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Sustained operations (SUSOPS) require military personnel to conduct combat and training operations while experiencing physical and cognitive stress and limited sleep. These operations are often conducted in a state of negative energy balance and are associated with degraded cognitive performance and mood. Whether maintaining energy balance can mitigate these declines is unclear. This randomized crossover study assessed the effects of energy balance on cognitive performance, risk-taking propensity, ambulatory vigilance, and mood during a simulated 72-h SUSOPS.Ten male Soldiers (mean ± SE; 22.4 ± 1.7 y; body weight 87.3 ± 1.1 kg) completed two, 72-h simulated SUSOPS in random order, separated by 7 days of recovery. Each SUSOPS elicited ∼4500 kcal/d total energy expenditure and restricted sleep to 4 h/night. During SUSOPS, participants consumed either an energy-balanced or restricted diet that induced a 43 ± 3% energy deficit. A cognitive test battery was administered each morning and evening to assess: vigilance, working memory, grammatical reasoning, risk-taking propensity, and mood. Real-time ambulatory vigilance was assessed each morning, evening, and night via a wrist-worn monitoring device.Participants exhibited heightened risk-taking propensity (p = 0.047) with lower self-reported self-control (p = 0.021) and fatigue (p = 0.013) during energy deficit compared to during energy balance. Vigilance accuracy (p 0.001) and working memory (p = 0.040) performance decreased, and vigilance lapses increased (p 0.001) during SUSOPS, but did not differ by diet. Percentage of correct responses to ambulatory vigilance stimuli varied during SUSOPS (p = 0.019) independent of diet, with generally poorer performance during the morning and night. Total mood disturbance (p = 0.001), fatigue (p 0.001), tension (p = 0.003), and confusion (p = 0.036) increased whereas vigor decreased (p 0.001) during SUSOPS, independent of diet.Prolonged physical activity combined with sleep restriction is associated with impaired vigilance, memory, and mood state. Under such conditions, maintaining energy balance prevents increased risk-taking and improves self-control, but does not improve other aspects of cognitive function or mood. Given the small sample in the present study, replication in a larger cohort is warranted.

Resume Objectif Chez les femmes atteintes d’endometriose symptomatique et n’ayant plus de desir de grossesse, l’hysterectomie associee ou non a une annexectomie bilaterale est souvent presentee comme une solution definitive a leurs symptomes. Malgre ce traitement radical, il faut savoir que pres de 15 % de ces patientes auront des douleurs persistantes. Ainsi l’objectif de cette revue etait determiner l’interet de l’hysterectomie totale associee ou non a une annexectomie bilaterale pour le traitement de l’endometriose profonde. Methode Les recherches ont ete realisees a partir de la US National Library of Medicine National Institutes of Health a partir des mots cles suivant : endometriosis, hysterectomy, oophorectomy, ovariectomy, radical treatment. Uniquement les articles rediges en anglais ont ete selectionnes. Resultats et recommandations L’hysterectomie avec ou sans annexectomie bilaterale, associee a l’exerese des lesions d’endometriose pourrait diminuer le taux de recidive et de reinterventions chirurgicales par rapport a la resection seule des lesions d’endometriose (NP4). Chez les femmes sans desir de grossesse, la balance benefice-risque d’une hysterectomie, avec ou sans annexectomie bilaterale, peut etre discutee dans le but de reduire le risque des recidives de la maladie endometriosique (accord d’experts). En tenant compte des effets defavorables multiples de la menopause precoce sur l’esperance et la qualite de vie (NP2), la conservation ovarienne doit etre discutee avec la patiente en cas d’hysterectomie pour endometriose profonde (accord d’experts). L’utilisation d’un traitement hormonal de la menopause (THM) ne semble pas augmenter les symptomes d’endometriose apres castration chirurgicale (NP3). Le THM n’est pas contre-indique chez les femmes menopausees operees d’une endometriose (grade C).

