for the receiver operating characteristic curve generated using a multivariate model with term interaction with head station was 0.70 (95% CI 0.62–0.77). The model failed to accurately predict shoulder dystocia.

Members of the family Lamippidae are obligate endoparasitic copepods that typically associate with octocorals. In the present work, the association between Lamippe bouligandi and its bathyal sea pen host Anthoptilum grandiflorum was examined. A total of 1463 females and 23 males of L. bouligandi were collected from 195 colonies of A. grandiflorum. Details of the external morphology and digestive organs of the female copepod are used to refine our understanding of its feeding strategy and relationship with the host, and a preliminary overview of the male is provided for the first time. A combination of histology, scanning electron microscopy and laboratory monitoring of live sea pens hosting L. bouligandi were used to elucidate aspects of its life history, including the reproductive cycle, brooding strategy, and embryonic and larval development.

Gersemia rubiformis is a soft coral belonging to the family Nephtheidae, known to provide habitat for many organisms and to play an essential role in benthic ecosystems. The present study examined the relationship between G. rubiformis and the epibiotic amphipod Stenula nordmanni in the coastal waters of eastern Canada. The prevalence of the association was 100% with an average burden of 35 amphipods (mostly juveniles) per coral host. The sex ratio in the amphipods was female-biased and there was a distinct sexual dimorphism, males being significantly larger than females. In a single coral colony, about 38% of female amphipods were found to brood propagules at various stages of development up to juveniles. Upon release, juvenile amphipods were transparent and acquired the pink color characteristic of the adult by feeding on the coral tissues, thereby mimicking the coloration of the host. Ingestion of coral tissues was confirmed by the presence of host sclerites in the digestive tract of amphipods. In turn, amphipods were seen to protect their host by repulsing predatory nudibranchs approaching the coral colony. Together, findings suggest that the amphipods display a specific and obligate mutualistic association with their coral host, considering that they benefit from shelter and food, and the host benefits from active protection against potential predators. The apparent trophic relationship does not appear to generate any detriment to the host. In addition, some of the symbiotic amphipods examined were found to be hosts themselves, to chytrid fungi attached to their exoskeleton.

Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress disorder (PTSD) is a pathology that finds its roots in exposure to a life-threatening event or an event related to death. Exposure to fetal death during a late-term fetal demise is, therefore, a situation at risk of trauma. The objective of this study was to assess the prevalence of PTSD symptoms in the short term among patients faced with late fetal demise, and to identify potential risk factors. All women were assessed at 15 days, one month, and three months after late fetal demise using the Impact of Event Scale-Revised (IES-R) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). At 15 days, 44.2% of patients presented a pathological score on the IES-R (≥ 33). At one month and three months, this figure was 34.1% and 9.1% respectively. Factor associated with PTSD symptoms were: peritraumatic dissociation (p = 0.014), seeing the fetus during hospitalization (p = 0.035), holding the fetus in one’s arms (p = 0.046), and the organization of a funeral service (p = 0.025). Patients experiencing late fetal demise are at significant risk of trauma. Care providers should remain vigilant to identify high-risk situations to offer appropriate care.Clinical trials registration number: NCT03433989.

Avoiding the use of nasogastric tubes (NGTs) is recommended after colorectal surgery but there is no consensus on intraoperative gastric decompression using NGTs during colorectal surgery. The objective was to assess the effect of avoiding insertion of NGTs during colorectal surgery for the recovery of gastrointestinal (GI) functions. 1561 patients undergoing colorectal surgery, for whom information on NGT use was available, were included in this retrospective analysis and propensity score analysis of the prospective GRACE Audit database. Patients who did and did not have an NGT during surgery were compared. Among the study population of 1561 patients, 696 patients were matched to correct baseline differences between groups. The no-NGT group significantly improved GI motility impairment (e.g., less postoperative nausea [OR = 0.59; CI 95%: 0.42–0.84] and a better tolerance of early feeding [OR = 2.07; CI 95%: 1.33–3.22]). Such an association was also highlighted for reduced postoperative morbidity [OR = 0.60; CI 95%: 0.43–0.83], and especially pulmonary complications [OR = 0.08; CI 95%: 0.01–0.59], or parietal complications [OR = 0.29; CI 95%: 0.09–0.87]. The risk of postoperative ileus was not significantly reduced in the no-NGT group [OR = 0.67; CI 95%: 0.43–1.06]. No NGT insertion during colorectal surgery is safe and could improve postoperative GI function recovery.

