Medical Humanism or Scientia Sexualis? Building a Sexological Concept in Fécondité

This article argues that Zola's late novel Fécondité, while on the surface a transparently didactic roman à thèse articulating populationist concerns, is in fact at the same time a roman de mœurs implicated genealogically in a broader range of issues than pro-natalist ethics and various behavioural and therapeutic bêtes noires, containing identifiable traces of other contemporary pathological concerns, contingently marshalled for pro-natalist ends. Exploiting the terminological flexibility of what Peter Cryle and Alison Moore have referred to as a long-established ‘constellation of themes’ constituted by ‘impotence, frigidity and sterility’, Fécondité participates in the fin-de-siècle production of a key sexological concept. It does so through relentless deployment of the malleable motif of female sexual coldness – a signifier of pathological conditions named in contemporary medical and pseudo-medical literature as ‘frigidité’, ‘froideur’, and so on – and its polyvalent application to distinct pathologies manifesting in a variety of its female characters, in particular inabilities to desire, to conceive, and, significantly, to climax. Zola's novel appears at a moment where women's sexual pleasure was becoming normalised, to the extent that its absence now counted as a pathological disorder; Fécondité deploys tropes of coldness – consequential upon anti-reproductive practices – to suggest that it is attempted disruption of the natural reproductive order that ensures such disordered absence. Ultimately, while Fécondité is readable as didactic expression of a ‘humanitarian’ natalist ethics and representation of doctor-patient encounters, treatment, experience of illness and other ‘medical humanities’ concerns, it is however important not to overlook this representation's discursive contingencies, particularly the coalescence of sexological and populationist concerns at a moment when both were of considerable significance. Fécondité in this sense straddles two major fin-de-siècle discursive economies, offering an ideal object for a critical medical humanities valuing the pathological as well as the pathographical.

Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection

Background Cesarean scar defect (CSD), especially CSD with residual myometrium less than 3 mm is reported to be the highest risk agent associated with uterine rupture for subsequent pregnancy. Currently, laparoscopic resection and suture was the mainstay therapy method for CSD with a residual myometrium less than 3 mm in women with a desire to conceive. Besides, the women have CSD related symptoms, especially postmenstrual bleeding, should be recommended for CSD treatment. This study is to investigate the efficiency of this novel laparoscopic surgery for the repair of cesarean scar defect (CSD) without scar resection for residual myometrium thickening. Method This retrospective clinical study enrolled 76 women diagnosed with CSD who had a residual myometrium thickness less than 3 mm and also had a desire to conceive, had undergone laparoscopic surgery for the repair of CSD in the time period March 2016 to March 2018. Two study cohorts were created among the 76 patients: 40 patients had undergone the novel laparoscopic repair of CSD without processing scar resection (Group A), whereas 36 patients had undergone the traditional laparoscopic resection and suture of CSD (Group B). Results Residual myometrium thickening occurred among all the 76 patients and the average residual myometrium thickness was increased to almost 6 mm, presenting no between-group difference. In Group A, all the CSD-related postmenstrual bleeding was resolved or improved, but one patient in Group B has no obvious change to postmenstrual bleeding. After CSD repair, 20 patients got pregnant naturally in Group A, and there was no cesarean scar pregnancy and uterine rupture. While, there were 9 cases of natural pregnancy in Group B. No uterine rupture occurred among these 9 pregnant women of Group B, but 1 case of pregnancy was terminated due to cesarean scar pregnancy. Conclusion Laparoscopic repair without processing scar resection seems to be a feasible, safe and simple operative approach for CSD treatment, which can thicken residual myometrium and improve postmenstrual bleeding.

Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

ObjectiveTo evaluate the efficacy and prognosis of fertility-sparing re-treatment on patients with recurrent endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their uterus after complete remission (CR) for primary conservative therapy.MethodsWe performed a retrospective study on recurrent EC or AEH patients who received fertility-sparing re-treatment after achieving CR. Data regarding clinicopathological factors, adverse events, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.ResultsOf the 98 recurrent patients with a median disease-free interval period of 19 (3–96) months, 18 patients decided to receive hysterectomy directly, and 80 patients received fertility-preserving re-treatment. Seventy-one (88.6%) cases achieved CR, 96.0% in AEH and 75.8% in EC patients, with the 6 (3–16) months’ median CR time. Seven (8.8%) patients failed to achieve CR and then underwent the hysterectomy: one partial response (PR), four stable disease (SD), and two progressive disease (PD). Forty-nine women attempted to get pregnant after CR, 13 (26.5%) became pregnant, seven (14.3%) successfully delivered, and six (12.2%) miscarried. During the follow-up period, 22 (31.0%) women had developed a second relapse with the median recurrence time of 12 (4–90) months, and 10 patients decided to receive the third round of fertility-sparing treatment. Seven (70.0%) patients, 33.3% in EC and 85.7% in AEH, achieved CR again. Hysterectomy was performed in two (20.0%) patients due to SD. After the third-round treatment, six women had the desire to conceive but no one became pregnant successfully.ConclusionFor patients with recurrent EC and AEH after primary conservative treatment, fertility-preserving re-treatment can still achieve a promising response, and patients have possibilities of completing childbirth.

