Physiological performance of common carp (Cyprinus carpio, L., 1758) exposed to a sublethal copper/zinc/cadmium mixture.

In a natural ecosystem, fish are subjected to a multitude of variable environmental factors. It is important to analyze the impact of combined factors to obtain a realistic understanding of the mixed stress occurring in nature. In this study, the physiological performance of juvenile common carp (Cyprinus carpio) exposed for one week to an environmentally relevant metal mixture (4.8 µg/L of copper; 2.9 µg/L of cadmium and 206.8 µg/L of zinc) and to two temperatures (10 °C and 20 °C), were evaluated. After 1, 3 and 7 days, standard (SMR) and maximum metabolic rate (MMR) were measured and aerobic scope (AS) was calculated. In addition, hematocrit, muscle lactate, histology of the gills and metal accumulation in gills were measured. While SMR, MMR and AS were elevated at the higher temperature, the metal mixture did not have a strong effect on these parameters. At 20 °C, SMR transiently increased, but no significant changes were observed for MMR and AS. During metal exposure, hematocrit levels were elevated in the 20 °C group. The bioaccumulation of Cd in the gills reflected the increased metabolic rate at the higher temperature, with more accumulation at 20 °C than at 10 °C. Anaerobic metabolism was not increased, which corresponds with the lack of significant histopathological damage in the gill tissue. These results show that common carp handled these metal exposures well, although increased temperature led to higher Cd accumulation and necessitated increased hematocrit levels to maintain aerobic performance.

Antagonistic bioaccumulation of waterborne Cu(II) and Cd(II) in common carp (Cyprinus carpio) and effects on ion-homeostasis and defensive mechanisms.

In the aquatic environment, metals are present as mixtures, therefore studies on mixture toxicity are crucial to thoroughly understand their toxic effects on aquatic organisms. Common carp (Cyprinus carpio) were used to assess the effects of short-term Cu(II) and Cd(II) mixtures, using a fixed concentration of one of the metals, representing 25 % of its individual 96h-LC50 (concentration lethal for 50 % of the population) combined with a variable concentration of the other metal corresponding to 10, 25 or 50 % of its 96h-LC50, and vice versa. Our results showed a fast Cu and Cd bioaccumulation, with the percentage of increase in the order gill > liver > carcass. An inhibitory effect of Cu on Cd uptake was observed; higher Cu concentrations at fixed Cd levels resulted in a decreased accumulation of Cd. The presence of the two metal ions resulted in losses of total Na, K and Ca. Fish tried to compensate for the Na loss through the induction of the genes coding for Na+/K+-ATPase and H+-ATPase. Additionally, a counterintuitive induction of the gene encoding the high affinity copper transporter (CTR1) occurred, while a downregulation was expected to prevent further metal ion uptake. An induction of defensive mechanisms, both metal ion binding protein and anti-oxidant defences, was observed. Despite the metal accumulation and electrolyte loss, the low mortality suggest that common carp is able to cope with these metal levels, at least during a one-week exposure.

Peruvian scallop Argopecten purpuratus: From a key aquaculture species to a promising biondicator species.

The present study analyzed the Peruvian scallop Argopecten purpuratus and its food sources for metal and fatty acid concentrations in order to determine spatial and temporal differences. Metals such as copper (Cu), manganese (Mn), and zinc (Zn) in gills and iron (Fe) and Zn in sediments were the most significant explaining factors for spatial differentiations (degree of contamination), while for fatty acids, it was C14:0, C15:0, C16:0 and C18:0 in A. purpuratus' muscle and in its food sources, which explained more temporal differences (El Niño-Southern Oscillation (ENSO) effect). Gills, digestive gland and intestine were the tissues where metal accumulation was the highest in A. purpuratus. Cd in digestive gland was always high, up to ∼250-fold higher than in other tissues, as previously reported in other bioindicator species for metal pollution. Fatty acids were good biomarkers when annual comparisons were performed, while metals when locations were compared. ENSO 2017 played an important role to disentangle A. purpuratus' biological conditions and food sources. A. purpuratus from Paracas locations mostly showed higher metal concentrations in gills and digestive glands, and lower fatty acid concentrations in muscle than those from Sechura and Illescas Reserved Zone.