The advantages of enhanced recovery programs (ERP) after colorectal surgery for morbidity and length of stay are well known. On a longer term, evidence is much more limited. The aim of this study is to determine the impact of ERP on survival after 3 years of follow-up, following colorectal cancer surgery.All the patients undergoing resection for colorectal cancer between the years 2010 and 2014 were included. Patients were classified according to their compliance with the ERP ( 70 or ≥ 70%).Among the 206 patients included during the period, 129 were male (62.6%). The 3-year overall survival rate was 70.4% (145 patients) and relapse-free survival was 59.2% (122 patients). The survival after 3 years was influenced by the initial metastatic status (p 0.0001), operative morbidity (p 0.001), and the presence of peritumoral emboli (p = 0.006). However, the compliance with the ERP ≥ 70% did not influence overall survival (p = 0.63), nor relapse-free survival (p = 0.93). The same observations were found among the "at-risk" population (synchronous metastasis and postoperative complication).The ERP does not seem to influence the 3-year relapse-free survival after colorectal resection for cancer.

International audience; PURPOSE: The quantification of mtDNA in cumulus granulosa cells (CGCs) surrounding an oocyte has been positively linked with morphological embryonic quality. In the present study, we evaluated the link between the amount of mtDNA in CGCs surrounding an oocyte and the chances for the corresponding embryo of implanting and leading to an ongoing pregnancy.METHODS: This is an observational study, performed on 84 oocyte-cumulus-complexes (OCCs) having led to the replacement of an embryo in the maternal uterus, retrieved from 71 patients undergoing IVF with intracytoplasmic sperm. The OCCs were classified in two groups, one including 26 OCCs having led to an implanted embryo and the other including 58 OCCs having led to a non-implanted embryo. The average mtDNA content of CGCs was assessed by using a quantitative real-time PCR technique.RESULTS: Significantly higher mtDNA copy numbers in CGCs were associated with implanted embryos than with non-implanted embryos (mean 215 [sd 375] and 59 [sd 72], respectively; p CONCLUSION: During in vitro fertilization (IVF) procedures, the probability of the implantation of the embryo appears to be closely correlated to the mtDNA copy numbers in the CGCs. Our results highlight the interest of mtDNA quantification in GCGs as a biomarker of the potential of embryo implantation.

In the list of participating investigators that appears in Acknowledgements, one of the investigators names appears incorrectly.

Although hydrostatic pressure is one of the most prominent abiotic drivers of faunal bathymetric ranges, it is one of the least understood. To better understand hyperbaric constraints on depth distributions, we explored responses to high pressure of adult echinoderms from eastern Canada. The sea urchin Strongylocentrotus droebachiensis, the sea star Leptasterias polaris and the sea cucumber Cucumaria frondosa were exposed to various pressures within and beyond their known bathymetric distribution (i.e. surface pressure; pressure at the midpoint in bathymetric distribution; pressure at twice the maximum depth in the species bathymetric distribution) for different durations (24 h, 72 h, 9 days). Survival was compromised by exposure to the highest pressure levels, with the sea urchin exhibiting the highest mortality. After 72-h exposure, mortality was observed for sea urchin and sea cucumber individuals while all sea star individuals survived. Following 9-day exposure of sea star individuals to high pressure, 100% mortality occurred. Exposure to pressures typical of natural distributions had little effect on the selected health and motor metrics. Pressures atypical of natural ranges negatively affected the motor functions of all species, irrespective of exposure duration. During and after 24-h exposure, feeding was reduced in sea urchin and sea cucumber individuals, but was unchanged in sea star individuals. Overall, there were no clear signs of acclimation to high pressure following sustained periods of exposure in any species. These results highlight constraints applied by hydrostatic pressure beyond current bathymetric ranges on life-sustaining behaviours in echinoderms. The potential of long-lived echinoderms to survive downward migration to greater depths is species-specific, suggesting there may be winners and losers in the face of near-future climate-driven migration patterns.