Real-World Experience Using the IUB Ballerine MIDI Copper IUD: A Multicenter, Multinational Observational Study

Objective: The aim of the study was to assess efficacy, safety and patient acceptability of the intrauterine ball (IUB) Ballerine MIDI copper intrauterine device (IUD), using real-world data collected from users and physicians.Study design: Retrospective analysis of two cross-sectional survey studies conducted in seven private clinics in Israel or Switzerland, and in one Swiss hospital between January and October 2018. Participants were healthy women who had the non-hormonal IUB Ballerine MIDI inserted >12 months before enrolment. In total, 382 participants and their 19 physicians completed questionnaires relating to device insertion, user experience and performance.Results: Mean age at insertion was 31.8±7.1 years, the survey was answered 16.0±4.7 months following IUB insertion. Most women were married (56.8%) and multigravid (83.5%). In 20 (5.2%) cases premature removal was due to desire to conceive. Excluding these women, the >12-month continuation rate was 71%. The expulsion rate was 17 (4.5%) and pregnancy rate was 4 (1.1%). The IUB was associated with high tolerability, 31% of current users reported no menstrual cramps/pain or light (34%) to moderate (20%) dysmenorrhea. The majority of women (69%) reported moderate to high satisfaction with the device, and 79% said they would recommend it to friends and relatives. Physicians reported in 87% of procedures the device was simple to deploy, with no difficulties encountered.Conclusions: The IUB Ballerine MIDI was demonstrated to be safe, effective and highly accepted in a cohort of women in different clinical settings and among a socioeconomically and demographically diverse population of contraception seekers.

Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya

Introduction. A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods. We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples’ clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results. Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion. The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.

Predictors of post-partum family planning uptake in Webuye Hospital, western Kenya

Background: A short inter-pregnancy interval increases the risk for maternal and neonatal deaths in addition to other pregnancy complications including: preterm delivery, low birth weight, anaemia and premature rupture of membranes. However, only one half of Kenyan women, who have no desire to conceive immediately after birth, are using contraception one year after delivery. Aim: The aim of this study was to determine the predictors of uptake of post-partum family planning (PPFP). Setting: The study was conducted among post-partum women accompanying their children for their first measles vaccination at Webuye County Hospital (WCH), in western Kenya. Methods: This was a cross-sectional study involving 259 randomly sampled post-partum women, accompanying their children for their first measles vaccination. A structured, interviewer-administered questionnaire was used to collect data. Logistic regression was used to identify correlates of PPFP uptake. Results: The uptake of PPFP among women at 9 months post-partum at WCH was found to be 78.4% ± 5.0%. The odds of PPFP uptake among women living with their sexual partners was 88.2% less than among those not living with their partners with the true population effect between 97% and 51% (OR = 0.118; 95% CI: 0.028–0.494; p = 0.003). Conclusions: Not living with her sexual partner in the same house is the key predictor of a woman’s PPFP uptake in WCH. This study recommends that any programme aimed at improving post-partum contraceptive use in WCH should target women who live with their partners in the same house.

