L’échec de fécondation en F.I.V.: intérêt d’un taux de récolte ovocytaire élevé et étude du taux de récidive

L’analyse de 1132 tentatives de FIV montre comment le taux de récolte détermine la fiabilité de l’estimation de l’échec de fécondation. L’étude de 64 couples ayant réalisé plusieurs tentatives dont une au moins s’est soldée par un échec de fécondation montre que 68,7% d’entre eux obtiennent des embryons lors d’une autre tentative. Les embryons replacés ont les mêmes aptitudes d’implantation et de développement que ceux obtenus par 130 couples ayant subi un premier échec d’implantation. Ces résultats sont mis en relation avec ceux obtenus par insémination subzonale après deux échecs de FIV.     

Fertilité de l’homme en fonction de l’âge

The aim of this work was to analyse the evolution of sperm characteristics according to age. To this end we analysed the spermogram of 2,126 men aged 20 to 64 who came for consultation for feminine indications for in vitro fertilization at the Clermont-Ferrand Human Reproduction Unit during the period 1980 to 1994. A search for a link between the age of the patient at the time of the spermogram and 10 sperm parameters, by studying a linear regression, did not reveal any evidence of a significant correlation between the age and the parameters studied. The mean values for volume, concentration of spermatozoa, percentage of mobile forms (normal, diminished), percentage of typical and mobile forms and percentage of abnormal forms were compared for age classes covering 5 years. These values showed no significant difference according to the age classes. Between 20 and 60 years the essential parameters of the spermogram seem generally to be independent of age, from which it can be deduced that ejaculate quality remains the same until 50 years of age. However a bias in the recruitment of the population studied and a very wide spread for the values for a given age mean that we may not have detected fluctuations in sperm characteristics linked with age.     

L’intersubjectif et l’intrasubjectif dans l’expérience de souffrance. Un regard psychanalytique

Psychoanalysis characterises subjectivity as a notion based on the “plurality of psychologically troubled persons”, revealed, for instance, in dreams. The author takes a closer look at a number of Freud’s dream analyses and argues that, in working with the dream, subjects often eject one of their psychologically troubled persons (often the “suffering child”) out of themselves, projecting the person into the Other. As a result, an intersubjective space is created, which is required to receive the divisions originating from the intrasubjective space. Freud’s 1895 Project, however, goes farther: the evacuation of the “disparate part” of the child to the Other grants access to logical and rational judgement, guaranteeing a child’s psychological life a fictional stability (the “Thing” or the “ego”). Freud adds that this process is possible if a Nebenmensch — or “fellow creature” — is present and has the quality of a “helping person” capable of receiving the child’s suffering cry. These two lines of thought, together, help clarify the intersubjective position underlying the analytical work: a tentative encounter between the patient’s distress and the analyst’s presence. Free-floating attention will enable the analyst to receive and hear this distress and ease the patient’s recovery of his or her intrasubjective space.     

L’Acheuléen saharien : Un constat et une perspective

In this document we are going to update the old data on the Saharan Acheulean, although this data isn’t plenty and all dated from the 20th century. But to resume a new era of research on the subject, it is quite obvious to evoke it. Despite the fruitful discoveries in many lower Paleolithic sites in the Sahara, no scientific interest has been brought, in particular to the numerous lithic collections interposed in several scientific research laboratories. The new Acheulean site “Tehentawek” which was discovered in the region of Idelès, in the Ahaggar, right in the heart of central Sahara, and which was excavated using new research methods, revealed in 2008 and 2010 an interesting lithic material, very representative of the Acheulean industry. The steps adopted in the study of this site are considered renovative in Saharan prehistory. Appropriate and adequate exploration of the environment, the adaptation of field work to the rocky context of the Ahaggar region, allowed us to reconsider the Saharan terrain. The technological study of lithic material has provided a variety of tools containing choppers, hand axes and cleavers, as well as many raw flakes, sometimes compatible with the nucleus. The lithic raw materials used for shaping are local. The results of the analyzes carried out on the sediments collected can lead to a discussion on the Saharan palaeoenvironment.     

L’homme souffrant en quête de sens: du récit de soi à l’identité narrative. Une réflexion à partir de Ricœur

The question of personal identity is central to any reflection on mankind and, therefore, immediately relevant to clinical anthropology. The notion of the continuity of personal identity over time represents Ric?ur’s contribution to the question. Upheaval and continuity in life are integrated into self-narrative, enabling temporal permanence of identity, which generates reflective consciousness and its concomitant ethical dimension. But from this anthropological point of view, the subject doesn’t construct a self and world through narrative. On the contrary, it is narrative elements that construct the subject, allowing the subject to make sense of his or her subjective life in the world. Through this narrative conception of the suffering individual, Ric?ur makes a distinct contribution to discourse in clinical anthropology in positing that suffering is a part of a person’s effort to recount their lives.     