Background The 2010 Healthy Eating Index (HEI-2010), a measure of diet quality, is used to quantify adherence to the Dietary Guidelines for Americans. Better HEI scores have been associated with positive health outcomes; however, the relationship between diet quality and psychological resilience, a mental health attribute for coping with adversity, has not been assessed. Objective The objective of the present study was to assess the relationship between diet quality and psychological resilience, and the relationship between resilience and demographics, anthropometrics, socioeconomic status, and health behavior. Design In this cross-sectional study, HEI-2010 scores and resilience were assessed using the Block food frequency questionnaire and the Connor-Davidson Resilience Scale. Other factors that can affect the relationship between HEI-2010 scores and resilience were assessed using surveys, and height and weight were measured to calculate body mass index. Participants/setting Male and female Army and Air Force recruits (n=834) enrolled in a randomized controlled trial and 656 (mean±standard deviation [SD] age=21±3.3 years) were included in this analysis. Data were collected before the initiation of military training at Fort Sill, OK (2012-2013) and Lackland Air Force Base, TX (2013-2014). Statistical analysis performed Participants were split into low- and high-resilience groups based on Connor-Davidson Resilience Scale scores. Student's t test and χ 2 tests were used to determine differences between groups for continuous and categorical variables, respectively. Logistic regression was utilized to identify predictors of resilience. Results Better diet quality was associated with resilience; higher HEI predicted an increased likelihood (odds ratio=1.02; 95% CI 1.01 to 1.04) of a participant being in the high-resilience group after including race, ethnicity, education, smoking, age, body mass index, sex, and military branch in the full model. The data indicate that with every 10-point increase in HEI score, there was a 22% increased likelihood of being in the high-resilience group. Conclusions Registered dietitian nutritionists should continue to encourage attainable changes to improve diet; study data suggest that small improvements in diet quality can be associated with better psychological resilience.

A method for assessing the relative sensitivity of research metrics is proposed and illustrated by comparing 18 outcome measures from a published study of the cognitive, mood, and hormonal effects of four different levels of stress induced by intense military training. Research on the human response to stress often assesses multiple disparate dependent measures. Selecting the most sensitive is difficult as formal methods to compare varied dependent measures have not been developed. The method first converts the outcome measures into standard scores (z-scores) and then compares them using analysis of variance to determine whether there are differences in how they assess the impact of graded levels of exposure to stress. The analysis detected various significant interactions in several measures and suggests self-report mood questionnaires were more sensitive to the stressors present in the study than the cognitive or hormonal measures which were used. These findings support the effectiveness of the z-score based method as a useful procedure for objectively evaluating the differential sensitivity of various metrics. This method could be useful for research on other independent variables when use of multiple assessment strategies is appropriate. It could be used for evaluating studies yielding conflicting results, such as those detecting effects on one parameter but not others. In such instances, cross-metric inconsistencies may be due to differential sensitivity of measurement strategies rather than actual differences in the effects of the independent-variable on the domains under investigation.

Stress influences numerous psychological and physiological processes, and its effects have practical implications in a variety of professions and real-world activities. However, few studies have concurrently assessed multiple behavioral, hormonal, nutritional and heart-rate responses of humans to acute, severe stress. This investigation simultaneously assessed cognitive, affective, hormonal, and heart-rate responses induced by an intensely stressful real-world environment designed to simulate wartime captivity. Sixty males were evaluated during and immediately following participation in U.S. Army Survival, Evasion, Resistance, and Escape (SERE) school, three weeks of intense but standardized training for Soldiers at risk of capture. Simulated captivity and intense mock interrogations degraded grammatical reasoning (p

First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.

First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.

In women with symptomatic endometriosis and no desire for pregnancy, hysterectomy with or without bilateral oophorectomy is often presented as a definitive solution to their symptoms. Despite this radical treatment, it should be known that nearly 15% of these patients will have persistent pain. Thus the objective of this review was to determine the interest of total hysterectomy with or without bilateral oophorectomy for the treatment of deep endometriosis.The research was conducted from the US National Library of Medicine's National Institutes of Health from the following keywords: endometriosis, hysterectomy, oophorectomy, ovariectomy, radical treatment. Only articles written in English have been selected.Hysterectomy with or without bilateral oophorectomy, associated with endometriotic lesions exeresis could decrease the rate of recurrence and surgical reoperations compared to resection alone endometriosis lesions (NP4). In women with no desire for pregnancy, the benefit-risk balance of a hysterectomy, with or without bilateral oophorectomy, may be discussed in order to reduce the risk of recurrence of endometriotic disease (Expert Agreement). Taking into account the multiple adverse effects of early menopause on expectancy and quality of life (NP2), ovarian preservation should be discussed with the patient in case of hysterectomy for deep endometriosis (Expert Agreement). The use of menopausal hormone therapy (THM) does not appear to increase the symptoms of endometriosis after surgical castration (NP3). THM is not contraindicated in postmenopausal women with endometriosis (grade C).