Understanding the trophic ecology of deep-sea communities provides valuable insight into deep-water ecosystem functioning, and can help inform fisheries management and conservation initiatives. However, few deep-sea food webs have been studied so far in the Northwest Atlantic. Here, stable isotope, gut content, and morphometric analyses were combined to explore trophic relationships in a deep-water fish assemblage off eastern Canada. While a weak depth effect was found on the isotopic composition of the species analyzed, isotopic and dietary records revealed the existence of two main, strongly coupled trophic pathways. The pelagic pathway either comprised pelagic fishes (e.g., meso- and bathypelagic species), primarily feeding on zooplankton and fish, or benthopelagic predators that showed a more pelagic-oriented diet. Such fishes displayed the lowest values of stable N and C isotope ratios. In contrast, demersal fishes representing the benthic trophic pathway had significantly higher values of δ15N and δ13C, and a taxonomically more benthic-oriented and diverse diet. Furthermore, smaller body sizes, larger mouths, and adaptations (e.g., bioluminescent structures and lures) prevailed in the pelagic species, consistent with living in a relatively food-poor environment. The largest average body sizes were found in the demersal fishes suggesting enhanced food intake and growth investment for the species. Only juvenile individuals of threatened species, such as Coryphaenoides rupestris and Rajella fyllae were caught, providing evidence of the vulnerability of such species to commercial fishing.

Cultural differences and/or poor linguistic validation of patient-reported outcome (PRO) instruments may result in differences in the assessment of the targeted concept across languages. In the context of multinational clinical trials, these measurement differences may add noise and potentially measurement bias to treatment effect estimation. Our objective was to explore the potential effect on treatment effect estimation of the “contamination” of a cultural subgroup by a flawed PRO measurement. We ran a simulation exercise in which the distribution of the score in the overall sample was considered a mixture of two normal distributions: a standard normal distribution was assumed in a “main” subgroup and a normal distribution which differed either in mean (bias) or in variance (noise) in a “contaminated” subgroup (the subgroup with potential flaws in the PRO measurement). The observed power was compared to the expected power (i.e., the power that would have been observed if the subgroup had not been contaminated). Even if differences between the expected and observed power were small, some substantial differences were obtained (up to a 0.375 point drop in power). No situation was systematically protected against loss of power. The impact of poor PRO measurement in a cultural subgroup may induce a notable drop in the study power and consequently reduce the chance of showing an actual treatment effect. These results illustrate the importance of the efforts to optimize conceptual and linguistic equivalence of PRO measures when pooling data in international clinical trials.

International audience; BACKGROUND: Incarcerated hernias represent about 5-15% of all operated hernias. Tension-free mesh is the preferred technique for elective surgery due to low recurrence rates. There is however currently no consensus on the use of mesh for the treatment of incarcerated hernias, especially in case of bowel resection.AIM: The aims of this study were (i) to report our current practice for the treatment of incarcerated hernias, (ii) to identify risk factors for postoperative complications, and (iii) to assess the safety of mesh placement in potentially infected surgical fields.METHODS: This retrospective study included 166 consecutive patients who underwent emergency surgery for incarcerated hernia between January 2007 and January 2012 in two university hospitals. Demographics, surgical details, and short-term outcome were collected. Univariate analysis was employed to identify risk factors for overall, infectious, and major complications.RESULTS: Eighty-four patients (50.6%) presented inguinal hernias, 43 femoral (25.9%), 37 umbilical hernias (22.3%), and 2 mixed hernias (1.2%), respectively. Mesh was placed in 64 patients (38.5%), including 5 patients with concomitant bowel resection. Overall morbidity occurred in 56 patients (32.7%), and 8 patients (4.8%) developed surgical site infections (SSI). Univariate risk factors for overall complications were ASA grade 3/4 (P = 0.03), diabetes (P = 0.05), cardiopathy (P = 0.001), aspirin use (P = 0.023), and bowel resection (P = 0.001) which was also the only identified risk factor for SSI (P = 0.03). In multivariate analysis, only bowel incarceration was associated with a higher rate of major morbidity (OR = 14.04; P = 0.01).CONCLUSION: Morbidity after surgery for incarcerated hernia remains high and depends on comorbidities and surgical presentation. The use of mesh could become current practice even in case of bowel resection.