Investigating the effects of a sub-lethal metal mixture of Cu, Zn and Cd on bioaccumulation and ionoregulation in common carp, Cyprinus carpio.

The aquatic environment is continuously under threat because it is the final receptor and sink of waste streams. The development of industry, mining activities and agriculture gave rise to an increase in metal pollution in the aquatic system. Thus a wide occurrence of metal mixtures exists in the aquatic environment. The assessment of mixture stress remains a challenge considering that we can not predict the toxicity of a mixture on the basis of single compounds. Therefore the analysis of the effects of environmentally relevant waterborne mixtures is needed to improve our understanding of the impact of metal pollution in aquatic ecosystems. Our aim was to assess whether 10 % of the concentration of the 96 h LC50 (the concentration that is lethal to 50 % of the population in 96 h) of individual metal exposures can be considered as a "safe" concentration when applied in a trinomial mixture. Therefore, common carp were exposed to a sublethal mixture of Cu 0.07 ±â€¯0.001 µM (4.3 ±â€¯0.6 µg/L), Zn 2.71 ±â€¯0.81 µM (176.9 ±â€¯52.8 µg/L) and Cd 0.03 ±â€¯0.0004 µM (3.0 ±â€¯0.4 µg/L) at 20 °C for a period of one week. Parameters assessed included survival rate, bioaccumulation and physiological biomarkers related to ionoregulation and defensive mechanisms such as MT induction. Our results showed a sharp increase in Cu and Cd concentration in gills within the first day of exposure while Zn levels remained stable. The accumulation of these metals led to a Na drop in gills, liver and muscle as well as a decreased K content in the liver. Biomarkers related to Na uptake were also affected: on the first day gene expression for H+-ATPase was transiently increased while a concomitant decreased gene expression of the Na+/H+ exchanger occurred. A fivefold induction of metallothionein gene expression was reported during the entire duration of the experiment. Despite the adverse effects on ionoregulation all fish survived, indicating that common carp are able to cope with these low metal concentrations, at least during a one week exposure.

Limited oxidative stress in common carp (Cyprinus carpio, L., 1758) exposed to a sublethal tertiary (Cu, Cd and Zn) metal mixture.

Analyzing effects of metal mixtures is important to obtain a realistic understanding of the impact of mixed stress in natural ecosystems. The impact of a one-week exposure to a sublethal metal mixture containing copper (4.8 µg/L), cadmium (2.9 µg/L) and zinc (206.8 µg/L) was evaluated in the common carp (Cyprinus carpio). To explore whether this exposure induced oxidative stress or whether defense mechanisms were sufficiently fitting to prevent oxidative stress, indicators of apoptosis (expression of caspase 9 [CASP] gene) and of oxidative stress (malondialdehyde [MDA] level and xanthine oxidase [XO] activity) were measured in liver and gills, as well as activities and gene expression of enzymes involved in antioxidant defense (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GPx], glutathione reductase [GR] and glutathione-S-transferase [GST]). The total antioxidative capacity (T-AOC) was also quantified. No proof of oxidative stress was found in either tissue but there was indication of apoptosis in the liver. CAT, GPx, GR and GST total activities were reduced after 7 days, suggesting a potential decrease of glutathione levels and risk of increased free radicals if the exposure would have lasted longer. There were no major changes in the total activities of antioxidant enzymes in the gills, but the relative expression of the genes coding for CAT and GR were triggered, suggesting a response at the transcription level. These results indicate that C. carpio is well equipped to handle these levels of metal pollution, at least during short term exposure.

A clinical score can predict associated deep infiltrating endometriosis before surgery for an endometrioma.