Although exceptional, endometriotic lesions of the troncular nerves of the lower limb may occur and are often diagnosed with delay. We report, hereby, the first case of femoral nerve endometriosis the treatment of which consisted of radical resection with femoral nerve transplant. We completed a review of the literature on sciatic nerve endometriotic lesions and discussed the physiopathology and surgical treatment.

Objective: This study investigated whether a stressful military training program, the 9- to 10-week U.S. Army basic combat training (BCT) course, alters the cognitive performance and mood of healthy young adult females. Background: Structured training programs including adolescent boot camps, sports training camps, learning enrichment programs, and military basic training are accepted methods for improving academic and social functioning. However, limited research is available on the behavioral effects of structured training programs in regard to cognitive performance and mood. Method: Two separate, within-subject studies were conducted with different BCT classes; in total 212 female volunteers were assessed before and after BCT. In Study 1, Four-Choice Reaction Time, Match-to-Sample, and Grammatical Reasoning tests were administered. The Psychomotor Vigilance Test (PVT) was administered in Study 2. The Profile of Mood States (POMS) was administered in both studies. Results: In Study 1, reaction time to correct responses on all three of the performance tests improved from pre- to post-BCT. In Study 2, PVT reaction time significantly improved. All POMS subscales improved over time in the second study, whereas POMS subscales in the first study failed to meet criteria for statistically significant differences over time. Conclusion: Cognition and mood substantially improved over military basic training. These changes may be a result of structured physical and mental training experienced during basic training or other factors not as yet identified. Application: Properly structured training may have extensive, beneficial effects on cognitive performance and mood; however, additional research is needed to determine what factors are responsible for such changes.

Gynecologie Obstetrique & Fertilite - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le vendredi 25 septembre 2015

Tubal sterilization, of common practice all over the world, has had a quick spread in France since its legalization in 2001 and the income of a new hysteroscopic method. As a matter of fact, France is the second greater country for women having Essure® and the first country where Essure® method forestall surgical tubal ligation. Thus we focus on good practice and update knowledge about Essure® method.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 41 - N° 2 - p. 194-197

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 8 - p. 944-952

Resume Objectifs L’objectif de cette etude etait de mettre en evidence des facteurs statistiquement lies a une evolution perinatale favorable lorsqu’un cerclage cervical avait ete realise en urgence pour incompetence cervicale au deuxieme trimestre de grossesse. Patientes et methodes Il s’agit d’une etude retrospective sur l’evolution des grossesses ayant eu un cerclage en urgence entre 16 et 28 semaines d’amenorrhee (SA), au centre hospitalier universitaire de Clermont-Ferrand sur une periode de 16 ans. Resultats Pour les 32 grossesses cerclees, le taux de survie postnatal a 28 jours etait de 80 %. L’âge gestationnel (AG) moyen a l’accouchement etait de 33,1 SA [18–41,3 SA]. L’accouchement est survenu apres 37 SA dans 39 % des cas. La survie postnatale a 28 jours etait amelioree en l’absence de metrorragies avant ou lors du diagnostic (p = 0,01), lorsque le col n’etait pas efface (p = 0,02), la dilatation cervicale etait de moins de 2 cm (p = 0,002), en l’absence de protrusion des membranes (p = 0,02) et lorsque l’AG etait plus avance au moment du cerclage (p = 0,005). Une expectative de 48 heures entre le diagnostic d’incompetence cervicale et la realisation du cerclage, en l’absence de contractions uterines ou de syndrome inflammatoire biologique, ne permettait pas d’ameliorer de facon significative le devenir perinatal (AG a la naissance [p = 0,1] et taux de survie a j28 [p = 0,3]). Discussion et conclusion L’evolution d’une grossesse apres cerclage en urgence est fonction des conditions cervicales et de l’AG lors de la realisation du geste. Une expectative de 48 heures entre le diagnostic et le cerclage n’ameliore pas le pronostic en l’absence de contractions uterines ou de syndrome inflammatoire.

