Evolution of the human brain, chorionic gonadotropin and hemochorial implantation of the placenta: insights into origins of pregnancy failures, preeclampsia and choriocarcinoma

Hyperglycosylated chorionic gonadotropin (CG-H) signals placental cytotrophoblast cell growth and invasion, and chorionic gonadotropin (CG) promotes uterine vascularization. A hypothesis is presented relating the evolution of these molecules to the evolution of human hemochorial implantation and that of the human brain. Deep placental invasion, vascularization and hemochorial placentation, under the influence of CG and CG-H, are a critical part of the nutrition and energy-generating mechanisms needed for human brain development and thus for the evolution of humans. Insufficient CG-H production and the resulting inappropriate implantation is associated with an unduly high incidence of pregnancy failures in humans. Low levels of CG-H and inappropriate hemochorial placentation also appear to be associated with subsequent preeclampsia. It is also of note that human CG-H drives invasion by gestational trophoblastic neoplasms that have been described only in humans.     

Quercetin and rutin as potential sunscreen agents: determination of efficacy by an in vitro method

Given that flavonoids are known for their ultraviolet (UV)B photoprotective properties in plants that contain them, we chose to study quercetin (1) and rutin (2) as agents that could potentially be used in sunscreen products. These two substances proved to behave in similar ways. When incorporated in oil-in-water emulsions, at a concentration of 10% (w/w), 1 and 2 give sun protection factor (SPF) values similar to that of homosalate, a standard substance. These two flavonoids also provided a non-negligible level of photoprotection in the UVA range. When used in association with titanium dioxide, the SPF obtained was around 30.     

The identification, management, and prevention of conflict with faculty and fellows: A practical ethical guide for department chairs and division chiefs

The relationship between chairs and divisions chiefs with faculty colleagues in departments of obstetrics and gynecology has important but heretofore unexplored ethical dimensions. Based on the ethical concept of fiduciary responsibility and contractual obligations, this paper provides ethically justified practical guidance for academic physician leaders in the identification, management, and prevention of conflicts in their relationships with faculty colleagues. The framework is developed in contrast with the fiduciary-contractual dimensions of the physician-patient relationship and is articulated in terms of the ethical principles of beneficence, respect for autonomy, and justice. The distinctive nature of the academic physician leader-colleague relationship is that beneficence-based obligations and justice-based obligations to colleagues can often justifiably override autonomy-based obligations to colleagues, about which it is crucial for academic leaders to be transparent in making and implementing leadership decisions.     

Neonatal and 5-year outcomes after birth at 30-34 weeks of gestation

OBJECTIVE: To evaluate the rates of in-hospital death, neonatal complications, and 5-year outcomes of infants born at 30-34 weeks of gestation. METHODS: In nine regions of France, all 2,020 stillbirths and live births at 30, 31, and 32 weeks in 1997 and all 457 births at 33 and 34 weeks in April and October 1997 were recorded. Survivors were evaluated at 5 years of age. RESULTS: Increasing gestational age from 30 to 34 weeks was associated with progressive decreases in in-hospital mortality (from 8.1% to 0.4%) and neonatal complications (respiratory distress syndrome, 43.8% to 2.6%; maternofetal infections, 7.2% to 2.6%; and severe white matter injury, 5.5% to 1.3%). Although infants at 33 and 34 weeks of gestation rarely experienced necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infections, they still required endotracheal ventilation, antibiotics, or parenteral nutrition. At 5 years of age, older gestational age was associated with significant decreases in rates of cerebral palsy (6.3% at 30 weeks and 0.7% at 34 weeks) and mild to severe cognitive impairments (35.3% at 30 weeks and 23.9% at 34 weeks). In singletons, preterm rupture of membranes or preterm labor carried an increased risk of cerebral palsy but not of cognitive impairment. CONCLUSION: Neonates born at 30-34 weeks experienced substantial morbidity and often required admission to neonatal intensive care units. These outcomes suggest that prolonging pregnancies beyond 34 weeks may be desirable whenever possible. Infants born at 30-34 weeks should be carefully monitored to ensure prompt detection and management of neurodevelopmental impairment.     

Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis

Endometriosis is a relatively common condition characterized by implantation and proliferation of endometrial glands outside the uterus affecting 8% to 15% of women. Intestinal involvement is common, reported in 12% to 37% of individuals with the disease. The sites most often affected are the sigmoid colon and rectum (85%), while small bowel involvement is seen less frequently (7%) and usually confined to the distal ileum. The cecum (3.6%) and appendix (3%) are the sites least affected.     

Quelle est la marge distale nécessaire ?

In rectal cancer, assessment of the distal margin is an important step when sphincter saving surgery is discussed. However there is still a controversy about the best time for this assessment, and by whom it should be done, either by the surgeon intraoperatively when the resection has been completed, or by the pathologist before or after fixation of the specimen? Approximately 70% of the shrinkage occurs during the first 10 to 20 minutes following completion of the resection, and the remaining 30% occur after fixation. A distal margin of 1cm on the fresh specimen is considered as adequate in many guidelines. The question of whether this 1cm rule for irradiated tumours should be revised is still debated.