Structures crâniennes internes de l’Homo erectus Sambungmacan 1 (Java,Indonésie)

The Sambungmacan 1 fossil (Java, Indonesia) is assigned to the Homo erectus group. The carbonated matrix contained in this calvaria prevents the analysis of the internal surface. The CT data of the original fossil enables us to observe the conservation and mineralization state and the internal structures. Furthermore, we use the CT data to reconstruct the endocast, which shows that the morphological character of Sambungmacan 1 is close to the Ngandong hominids.     

Intérêt de l’étude de l’oxydation de l’ADN des spermatozoïdes par marquage de la 8-oxo-guanine en cytométrie en flux chez l’homme infertile

Oxidative stress in semen is essentially due to excessive production of oxygen-reactive species (ORS) essentially derived from leukocytes. DNA oxidation is due to the direct action of ORS which produce several adducts the most extensively studied of which is 8-oxo-guanine. Integrity of DNA is essential for the fertility of sperm and is an important subject of research for scientists and clinicians all over the world. Although evaluation of the global integrity of sperm DNA has considerably developed over recent years, few tests are available to document oxidative DNA damage. This study was designed to review the various tests of sperm DNA integrity commonly used in the literature and to present the results of our study on DNA oxidation with 8-oxo-guanine labelling by flow cytometry in infertile men. This study was based on 15 semen samples that were submitted to sperm analysis according to WHO guidelines, with determination of the leukocyte concentration by a cytochemical method revealing peroxidase in cytoplasmic granulations. The DNA oxidation study was performed with 8-oxo-guanine labelling by flow cytometry. Linear regression analysis showed a strong correlation between DNA oxidation and leukocyte count in the semen (p = 0.006, r = 0.7). A leukocyte cut-off of 250,000/ml of semen was associated with a significant increase of DNA oxidation (p = 0.03). 8-oxo-guanine can therefore be considered to be a biological marker of the direct action of oxidative stress on sperm DNA which appears to be susceptible to relatively low levels of ORS produced by leukocytes present at concentrations well below the limit of leukospermia defined by WHO.     

Caractères ultrastructuraux du pollen de quelques Podostémales. Affinités avec les Rosidae évoluées

The order Podostemales are two pantropical families of aquatic plants living in running water: Tristichaceae (five genera, ten species) and Podostemaceae (35 genera, 200 species). Pollen of the 26 genera and 62 species studied is characterized by: a granular infratectum in which the granules are sometimes organized as columellae like units, and a lamellar and/or granular endexine in all pollen types, single or in dyads. Most of the apertural characters and the ornamentation of the exine allow us to distinguish the previously established taxonomic groups: Weddellinoideae have tricolporate rugulo-areolate, pollen with a smooth apertural membrane; in Tristichoideae, pollen is periporate and the microspines of the tectum and of the apertural membrane are massive; in Podostemaceae, the tectal spines with their broad bulbous base are formed from numerous masses of sporopollenin, the endexine is microfibrillar at the base, the apertural membrane is constituted of structured ectexinous masses, and the endexine is granular at the aperture. Presence of the tricolporate pollen type associates the Podostemales with the higher eudicotyledons. Most of the pollen characters of Podostemales and their variations are found among advanced Rosidae (Hamamelidales, Polygalales, Santalales, Violales, Euphorbiaceae).     

Etiologie des infertilités secondaires de l’homme

Introduction

Secondary infertility is defined as the inability to achieve a new pregnancy for a couple that has been able to procreate in the past.

Material and methods

Over a 16-year period, 49 patients consulted for male secondary infertility. Clinical, laboratory or ultrasound assessment demonstrated the cause of infertility.

Results

These patients had a mean age of 33.6 years (range: 26 to 44 years). These couples had an average of 1 living child per family, corresponding to a girl in two-thirds of cases and a boy in one-third. In these patients, infertility was due to the presence of varicocele in 15 patients (31% of cases), infection in 14 patients (29%), and varicocele associated with infection in 11 cases (22%).

Conclusion

This assessment revealed two main aetiologies, but some causes remain obvious, such as surgery with resection of the prostate or testicles, or certain cytotoxic therapies.     