Resume Objectif L’objectif de cette etude etait d’analyser les resultats de nos trois premieres annees de photocoagulation-laser (PL) et de comparer le devenir perinatal des grossesses gemellaires compliquees d’un syndrome transfuseur-transfuse (STT) avant et apres la mise en place du traitement par PL. Patients et methodes Cette etude retrospective de type avant/apres a ete menee dans un seul centre. Elle comparait le devenir perinatal d’enfants issus de 19 grossesses consecutives compliquees de STT au deuxieme trimestre et traitees par amniodrainages iteratifs (AI), sur une periode de dix ans, a celui d’enfants issus de 49 grossesses consecutives compliquees de STT et traitees par PL, sur une periode de trois ans. Resultats La PL ameliorait de facon significative la survie a la naissance ( p = 0,02) et apres 28 jours de vie ( p = 0,01), sans variation significative des taux de complications neurologiques ( p = 0,5) et cardiologique ( p = 0,3). Le taux de survie du donneur etait significativement augmente par la PL a la naissance ( p = 0,04). Discussion et conclusion Cette etude confirme la superiorite de la PL par rapport a l’AI. Elle montre sa faisabilite par une equipe emergente avec des resultats comparables a ceux d’equipes experimentees.

Resume Objectif Comparer, selon differents delais postoperatoires, l’intensite des douleurs en evaluant differentes techniques utilisant ou non des renforts prothetiques. Patientes et methode Cent trente-deux patientes operees consecutivement d’un prolapsus genital entre 2006 et 2008 par voie vaginale dont la moitie par reparation par tissu autologue et la moitie par renforts prothetique (Prolift™). L’evaluation etait prospective par questionnaire cotant l’echelle visuelle analogique (Eva) de douleur, a j1 postoperatoire, a la sortie du service, au premier mois postoperatoire et a l’evaluation entre le troisieme et le sixieme mois postoperatoire. Les facteurs etudies etaient : l’utilisation de renfort prothetique, l’âge, une cure de prolapsus prealable, la realisation d’une hysterectomie, la realisation d’une sacrospinofixation, l’association d’une bandelette sous-uretrale, le stade POP-Q pre- et postoperatoire. Resultats L’utilisation de renfort prothetique est significativement plus douloureuse le jour de la sortie d’hospitalisation en comparaison a la reparation autologue (Eva a 1,2 ± 1,8 contre 0,5 ± 0,9 ; p = 0,021). Les scores d’Eva des deux groupes n’offrent plus de difference significative a M1 et a M3–6. L’analyse montre que l’hysterectomie influence de maniere significative la survenue de douleurs a j1 postoperatoire, avec une simple tendance pour la sacrospinofixation a j1 ( p = 0,08). Les bandelettes sous-uretrales associees a une reparation autologue sont significativement plus douloureuses a j1 que lorsqu’elles sont associees a une reparation prothetique. Discussion et conclusion Les cures de prolapsus par voie vaginale offrent des suites operatoires peu douloureuses (Eva

L’uterus cicatriciel est devenu le premier motif de cesarienne iterative. Le risque de rupture uterine est estime autour de 0,7 ‰, et environ 600 cesariennes seraient necessaires pour eviter une complication neonatale grave. Parallelement, la morbidite maternelle a augmente par les anomalies d’insertions placentaires, responsables de complications hemorragiques graves. Il convient de discuter avec le couple de la voie d’accouchement en cherchant d’abord a identifier d’emblee toute contre-indication a la voie basse, puis les arguments favorables au succes de celle-ci. En cas de cesarienne prophylactique, on attendra 39 SA pour diminuer la morbidite respiratoire fœtale. En cas de declenchement, il faudra respecter les recommandations de la Haute Autorite de Sante (HAS) et informer la patiente du risque majore de rupture uterine.