STUDY QUESTION: Is it possible to detect associated deep infiltrating endometriosis (DIE) before surgery for patients operated on for endometriomas using a preoperative clinical symptoms questionnaire? SUMMARY ANSWER: A diagnostic score of DIE associated with endometriomas using four clinical symptoms defined a high-risk group where the probability of DIE was 88% and a low-risk group with a 10% probability of DIE. WHAT IS KNOWN ALREADY: Many clinical symptoms are already known to be associated with DIE but they have not yet been used to build a clinical prediction model. STUDY DESIGN, SIZE, DURATION: We built a diagnostic score of DIE based on a case control study of 326 consecutive patients operated on for an endometrioma between January 2005 and October 2011: 164 had associated DIE (DIE+) and 162 had no DIE (DIE-). We derived the score on a training sample obtained from a random selection of 2/3 of the population (211 patients, 101 DIE+, 110 DIE-), and validated the results on the remaining third (115 patients, 63 DIE+, 52 DIE-). The gold standard for the diagnosis of DIE was based on surgical exploration and histological diagnosis. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were consecutive patients aged 18-42 years who underwent surgery for an endometrioma with histological confirmation and complete treatment of their endometriotic lesions: data for these women were extracted from a prospective database including a standardized preoperative questionnaire. On the training dataset, variables associated with DIE in a univariate analysis were introduced in a multiple logistic regression and selected by a backward stepwise procedure and a Jackknife procedure. A diagnostic score of DIE was built with the scaled/rounded coefficients of the multiple regression. Two cut-off values delimitated a high and a low risk group, and their diagnostic accuracy was tested on the validation dataset. MAIN RESULTS AND THE ROLE OF CHANCE: Four variables were independently associated with DIE: visual analogue scale of gastro-intestinal symptoms ≥5 or of deep dyspareunia >5 (adjusted diagnostic odds ratio (aDOR) = 6.0, 95% confidence interval (CI) [2.9-12.1]), duration of pain greater than 24 months (aDOR = 3.8, 95% CI [1.9-7.7]), severe dysmenorrhoea (defined as the prescription of the oral contraceptive pill for the treatment of a primary dysmenorrhoea or the worsening of a secondary dysmenorrhoea) (aDOR = 3.8, 95% CI [1.9-7.6]) and primary or secondary infertility (aDOR = 2.5, 95% CI [1.2-4.9]). The sum of these variables weighted by their rounded/scaled coefficients constituted the score ranging from 0 to 53. A score <13 defined a low-risk group where the probability of DIE was 10% (95% CI [7-15] with a sensitivity of 95% (95% CI [89-98]) and a negative likelihood ratio of 0.1 (95% CI [0.0-0.3]). A score ≥35 defined a high-risk group where the probability of DIE was 88% (95% CI [83-92%]), with a specificity of 94% (95% CI [87-97]), and a positive likelihood ratio of 8.1 (95% CI [3.9-17.0]). The performance of the score was confirmed on the validation dataset with 11% of DIE+ patients having a score <13 (sensibility: 95%) and 90% of DIE+ patients having a score ≥35 (specificity: 94%). LIMITATION, REASONS FOR CAUTION: This study was performed in a department specialized in DIE management. Score accuracy could be different in less specialized centres. WIDER IMPLICATIONS OF THE FINDINGS: This score could have a major clinical impact on the time of diagnosis, the management of DIE and could reduce the cost of investigations by helping to identify high-risk patients, while preserving the quality of care. STUDY FUNDING/COMPETING INTERESTS: The authors have no competing interests to declare. No grant supported the study.

[Recurrence of pain after surgery for deeply infiltrating endometriosis: How does it happen? How to manage?]. / Récidive de la douleur après chirurgie pour endométriose profonde : pourquoi ? Que faire ?

Recurrence of deep endometriosis remains a major issue in the management of endometriosis. The main cause for recurrence appears to be an incomplete excisional surgery. Therefore, the goal of the primary surgery should be the complete resection of all endometriotic lesions. If surgical skills cannot meet this objective it seems preferable to refer the patient to a center with a recognized expertise in this field rather than performing an incomplete surgery. It seems also possible to tailor the indications according to the symptoms, especially when endometriosis affects the bladder in association with an asymptomatic vaginal and/or rectal involvement. This strategy does not increase the rate of recurrence. Postoperative medical treatment based on ovarian function suppression is attractive as it diminishes the recurrence rate. Facing the recurrence, appropriate assessment of the benefit risk balance must be performed. Medical treatment is an option. When surgery is chosen, it seems interesting to discuss carefully the indication of hysterectomy with bilateral oophorectomy, especially for women over 40 years old with no desire for pregnancy and/or symptomatic adenomyosis. Risks of induced ovarian castration must be taken into account.