Indications de la TEP-FDG en oncologie. Mise à jour selon les recommandations de prise en charge européennes et américaines

[18F]-Fluoro-2-Deoxy-D-Glucose-Positon Emission Tomography (PET) is a powerful tool which availability increases in France. The oncological PET indications are plentiful and are increasing. Yet, its cost is significant. Thus, it is important to use PET in validated indications and/or in situations in which it can improve the patient management. The first part of this work reviews the PET indications in oncology, according to the international clinical practice guidelines (European Society for Medical Oncology [ESMO] and National Comprehensive Cancer Network [NCCN]), and compares those with the French guidelines (Guide de bon usage [GBU] des examens d’imagerie médicale). The second part assesses the indication distribution of 400 consecutive PET-CT studies in an against cancer center, according to the cancer type and confronts those with the guidelines.     

Développement de l'hypophyse de Rana temporaria L. Etude au microscope électronique

Résumé Nous avons procédé à une étude comparative de la cytologie et de l'ultrastructure de l'hypophyse de Rana temporaria durant la métamorphose.Au stade 7 mm, les cellules de l'ébauche hypophysaire présentent les caractéristiques de cellules embryonnaires indifférenciées riches en plaquettes vitellines, gouttelettes lipidiques et grains de mélanine.Le stade 10 mm, est caractérisé par le développement dans la zone présomptive de la pars intermedia des premières cellules glandulaires et l'apparition d'un petit nombre de fibres neurosécrétrices dans la future neurohypophyse.Durant la prémétamorphose, on note dans la pars distalis, la différenciation de cellules acidophiles à grains de 140 à 300 m, localisées dans la région dorsale. Parmi les cellules chromophobes de la région ventrale on distingue une première catégorie de cellules glycoprotidiques à fines granulations (100 à 200 m) (cellules PAS positives). Vers la fin de ce stade, il apparaît dans la zone ventrale une deuxième catégorie de cellules à grains glycoprotidiques volumineux (150 à 400 m) (cellules bleu alcian — PAS positives). Parallèlement, le nombre de fibres neurosécrétrices augmente dans la neurohypophyse. Dans la pars intermedia, les premiers contacts neuroglandulaires s'établissent.Au cours de la prométamorphose, des terminaisons neurosécrétrices caractéristiques aboutissent dans la région de l'éminence médiane. Ces fibres à fines granulations (70 à 130 m) s'opposent à celles de la pars nervosa à granulations neurosécrétrices plus volumineuses 100 à 200 m). Dans la pars distalis on enregistre une augmentation de l'activité glandulaire des différents types cellulaires.Pendant le stade climax, se développe la deuxième catégorie de cellules acidophiles dont les grains mesurent de 130 à 250 m. L'éminence médiane poursuit son développement. A la fin de cette étape, l'hypophyse présente sa structure définitive.La signification fonctionnelle des différentes catégories de cellules adénohypophysaires est discutée.

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Development of the hypophysis of Rana temporaria L., electronmicroscopical study

Summary The ultrastructure and cytology of the hypophysis of Rana temporaria has been investigated during the embryonic and larval development.At stage 7 mm the presumptive structure of the hypophysis contains undifferentiated embryonic cells with numerous vitelline platelets, lipid droplets and melanine granules.At stage 10 mm the first granulated cells appear in the presumptive zone of the pars intermedia. A few typical neurosecretory axons reach the diencephalic floor.During the premetamorphic stage, the differentiation of several glandular cell types occurs in the pars distalis. One type of acidophils with granules of 140 to 300 m develops in the dorsal part of the gland. More rostrally glycoprotein containing cells with fine granules, (100 to 200 m), (PAS +), and chromophobes are predominant. During the last phase of the premetamorphosis the first glycoprotein containing cells with voluminous granules (150 to 400 m) (alcian-blue-PAS +), develop ventrally. The number of neurosecretory axons increases in the neurohypophysis; neurosecretory fibers appear also between the glandular cells of the pars intermedia.At the prometamorphic stage characteristic axon terminals with fine neurosecretory granules (70 to 130 m) reach the median eminence. These axons differ in their ultrastructure from those present in the pars nervosa which contain a great number of big neurosecretory granules (100 to 200 m). In the adenohypophysis the glandular activity of the different cell types becomes more pronounced.During the last metamorphic stage (climax) a second acidophilic cell with granules ranging from 130 to 250 m was distinguished in the pars distalis. The median eminence obtains its definite structure.The possible functional significance of the different cell types of the adenohypophysis is discussed.