Resume Objectif Definir les modalites de realisation et les risques encourus en cas de geste invasif a visee diagnostique (amniocentese/choriocentese) dans un contexte de grossesse gemellaire. Materiel et methodes Une recherche bibliographique PubMed a ete realisee ainsi qu’une consultation de la base de donnees Cochrane et des recommandations de plusieurs societes savantes. Resultats Le risque de perte d’une grossesse gemellaire apres geste invasif apparait un peu plus eleve que celui observe sur singleton soit de l’ordre de 1,5-2% pour une amniocentese realisee apres 15 SA et de l’ordre de 2% pour une choriocentese realisee au premier trimestre (NP3). Le prelevement systematique des deux conceptus n’est pas toujours necessaire. Toutefois la demande du couple peut conduire a le realiser (avis d’expert). Les prelevements ovulaires sur grossesse gemellaire comportent plusieurs risques specifiques : prelevement redondant, permutation des echantillons et mauvaise identification du fœtus atteint en cas de discordance. Pour lutter contre ces risques, il est recommande que le prelevement soit assure par un operateur entraine, sous echoguidage permanent, apres un reperage topographique soigneux consigne dans un schema ou figurent les insertions placentaires et funiculaires (avis d’expert). Si un fœticide selectif est susceptible d’etre pratique, il est fortement recommande que le(s) prelevement(s) initial(aux) soi(en)t realise(s) par la meme equipe medicale (avis d’expert). Pour l’amniocentese, le choix d’inserer deux aiguilles ou une seule est laisse a l’operateur sauf pour les situations d’infection a risque de transmission maternofœtale ou deux ponctions distinctes doivent etre realisees (avis d’expert). Pour la choriocentese, il est imperatif d’avoir recours a un operateur entraine et de realiser le prelevement a proximite de chaque insertion funiculaire (avis d’expert). Conclusion La choriocentese peut etre realisee des le premier trimestre et permet ainsi d’acceder a un resultat et a un eventuel fœticide plus precocement que l’amniocentese. Les deux techniques necessitent une bonne maitrise des gestes invasifs fœtaux pour eviter les risques specifiques dans le contexte de gemellite.

Repeated carbohydrate feedings and caffeine have been shown to increase self-paced physical activity. Whether a field ration pack that promotes snacking of these items would enhance physical activity remains unclear.Evaluate the effectiveness of a ration pack consisting of eat-on-move items to promote snacking, as well as caffeine items, as a nutritional strategy to improve performance.Twenty-eight wildland firefighters consumed both an eat-on-move ration (first strike ration (FSR): 13.2 MJ, 420 g CHO, 665 mg caffeine daily) and entrée-based ration (meals, ready-to-eat (MRE): 11.9 MJ, 373 g CHO, 100 mg caffeine daily) for 2 d separated by 1 d. Diet order was counterbalanced. Outcome measurements included self-paced physical activity determined by actimetry, reaction time, number of eating occasions using dietary recall, and dietary intake from food wrapper collection.Total eating episodes were higher with FSR compared with MRE (P = 0.013; mean +/- SD: 8.2 +/- 1.3 vs 7.6 +/- 1.1 episodes x 2 d(-1)), as were 2-d energy intake (22.0 +/- 2.4 vs 18.4 +/- 2.5 MJ; P0.01), carbohydrate intake (698 +/- 76 vs 546 +/- 82 mg; P0.01), self-reported caffeine intake (347 +/- 262 vs 55 +/- 65 mg; P0.01), and average end-shift salivary caffeine (1.6 +/- 1.9 vs 0.7 +/- 1.0 microg x mL(-1); P0.01). Total activity counts were higher (P = 0.046) when consuming FSR (507,833 +/- 129,130 counts per shift) compared with MRE (443,095 +/- 142,208 counts per shift). This was accomplished by spending a greater percentage of work shift with activity counts1000 counts x min(-1) (21 +/- 8% vs 18 +/- 6%; P = 0.01) and less percent of work shift50 counts x min(-1) (33 +/- 10% vs 38 +/- 10%; P = 0.01).Delivery of energy and caffeine in a manner that promotes snacking behavior is advantageous for increasing self-selected physical activity during arduous labor.