[Allergy investigations after two cases of adverse reactions to a neuromuscular blocking agent and management for subsequent general anaesthesia]. / Bilan allergologique après un choc anaphylactique à un curare non dépolarisant: conduite à tenir pour une anesthésie ultérieure.

We report two cases of severe anaphylactic reactions to rocuronium. Diagnosis was confirmed by skin tests and specific IgE assay. Cross-reactivity to all neuromuscular blocking agents was investigated by intradermal tests and leucocyte histamine release test. Intradermal tests and leukocyte histamine release were negative for cisatracurium. The two patients had undergone a subsequent general anaesthesia using cisatracurium and did not present any adverse reaction.

Control by quality: proposition of a typology.

The application of Quality tools and methods in industrial management has always had a fundamental impact on the control of production. It influences the behavior of the actors concerned, while introducing the necessary notions and formalizations, especially for production systems with little or no automation, which constitute a large part of the industrial activity. Several quality approaches are applied in the workshop and are implemented at the level of the control. In this paper, the authors present a typology of the various approaches that have successively influenced control, such as statistical process control, quality assurance, and continuous improvement. First the authors present a parallel between production control and quality organizational structure. They note the duality between control, which is aimed at increasing productivity, and quality, which aims to satisfy the needs of the customer. They also note the hierarchical organizational structure of these two systems of management with, at each level, the notion of a feedback loop. This notion is fundamental to any kind of decision making. The paper is organized around the operational, tactical, and strategic levels, by describing for each level the main methods and tools for control by quality. The overview of these tools and methods starts at the operational level, with the Statistical Process Control, the Taguchi technique, and the "six sigma" approach. On the tactical level, we find a quality system approach, with a documented description of the procedures introduced in the firm. The management system can refer here to Quality Assurance, Total Productive Maintenance, or Management by Total Quality. The formalization through procedures of the rules of decision governing the process control enhances the validity of these rules. This leads to the enhancement of their reliability and to their consolidation. All this counterbalances the human, intrinsically fluctuating, behavior of the control operators. Strategic control by quality is then detailed, and the two main approaches, the continuous improvement approach and the proactive improvement approach, are introduced. Finally, the authors observe that at each of the three levels, the continuous process improvement, which is a component of Total Quality, becomes an essential preoccupation for the control. Ultimately, the recursive utilization of the Deming cycle remains the best practice for the control by quality.

[Granulomatous peritonitis after laparoscopic surgery of an ovarian dermoid cyst. Diagnosis, management, prevention, a case report]. / Péritonite granulomateuse après traitement coeliochirurgical d'un kyste dermoïde de l'ovaire. Diagnostic, prise en charge, prévention, à propos d'un cas.

We report a case of granulomatous peritonitis which occurred following laparoscopic exeresis of a dermoid cyst of the ovary performed together with medically induced abortion. The peritoneal cavity was contaminated when the cyst ruptured during the procedure emptying sebum and hairs in the peritoneum. Abondant washing with aspiration of all the visible particles was done with a 5 mm canula. The diagnosis of granulomatous peritonitis was suggested with the development of persistant fever, degradation of the patient's general health, moderate abdominal pain and a nodular image at echography located on the operated ovary. The nodule was found to be an inflammatory granuloma on a foreign body. Two second-look laparotomies, one transrectal and the other via the xypho-pubian route, were required 1 month after the initial operation for complete cure. The diagnosis was confirmed on the pathology report.

[Vascular complications of lumbar disk surgery. Report of two cases and review of the literature on 122 cases]. / Complications vasculaires de la chirurgie discale lombaire. A propos de deux cas et d'une revue de littérature de 122 cas.