The deep-sea pennatulacean coral Anthoptilum grandiflorum exhibits a cosmopolitan distribution and was recently determined to serve as habitat for other invertebrates and fish larvae in the northwest Atlantic. Colonies collected at bathyal depths between 2006 and 2010 in eastern Canada were analysed to determine their fecundity and characterize spatial and temporal trends in their reproductive cycle. Anthoptilum grandiflorum is a gonochoric broadcast spawner with a sex ratio that does not differ significantly from equality (although one hermaphrodite colony was observed). In male colonies, all the spermatocysts synthesized become mature over the annual cycle, while only ~21 % of the initial production of oocytes reaches maturity in female colonies. Female potential fecundity based on mature oocytes just before spawning was on average 13 oocytes polyp−1; male potential fecundity was 48 spermatocysts polyp−1. The spawning period of A. grandiflorum differs between geographic regions, from April (in southern Newfoundland) to July (in Labrador), closely following regional spring phytoplankton blooms after accounting for the deposition of planktic detritus. Release of oocytes by a live colony held in the laboratory was recorded in April 2011, coincident with field data for similar latitudes. Seawater temperatures at the time of spawning were around 3.6–4.8 °C in all regions and in the laboratory. Early stages of gametogenesis were detected in colonies collected shortly after the spawning season, and early and late growth stages occurred successively until December. Mature colonies were observed between April and July (depending on latitude). The diameter of mature oocytes (~1,100 μm maximum diameter) is consistent with lecithotrophic larval development.

This study developed an objective quantitative method for detecting small-scale temporal or spatial differences in gametogenesis in echinoderms. The method was applied to conventional monthly samples of the planktotrophic brittle star, Ophiopholis aculeata, collected at a single site in Newfoundland (eastern Canada) at 10–15 m depth. The samples were analysed to determine gonad index, oocyte size and gonadal stage using histology. The maturity stage index (MSI) was developed to integrate a measure of brittle star size (disc diameter), oocyte size and oocyte density. The MSIs ranged from 0 to 800 and had significantly different means among the four gametogenic stages (early growth, growth, mature and spent). The MSI was more sensitive in revealing significant differences between consecutive stages than any of its individual constituents. The MSI was also applied to gametogenic data from the lecithotrophic holothuroid, Mesothuria lactea, again revealing significant differences between successive oogenic stages. This method is expected to be useful in field and experimental studies of gametogenesis in echinoderms (and possibly other taxa), where it is important to detect not just the timing of annual peaks in reproduction but small differences in reproductive status among individuals or populations (e.g. from different habitats or feeding regimes).

The stiffness of large arteries has an important role in cardiovascular hemodynamics. Aortic stiffness (AoStiff) can be assessed non-invasively with regional and local methods. In this paper, we compared these two techniques for evaluating AoStiff. Our subjects comprised of 118 consecutive patients (85 men, mean age: 49 ± 14 years). We evaluated regional AoStiff with carotid-femoral pulse wave velocity (PWV) measured with a tonometric technique and by bioelectrical impedance (BI) wave velocity (IWV). The local AoStiff was calculated from BI signals recorded at the chest. We used glyceryl trinitrate (GTN) to test the effect of peripheral vasodilatation on both methods in a subgroup of 52 patients (37 men, mean age: 52 ± 11 years). We found a significant correlation between IWV and PWV measurements (r = 0.88, P < 0.0001) as well as between AoStiff and PWV measurements (r = 0.75, P < 0.0001). GTN administration decreased mean arterial blood pressure by 4% (95% confidence interval: 2-8%, P = 0.002) without significant changes in AoStiff and regional IWV. Local AoStiff is correlated with regional measurements and is not influenced by changes in arterial pressure because of systemic peripheral vasodilatation.