Military exercises generate high levels of stress to simulate combat, providing a unique opportunity to examine cognitive and physiologic responses of normal humans to acute stress.Cognitive and physiologic markers of stress were evaluated before, during, and after an intense training exercise conducted for 53 hours in the heat. Cognitive performance, mood, physical activity, sleep, body composition, hydration, and saliva cortisol, testosterone, and melatonin were assessed. Volunteers were 31 male U.S. Army officers from an elite unit, aged 31.6 +/- .4 years.Wrist activity monitors documented that soldiers slept only 3.0 +/- .3 hours during the exercise and were active throughout. Volunteers lost 4.1 +/- .2 kg (p.001) of weight, predominately water (3.1 +/- .3 L) (p.001). Substantial degradation in cognitive function, assessed with computerized tests, occurred. Vigilance, reaction time, attention, memory, and reasoning were impaired (p.001). Mood, including vigor (p.001), fatigue (p.001), confusion (p.001), depression (p.001), and tension (p.002), assessed by questionnaire, deteriorated. The highest cortisol and testosterone levels were observed before the exercise.This study quantifies the overwhelmingly adverse impact of multiple stressors on cognitive performance, mood, and physiologic parameters, during a continuous but brief military exercise conducted by highly motivated, well-trained officers.

Resume Nous rapportons un cas d’hypertriglyceridemie a 140 fois la normale de decouverte fortuite a 33 semaines d’amenorrhee (SA), au cours d’une deuxieme grossesse. Le risque de pancreatite aigue a fait realiser trois seances de plasmaphereses permettant une reduction de la triglyceridemie (6N) avec une bonne tolerance fœtale. La reascension immediate a conduit au declenchement a 34 SA avec resolution spontanee en post-partum. Les explorations complementaires ont retrouve des activites lipasiques abaissees sans mutation de l’apolipoproteine E, ni de la lipoproteine lipase (LPL), ce qui pourrait etre en faveur d’un inhibiteur de la degradation des lipoproteines present uniquement lors de la grossesse.

Rationale Acute stress produces behavioral and physiological changes modulated by central catecholamines (CA). Stress increases CA activity, and depletion of CA stores reduces responses to stress. Increasing CA activity by administration of the dietary amino acid CA precursor tyrosine may increase responsiveness to stress. This study determined whether tyrosine enhances the ability of humans to respond to severe stress. Methods Severe psychological stress was generated during training at Survival, Evasion, Resistance, and Escape (SERE) School. The acute stressor consisted of two mock interrogations conducted during several days of simulated captivity. Seventy-eight healthy male and female military personnel participated in this double-blind, between-subjects study, in which they received either tyrosine (300 mg/kg, N = 36) or placebo (N = 36). Tyrosine (or placebo) was administered in food bars in two doses of 150 mg/kg each approximately 60 min before each mock interrogation. Mood (Profile of Mood States), saliva cortisol, and heart rate (HR) were assessed prior to stress exposure during a week of academic training preceding mock captivity and immediately following the mock interrogations. Results The severe stress produced robust effects on mood (i.e., increased tension, depression, anger, fatigue, vigor, and confusion; p

Tubal sterilization, of common practice all over the world, has had a quick spread in France since its legalization in 2001 and the income of a new hysteroscopic method. As a matter of fact, France is the second greater country for women having Essure® and the first country where Essure® method forestall surgical tubal ligation. Thus we focus on good practice and update knowledge about Essure® method.

To assess postoperative pain after POP surgery by vaginal approach with and without mesh.One hundred and thirty-two consecutives patients operated on for POP (POP-Q ≥ 2) were enrolled. Surgical procedure was a traditional repair without mesh in 66 women and a mesh repair (Prolift) in 66 women. Postoperative pain was prospectively assessed by autoadministred questionnaires including analog visual scale. Pain scores were recorded 1 day after surgery (D1), at discharge, at 1 month follow-up (M1) and at 3 to 6 months follow-up (M3-6). We focused specially on mesh repair, age, previous prolapse procedure, hysterectomy, sacrospinofixation, transobturator sling, pre- and postoperative POP-Q score.At discharge, pain score was significantly higher in the mesh group (1.2 ± 1.8 versus 0.5 ± 0.9, P=0.021). Pain score were low (VAS3) and similar in the two groups with or without mesh at M1 and M3-6 follow-up. When focusing on associated factors, hysterectomy as a significant higher pain score at day 1, transobturator slings associated to traditional repair are more painful at D1 versus associated to mesh repair, sacrospinofixation has only a statistical tendency (P=0.08) more painful at D1.Pain score are low after both traditional or mesh repair by vaginal route. Mesh repair, hysterectomy and sacrospinofixation are more painful only in the first days after surgery. Our study supports the theory that transvaginal mesh procedure allows a quick return to normal life.