We report two cases of right lumbar common iliac arteriovenous injury after an operation on the L4-L5 disk. One case was an arteriovenous fistula disclosed 5 years after the operation and in the other case, a postoperative acute haemorrhage. A retrospective study is carried out in the literature aiming at establishing the frequency of vascular injury in lumbar disk surgery, their nosologic definition, and the provided treatment. One hundred and twenty two observations were taken into account. The frequency cannot be determined. 78 of these observations (63.9%) reported an arteriovenous fistula between two elements of the aortic-cava intersection, with acute revelation (6.4%), sub-acute (19%) or late as a right cardiac failure (64%). Thirty one cases of acute haemorrhages through isolated arterial wound (25.4%), 3 cases of arterial or venous thrombosis (2.5%) and 10 cases of false aneurysms (8.2%) were found. The treatment was always surgical, sometimes in high emergency. In the case of haemorrhage the death rate was 21% and in the event of fistula 1.3%. Morbidity was 11.5%, mostly due to a post-phlebitic syndrome. These results reduce the mildness reputation of lumbar disk surgery all the more as recording of the complications is under estimated and most of them are found far from the initial act.

[Intraoperative radiotherapy. Preliminary results]. / La radiothérapie per-opératoire. Résultats préliminaires.

We report a series of 40 patients treated by intraoperative radiotherapy between 1988 and 1992 (18 primary tumors, 13 local recurrences and 9 nodal extensions). The doses delivered were 15 Gy to 25 Gy, completed by external radiotherapy (15 to 45 Gy) in 13 cases. The local tumor control rate was 61% for initial therapy in primary tumors (70% for adenocarcinoma of the stomach) and 80.9% after complete en bloc surgery. The local control rate after palliative surgery for local recurrences is 38% and 33% for nodal extension. Two patients died (5%) during the postoperative period. We observed 2 hemorrhages and 3 cases of stone-free cholecystitis. The value of this approach must be confirmed in rigorous indications in comparison with surgery alone in controlled and randomised clinical trials.

Effects of atrial pacing on right ventricular contractility after coronary artery surgery.

Increasing heart rate enhances the strength of contraction of cardiac fibers. This has been demonstrated in vitro and recently for the left ventricle. To study this phenomenon on the right ventricle, the effects of increasing heart rate by atrial pacing on right ventricular (RV) contractility were observed after coronary artery surgery in 20 patients. Right ventricular ejection fraction (EF) and stroke volume (SV) were measured by use of a rapid-response thermistor pulmonary artery catheter. Right ventricular volumes were calculated from EF and SV. Right ventricular contractility was assessed by the slope of the end-systolic pressure-volume relationship (ESPVR) before and after increasing RV preload by means of military antishock trousers (MAST) inflation. The dP/dtmax/end-diastolic volume index (EDVI) ratio, which is independent of ventricular preload, was also used as an inotropic index. Results are expressed as mean +/- SEM. Right ventricular preload, as reflected by RVEDVI, was increased by MAST inflation (99 +/- 6 mL/m2 v 106 +/- 7 mL/m2, P < 0.01), but returned to control values when inflation of MAST was combined with pacing (100 +/- 6 mL/m2). The slope of the RV ESPVR significantly increased when heart rate was increased (0.22 +/- 0.03 mmHg/mL/m2 before pacing v 0.77 +/- 0.07 mmHg/mL/m2 during pacing, P < 0.05). The dP/dtmax/EDVI ratio was also increased by pacing (2.32 +/- 0.4 mmHg/min/mL/m2 before pacing v 3.15 +/- 0.5 mmHg/min/mL/m2 during pacing, P < 0.01). Moreover, cardiac index was increased by pacing alone (2.45 +/- 0.2 L/min/m2 v 2.78 +/- 0.2 L/min/m2, P < 0.01), and significantly more when MAST were inflated (2.94 +/- 0.2 mL/m2, P < 0.05 v pacing alone). It is concluded that increasing heart rate by atrial pacing increases RV inotropic status after coronary artery surgery.

Varicella zoster virus infection during pregnancy: the limits of prenatal diagnosis.