The patterns of genetic diversity and connectivity were investigated in Cucumaria frondosa, the most abundant sea cucumber in the North Atlantic, to assist in the management and conservation of this ecologically important marine invertebrate, which is the target of an emerging fishery. Mitochondrial DNA COI sequences of 334 C. frondosa were obtained and analyzed, mainly from its western North Atlantic range, where the commercial fishery is being developed, with complementary sampling in the mid- and eastern North Atlantic. Analysis of molecular variance showed no significant (P > 0.05) differences among subpopulations in the western region suggesting that it constitutes one panmictic population. The same analysis showed low, but significant differences between eastern and western Atlantic populations. Coalescent analyses using isolation with migration models and a Bayesian skyline plot indicated historical divergence and a general increase in population size prior to the last glacial maximum and highly asymmetric gene flow (nearly 100 times lower from west to east) between sea cucumbers from North America and Norway. Results suggest that subpopulations of C. frondosa within the western North Atlantic have been highly connected. We propose that aided by the high-connectivity local subpopulations can recover rapidly from natural (i.e., ice ages) or anthropogenic (i.e., overfishing) population declines through recruitment from deep refugia.

Increasing threats to deep-sea corals highlight the need to expand knowledge of these taxa so that conservation measures can be developed. The present study focused on the reproductive patterns of the deep-sea solitary coral Flabellum angulare. A series of samples (n = 398) collected in 2006–2008 in the northwest Atlantic at depths of 925–1,430 m revealed that gametogenesis was synchronous among males and females and fluctuated seasonally. Initiation of gamete synthesis was estimated to be in August–September and spawning in June. Further analysis and daily monitoring of 30–60 individuals maintained in a flow-through mesocosm showed that gamete release occurred in March–June with a peak in May. Release of oocytes coincided with rising seawater temperatures and high deposition rates indicative of elevated water column productivity. Oocytes (900–1,200 μm diameter) were released through the oral cavity, generally in bundles of 3–5 surrounded by mesenterial filaments and attached to a thread (30–50 mm long). As oocytes became free in the water column, ovulation occurred followed by fertilization. Eggs/embryos initially remained on the tentacles of the spawner before either falling onto the substratum or floating to the surface. The embryos developed into planula larvae measuring 2–3 mm in length within about 24 h. Together, these findings shed new light on the strategies used by deep-sea corals to maximize their reproductive success.

While breeding synchrony among conspecifics is increasingly well understood with regards to the reproductive success of vertebrate and invertebrate taxa, the occurrence of simultaneous multispecies breeding events remains intriguing. The fairly recent discovery of mass annual spawnings in reef corals has provided a first glimpse at putative strategies of reproductive isolation during such events. However, the mechanisms and advantages of same-day heterospecific breeding are still poorly understood and have not yet been investigated in non-coral taxa with different life history strategies. In an effort to bridge this gap, we investigated spawning periodicity and synchrony among 26 sympatric species of free-spawning, capsule-laying, and brood-protecting macroinvertebrates belonging to six different phyla. Twenty-four of these species released gametes or larvae between early March and late April. We analyzed the events over fine temporal scales to test the hypothesis that breeding activities were not random in time or relative to each other. We found that the two main reproductive pulses followed a lunar periodicity and that consistent species- and gender-specific modulations in the timing of spawning occurred during same-day episodes involving up to six free-spawning species. Mass spawning accounts from the literature were reviewed and compared. This work suggests that many species participate in synchronous heterospecific spawning events either because they respond to the same environmental cues or rely on cross-cueing and that reproductive isolation is favored by species-specific circadian patterns, spawning behaviors and cross-gender signaling.