To describe invasive diagnostic procedures (amniocentesis/choriocentesis) and subsequent risks in twin pregnancies.PubMed and Cochrane database investigations were conducted using following key words: twin gestation, amniocentesis, chorionic villous sampling, karyotype. Guidelines for twin management edicted by different societies were reviewed.Risk of pregnancy loss after invasive diagnostic procedure in twin pregnancies seems to be slightly higher to singletons, i.e about 1.5-2% after mid-trimester amniocentesis and about 2% after first trimester choriocentesis. Dual sampling is not always mandatory but can be performed on parent's request. Specific risks are associated with twins: redundant sampling, permutation or misidentification of affected twin in case of discordant status. Procedures should be performed by highly-skilled operators under permanent ultrasound-guidance. A scheme describing placental locations and funicular insertions appears to be useful for correct identification. If foeticide can be anticipated, diagnostic procedure and foeticide should be performed by the same operators. For amniocentesis, one or two needles can be used except for cases with infectious disease (two needles and two separate insertions required). For choriocentesis, sampling should be performed close to funicular insertions.First-trimester choriocentesis makes earlier diagnosis and earlier foeticide possible compared with mid-trimester amniocentesis. Both techniques require highly-skilled operators to reduce subsequent risks in the context of twin pregnancies.

The objective of this study was to identify factors associated with favourable perinatal outcome after emergency cervical cerclage during mid-trimester of pregnancy.This is a retrospective study of all cases who underwent emergency cervical cerclage between 16 to 28 weeks of gestation (WG) over a period of 16 years in a University Hospital.Among the 32 cases, the postnatal survival rate (day 28) was 80%. Delivery occurred at a mean gestational age of 33.1 WG [18-41.3 WG] and after 37 WG in 39% of cases. The perinatal outcome was improved by absence of bleeding (P=0.01), unripened cervix (P=0.02), cervical dilatation below 2 cm (P=0.002), no protruding membranes (P=0.02) and more advanced gestational age at the procedure (P=0.005). When no uterine contraction and no maternal blood inflammation were observed at admission, an expectancy of 48 hours before the procedure did not improve significantly perinatal outcome (gestational age at birth and survival rate [P=0.1 and P=0.3 respectively]).Perinatal outcome after emergency cerclage depends on cervical status and gestational age at procedure. It is not influenced by an expectancy of 48 hours before intervention for patients with no uterine contraction and no maternal blood inflammation at admission.

Our objective was to report perinatal outcome during the first three years of an emerging centre for laser photocoagulation in twin-twin transfusion syndrome (TTTS) and to compare with outcome observed earlier in the same centre when management consisted in recurrent amniodrainage.We conducted a single centre retrospective study. We compared perinatal outcome of 19 consecutive cases of mid trimester TTTS managed by amniodrainage over a 10-year period with 49 cases of TTTS managed by laser photocoagulation over a 3-year period.Laser photocoagulation increased survival rate at birth (P=0.02) and at postnatal day 28 (P=0.01). Neurologic and cardiologic complications did not differ significantly (P=0.5 and P=0.3 respectively). We observed a significant increase in survival of the donor after laser coagulation at birth (P=0.04).Our study demonstrated better outcome after laser photocoagulation. Early results of an emerging centre appeared comparable to those of more experienced centres.