In a mother with clinical evidence of chicken-pox at 12.5 weeks, fetal herpes varicella zoster infection was revealed by transient fetal ascites with liver calcifications at 27 weeks routine ultrasound. At 27 and 35 weeks fetal blood sampling and amniocentesis failed to demonstrate fetal viral infection. However, the diagnosis was confirmed postnatally based on thoracic herpes zoster at 8 months in an otherwise healthy infant. Polymerase chain reaction (PCR) on stored amniotic cells performed retrospectively was positive for varicella zoster virus (HVZV). This observation suggests that (1) in contrast to PCR, conventional fetal biology lacks sensitivity for prenatal diagnosis of HVZV infection, (2) the association of fetal sonographic abnormalities and positive amniotic PCR can be associated with a favorable pediatric outcome. Therefore, prenatal diagnosis of HVZV infection should be considered with the greatest caution.

Antibiotic prophylaxis in pulmonary surgery. A prospective randomized double-blind trial of flash cefuroxime versus forty-eight-hour cefuroxime.

The aim of this study was to determine whether a 48-hour antibiotic prophylaxis regimen with a second-generation cephalosporin was more efficient than a flash antibiotic prophylaxis regimen in pulmonary operations. All the included patients underwent lung resection. Patients with preoperative infection were excluded. All the patients were given cefuroxime (1.5 gm intravenously) at the time of the anesthetic induction and again 2 hours later. The randomization was done postoperatively: group 1 was given placebo intravenously (n = 102) and group 2 was given cefuroxime intravenously (n = 101), each every 6 hours for 48 hours. The overall rate of infections was 46% in the 48-hour cefuroxime group versus 65% in the flash group (p = 0.005). The difference remained significant even after an adjustment with prognosis variables (p = 0.01). Six empyemas (6%) in the flash group were noted versus one (1%) in the 48-hour group (p = 0.03). From day 3 to day 8 after the operation, chest x-rays films were more often assessed as being normal in the flash group than in the 48-hour group (p = 0.005). On day 3 after operation, white blood cell counts were 13,020 +/- 1,220 elements/mm3 in the flash group versus 11,620 +/- 1,220 elements/mm3 in the 48-hour group (p = 0.03). A 48-hour antibiotic prophylaxis regimen decreases the rate of deep infections and particularly the rate of empyemas.

[Chickenpox and pregnancy]. / Varicelle et grossesse.

The authors report a case of chickenpox exposure during the first three months of pregnancy. Ultrasonographic monitoring of the fetus revealed signs of fetal infection starting from 32 weeks of amenorrhea (hepatomegaly, ascites, pleural effusion) but clinical examination of the child at birth showed nothing abnormal. The diagnosis was confirmed by the development of herpes zoster in the child after birth. The difficulty of determining a fetal prognosis during pregnancy is emphasised.

[Hemodynamic complications during the recovery period after anesthesia]. / Les complications hémodynamiques au cours de la phase du réveil de l'anesthésie.

In the postoperative period the alterations of blood pressure are the main hemodynamic complications. Hypotension or hypertension may compromise the coronary circulation and increase the metabolic demand of the myocardium. Pulmonary oedema is the most frequent manifestation of heart failure. The aim of its treatment is to increase myocardial contractility and decrease the metabolic demand. Myocardial ischemia is mostly silent and is an important correlate of adverse cardiac outcomes. The treatment of these hemodynamic events starts during the peroperative period by prevention of their risk factors.

[Orbito-palpebral prosthesis and intraosseous implants]. / Epithèse orbito-palpébrales et implants intra-osseux.

Authors report their experience of the use of intraosseous implants for orbito-palpebral prosthesis. Principles are reminded and advantages discussed.

[Orbito-palpebral prosthesis retained by intraosseous implants]. / Prothèse orbito-palpébrale fixée par implants endo-osseux.

The use of intraosseous implants, whose tolerance is continually improving, constitutes an important progress in the field of prosthetic rehabilitation. In particular, titanium implants largely resolve the problem of retention of craniofacial prostheses. Our experience, based on that of Swedish authors concerning the extra-oral use of intraosseous implants, was sufficiently convincing to adopt this effective technique in our patients candidates for prosthetic rehabilitation. The case of a patient rehabilitated by means of an orbito-palpebral prosthesis is presented after a brief biomechanical review and presentation of the technique. Our results, although preliminary, are very encouraging in terms of the technical aspects as well as patient comfort. A further study could reinforce our decision.