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Avec la collaboration technique de Melle R. O. Scheer.     

Mise en évidence de la dynamique de quelques écosystèmes forestiers et préforestiers provençaux aux étages méditerranéens S.L. à l'aide des taxons indicateurs

Evidence is presented for dynamic successions in the Provence on the basis of a multivariate analysis, of a very large sample. Different phases in the Quercus suber series on silicious substrate are shown. Also the evolution of the vegetation groupings on Ventoux and Sainte-Baume mountains on calcareous substrate and at different levels in the zonation is specified. The succession of the grasslands is as follows: Isoetes and Nasturtium groupings, Serapias, Lotus and Trifolium, then Vulpia and Aira groupings, and finally Helianthemum guttatum grasslands, preceding the shrub groupings: Cistus ladaniferus, then Cistus albidus and Cistus monspeliensis. Then follow either Erica and Calluna maquis or Quercus suber formations. On Mont Ventoux, the stages of degradation of the Quercus pubescens forests are Aphyllantes and Thymus vulgaris grasslands, and Buxus sempervirens and Genista scorpius scrubs. On the oromediterranean level, the transition from Avena setacea and Galium villarsii grasslands, then Ononis caenisia grasslands to Pinus uncinata forests is demonstrated. The development of reforestation is predicted on the basis of the floristic composition of the previous stages. On Sainte-Baume Mountain, the Quercus pubescens supramediterranean series is formed by the following stages: low scrubs of the Lavandulo-Astragaletum, and Prunus mahaleb and Phillyrea media, Acer monspessulanum groves, and forests with prevailing Quercus pubescens. The succession on rocky traverses and crests is slightly different. The first stages are Sesleria grasslands and the later ones are woodland groupings of Tilia platyphyllos, Acer opalus and Ilex aquifolium.     

L’Inhibine B sérique, marqueur sensible de la production spermatique chez l’homme

Several recent papers indicate that the blood concentration of inhibin B measured by the dimeric assay is a marker of human spermatogenesis. The aim of the present study was to validate the dimeric assay in our hospital. For this purpose, we studied a population of 106 patients attending our infertility clinic. We found that serum inhibin B levels were positively correlated with the level of sperm production as reflected by the sperm concentration and negatively correlated with serum FSH levels. Serum inhibin B concentrations were found to be superior to FSH levels for discriminating between subgroups of patients with different levels of sperm production. For example, the differences in the inhibin B levels in severe oligozoospermia (< 5×106 sperm/ml) compared to non-obstructive azoospermia were more pronounced than the differences in FSH (p=0.0002 vs p=0.007, respectively). Overall, the results obtained in the present study were similar to those reported in other studies based on the same assay. Serum inhibin B levels in patients with non obstructive azoospermia were ten times lower than in patients with normal sperm concentrations. From a practical point of view, the measurement of serum inhibin B opens up new possibilities for the diagnosis and prognosis of many testicular disorders. Firstly, serum inhibin B determination should be performed whenever reproductive hormones are prescribed. In the particular case of azoospermia, serum inhibin B concentrations appear to be particularly useful to distinguish between obstructive and non-obstructive situations. Finally, according to a recent publication, a serum inhibin B cut-off value (> 40 pg/mL) could predict the success of testicular sperm extraction in patients with non-obstructive azoospermia. Serum inhibin B could therefore represent a unique non-invasive marker of focal hypospermatogenesis in men with non-obstructive azoospermia, who are candidates for intracytoplasmic sperm injection (ICSI) and a useful early marker to monitor possible recovery of spermatogenesis after chemotherapy or radiotherapy.     

Physiopathologie des troubles de l’érection chez l’homme paraplégique

Peripheral mechanisms responsible for penile erection are dependant upon a complex control by the nervous system, including peripheral nervous pathways, spinally mediated reflex loops and supraspinal nervous structures. Spinal cord injury is accompanied by a partial or a complete modification of these controls. In relation to the reflexogenic or psychogenic origin of penile erection, spinal cord injury does not cause the same effects. Reflexogenic erections sitll occur after spinal cord injury at a suprasacral level. After lesions at a level lower than the thoracolumbar spinal cord, tumescence following psychogenic stimulation has been observed. The hypotheses resulting from clinical and experimental observations and explaining the differences at the origin of these response are detailed. The recent developments in the neurophysiology of penile erection and the role of neurotransmitters allow a more analytical approach of the phenomenous and also bring new insights into possible compensatory pathways following spinal cord injury.