Background: Anecdotal information and limited research suggest that short-term caloric deprivation adversely affects cognition. However, this issue has not been studied using double-blind, placebo-controlled procedures, because the formulation of a calorie-deficient feeding regimen identical to one with calories is impossible using ordinary foods. Therefore, test meals varying in caloric content, but indistinguishable in sensory characteristics, were formulated using hydrocolloid-based gels as the principal structural component. Objective: The purpose of this study was to examine the effects of 2 d of near-total caloric deprivation on cognitive function, satiety, activity, sleep, and glucose concentrations in a controlled environment. Design: A double-blind, placebo-controlled crossover study of caloric deprivation was conduced in a controlled environment for 48 h. Cognitive function in 27 healthy young subjects was assessed repeatedly with standardized tests of vigilance, reaction time, learning, memory, logical reasoning, mood, and satiety. Wrist-worn monitors were used to assess ambulatory vigilance, activity, and sleep. Interstitial glucose concentrations were assessed continuously with a minimally invasive monitor. Results: When the subjects received the near calorie-free diets, mean calorie consumption totaled 1311 kJ (313 kcal) over the testing period. During the fully fed treatment sessions, the subjects consumed a mean of 9612 kJ/d (2294 kcal/d), which matched their individual, daily energy requirements. Satiety and interstitial glucose concentrations were lower during the calorie-deprived diet (P < 0.001) than during the fully fed diet. There were no detectable effects of calorie deprivation on any aspect of cognitive performance, ambulatory vigilance, activity, or sleep. The mood states assessed, including fatigue, were not affected by calorie deprivation. Conclusions: Cognitive performance, activity, sleep, and mood are not adversely affected in healthy humans by 2 d of calorie-deprivation when the subjects and investigators are unaware of the calorie content of the treatments.

We report a case of unexpected severe hypertriglyceridemia (140N) diagnosed at 33 weeks during a second gestation. The risk of acute pancreatitis indicated plasmapheresis (three procedures) with reduction of hypertriglyceridemia (6N) and no impact on fetal well-being. Immediate recurrence led to induction of labour at 34 weeks. Spontaneous regression occurred after delivery. We demonstrated reduced lipoprotein lipase activity with no mutation for apolipoprotein E, nor lipoprotein lipase in favour of a potential pregnancy-induced inhibitor of lipoprotein degradation.

Anecdotal reports from military conflicts suggest cognitive performance and mood are severely degraded by the stress of combat. However, little objective information is available to confirm these observations.Our laboratory had several unique opportunities to study cognitive function in warfighters engaged in exercises designed to simulate the stress of combat. These studies were conducted in different environments with two different types of military volunteers. In one study, subjects were officers, with an average 9 yr of military service, who were members of an elite U.S. Army unit, the Rangers. In the other study, participants were younger, mostly enlisted, trainees with only 3 yr of military experience on average, in training to determine if they would qualify for an elite U.S. Navy unit, the SEALS. We administered a variety of identical, computer-based cognitive tests to both groups.In both groups, during stressful combat-like training, every aspect of cognitive function assessed was severely degraded compared with baseline, pre-stress performance. Relatively simple cognitive functions such as reaction time and vigilance were significantly impaired, as were more complex functions, including memory and logical reasoning.The deficits observed were greater than those typically produced by alcohol intoxication, treatment with sedating drugs, or clinical hypoglycemia. Undoubtedly, such decrements would severely degrade operational effectiveness. Furthermore, it is likely such cognitive decrements would be greater during actual combat. War planners, doctrine developers, and warfighters, especially leaders, need to be aware that combat stress will result in extensive and severe deficits in cognitive performance.

Until recently scientists had limited opportunities to study human cognitive performance in non-laboratory, fully ambulatory situations. Recently, advances in technology have made it possible to extend behavioral assessment to the field environment. One of the first devices to measure human behavior in the field was the wrist-worn actigraph. This device, now widely employed, can acquire minute-by-minute information on an individual"s level of motor activity. Actigraphs can, with reasonable accuracy, distinguish sleep from waking, the most critical and basic aspect of human behavior. However, rapid technologic advances have provided the opportunity to collect much more information from fully ambulatory humans. Our laboratory has developed a series of wrist-worn devices, which are not much larger then a watch, which can assess simple and choice reaction time, vigilance and memory. In addition, the devices can concurrently assess motor activity with much greater temporal resolution then the standard actigraph. Furthermore, they continuously monitor multiple environmental variables including temperature, humidity, sound and light. We have employed these monitors during training and simulated military operations to collect information that would typically be unavailable under such circumstances. In this paper we will describe various versions of the vigilance monitor and how each successive version extended the capabilities of the device. Samples of data from several studies are presented, included studies conducted in harsh field environments during simulated infantry assaults, a Marine Corps Officer training course and mechanized infantry (Stryker) operations. The monitors have been useful for documenting environmental conditions experienced by wearers, studying patterns of sleep and activity and examining the effects of nutritional manipulations on warfighter performance.© (2005) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.