The present study examined the mode and timing of reproduction of poorly understood deep-water octocorals and the environmental factors that may influence their reproductive patterns. Data on reproductive characteristics of the octocoral Drifa glomerata (Alcyonacea: Nephtheidae) collected between 2004 and 2007 at ca. 100–330 m depth off Newfoundland and Labrador (eastern Canada) were compared among years, months and depth ranges. No male gonad was ever observed during the study. The ratio of fertile colonies possessing large pinkish polyps with oocytes/planulae was >50% throughout the year. The number of brooded planula larvae within a single fertile polyp varied between 1 and 10 for a total of approximately 40–3,000 in a whole colony. The size of oocytes and/or planulae was consistently greater in the polyps than in the branchlets, indicating that the development pathway of oocytes to planulae is from the branchlets to the polyps. Although larval production seemed to persist year round, the onset of major planulation events occurred in December–January of two consecutive years, when large mature planulae were released in correlation with the first increase of photoperiod and maximum temperature at 150 m. A second peak in planulation between April and early June followed the phytoplankton bloom. Seasonal trends were more apparent in colonies from

Combining field and laboratory work, this study investigated the reproductive cycle, aggregative behavior, spawning periodicity, development and early growth of the sea star Henricia lisa living at bathyal depths off eastern Canada. Marked differences were found between individuals from ~1,300 and ~600 m deep. The former had a male biased sex ratio and an aperiodic reproductive cycle, whereas the latter displayed an equal sex ratio and a biannual breeding pattern. Furthermore, the maximum size was larger and female fecundity roughly five times higher in shallower compared to deeper populations. In the tanks, aggregative behavior was recorded twice a year during the summer and winter breeding periods. The onset of aggregations and spawning coincided with a temperature of 3–4°C. Males spawned first and females typically responded inside 30–60 min. Between 12 and 20 eggs were retained to be brooded under the arched arms of the female, whereas the remainder were broadcasted and developed without parental care. The fertilized eggs underwent a first cleavage after 12 h, reached the brachiolaria stage in 1 month, became juveniles within 3–4 months and reached ~ 4 mm in diameter after 14–17 months of growth. The embryos and juveniles developed at the same rate whether brooded or not, and development of winter cohorts was typically slower due to lower prevailing temperatures. This study of H. lisa provides the first evidence of lecithotrophy in a seasonally breeding deep-sea echinoderm and of brooding in a deep-sea asteroid.

This study investigated the influence of environmental factors on the foraging cycle, breeding activity, settlement and growth of the opisthobranch Hydatina physis using laboratory trials and field observations. Results showed that H. physis follows a nocturnal circadian rhythm mediated by photic intensity and modulated by food availability. The adults foraged between 1900 and 0530 h, with an activity peak between 2000 and 2200 h, and remained inactive and burrowed in the sand during the day. This pattern was clearly influenced by cloud cover, rain and laboratory manipulated light:dark cycle. The reproduction of H. physis was primarily influenced by the lunar cycle. For 4 consecutive months, hermaphroditic reciprocal copulation, preceded by pre-copulatory courtship behaviour, occurred at night 5–7 d before the full moon. Spawning occurred 3–5 d later for up to 5 consecutive nights, the egg mass gradually decreasing in size with each spawning. An overcast sky or rain prevented or delayed both copulation and egg release. Settlement of veligers was largely influenced by the nature of the substrate. In multiple-choice experiments, settlement occurred predominantly on sand containing cirratulid polychaetes. The juveniles reached ca. 3.9 mm in shell length after 5.5 months growth.

Samples of Echinarachnius parma (Lamarck), collected during summer 1988 from three sites along the eastern coast of Canada (the northern Gulf of St. Lawrence, Chaleur Bay and the Bay of Fundy), showed sexual dimorphism in the shape of the oral surface in addition to marked changes in the camber of the aboral surface related to the strength of wave and current activity. The oral surface is more concave in males than in females. The dimorphism develops as individuals become sexually mature and is pronounced for individuals measuring >4 cm in diameter. Associated with this shape difference, the volume of females is greater than for males, and this corresponds to the larger size attained by the ovaries compared to the testis. Shape differences between males and females are rare in echinoderms, and E. parma is the first species for which the sexes can be separated with a high degree of accuracy (>80%) on the basis of shape.