Mind-Body Dialectics in the Latest Science Fiction TV-Series

The article is devoted to the analysis of the latest science fiction series in the context of the mind-body philosophical problems. The synthesis of theoretical knowledge and empirical science (phenomenological, psychoanalytic, neurophysical and cybernetic experience) is used for the analysis. Prospects for the development of artificial intelligence, including the issue of creating self-conscious robots, unfold not only in science fiction but also in reality thus causing the high ratings of the cyberpunk genre. The destruction of the boundary between man and machine, natural and artificial body, physical and non-physical, real and virtual, is the key point of the newest series The Black Mirror, Electric Dreams of Philip K. Dick, Altered Carbon, Westworld. Mind-body dialectics in philosophy construed by R. Descartes and B. Spinoza, further developed by phenomenologists, is actualized today in the context of technological development. Despite the insights and warnings of science fiction writers, scientists seek for making the breakthrough in the invention of an artificial man. This tendency is caused, first of all, by the desire to conceive the arrangement of human consciousness: how it is generated by matter - the network of neurons of the brain. Solving this philosophical dilemma inevitably leads to unpredictable consequences and radical changes in the development of civilization. Nevertheless, this step is fatal in the general tendency of demiurgy and mimesis, which underlie all the cultural, creative and aesthetic activities of mankind. The author comes to the conclusion that cinema demonstrates models of the possible development of events and the consequences of technogenic tendencies, while the reality clearly indicates that the era of posthumanism has already begun, and were witnessing the most incredible scenarios created by the world of science fiction.

Fertility and ulipristal acetate case report of two spontaneous pregnancies in the same patient following one cycle of treatment

Ulipristal acetate (UPA) is an oral selective progesterone receptor modulator. It is one of the most recent alternatives in the management of symptomatic fibroids and its safety and effectiveness have already been demonstrated in several studies. Nevertheless, there is few evidence regarding its use in the subgroup of women who experience fertility issues and desire to conceive. The authors report a case of a 39- years-old woman with abnormal uterine bleeding and anemia. She had had an uncomplicated pregnancy some years before and was trying to have a second child. She was treated for 3 months with UPA, at a daily dose of 5 mg, per os, followed by a ressectoscopic myomectomy. After five months, she conceived spontaneously and had an uneventful pregnancy. She then remained asymptomatic and almost two years after she was pregnant again. This case supports the idea that UPA is a valid alternative in patients still have a desire to conceive and thus want to avoid surgery. Even tough larger studies on the subject are required, UPA may become very important role in the management of fibroids in the infertility context.

Safety of Pregnancy After Surgical Treatment for Breast Cancer: A Meta-Analysis

PurposeBecause of the rising trend of delayed pregnancies, more and more women remain nulliparous at the diagnosis of breast cancer, and approximately 71% of them desire to conceive after breast cancer treatment. Advances in breast cancer screening have made early diagnosis of breast cancer possible, and many patients have the opportunity to be treated by surgery. In this study, we conducted a meta-analysis to evaluate the effect of pregnancy on patient survival and prognosis after surgical treatment for breast cancer.MethodsAn electronic search was performed in MEDLINE (PubMed), EMBASE, and Web of Science to identify potentially eligible studies published before August 2013. Both fixed-effect and random-effect models were used to calculate the pooled relative risk (PRR). The Q test and I2 statistics were used to assess the heterogeneity among the studies.ResultsA total of 5 studies were included in our meta-analysis. Five hundred fifty-four patients who become pregnant after surgical treatment for breast cancer were compared with a control group of 2354 patients for overall survival (OS). Our analysis demonstrated that pregnancy after surgical treatment for breast cancer had a significant beneficial effect on OS (PRR, 0.78; 95% confidence interval, 0.64–0.95). The disease-free survival outcome also favored patients in the pregnancy group (PRR, 0.87; 95% confidence interval, 0.71–1.08).ConclusionsThis meta-analysis indicates that pregnancy after surgical treatment does not increase the risk of breast cancer recurrence and may actually improve OS.

Changes and Perspectives in Food Studies

Food Studies represent the bases for multidisciplinary knowledge in food science, food engineering, food management, and how to use these scientific bases in a food worldwide context. Teaching and learning must be adapted to the new students, to the new tools, considering the cost of studies and equipment. The international availability of raw materials, the diversity of cultures, tastes and habits must be taken into account in the controlled food processes. Food engineering must be taught with reference to nutrition, health and security, but also to packaging, logistics, international rules, management of water, energy, wastes and cost. So how do we teach the present and future food engineers, to help them to acquire and build their own knowledge, to develop curiosity, an open mind and team work? How do we teach them to use, in an efficient way, computers, data bases, the internet, but also to learn and practice in the lab, on pilot equipment, in the plant during long internships? How do we give them the desire to conceive, to create, to manage, to communicate and to continue to learn during their professional life? International networks of universities, with associated people from research and industry, with teachers in elementary and secondary schools, with students, represent a main factor for reciprocal knowledge and exchanges, to preserve and use diversity to develop new ideas for teaching and learning. The objectives are to contribute to the development of our society, to feed in an harmonized way the world made of human beings, consumers, and workers in industry, research and universities.