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Uterine niche is a potential significant consequence of Caesarean section and is diagnosed by ultrasound. The timing of Caesarean section (during pre, early or advanced labour), location of the incision (distance from the internal os), techniques for opening and closing the uterine cavity, and bladder flap have been frequently mentioned in the literature, however, these factors continue to be a source of disagreement with respect to whether they increase the risk of uterine niche or protect against this complication. In this review, we outline and discuss the possible risk factors that may be responsible for this entity. The main factor upon which obstetricians can act is the rate of first Caesarean section, which can and should be reduced. Moreover, a rather high incision at a distance from the internal os, and a sparing use of bladder detachment should be always kept in mind as well.

Acute myeloid leukemia (AML) is a rare disorder of childhood. It could arise as primary tumor or secondary transformation from a myelodysplastic syndrome (MDS). While some cases are likely acquired...

International audience; The aim of this study was to identify specific unusual prenatal ultrasound (US) patterns of the adrenal gland and to propose a systematic approach for diagnosis. Six fetuses with unusual aspects of one or both adrenal glands, detected during routine prenatal US screening, were evaluated. Prenatal and postnatal management are described. A checklist of US features was created to perform a detailed analysis of adrenal lesions and guide prenatal management; this includes the time of appearance, location, growth, vascularization, structure, and presence of findings suggestive of malignancy.

With the purpose of revising World Meteorological Organization’s Commission for Instruments and Methods of Observation (WMO/CIMO) Guide #8 on weather stations siting, and in the framework of EMPIR project ENV58 MeteoMet 2, an experiment to evaluate metrologically the maximum influence of a paved road on 2-m air temperature measurements (“road siting effect”) has been designed, installed and run in Italy. It consists of a 100-m long array of seven measurement stations, at increasing distances from a local road, equipped with shielded Pt100 thermometers and ancillary sensors (hygrometers, anemometers, solar radiation meters). Data coming from 1 year of observations, has been analysed for daily climatological metrics, finding that the road mostly effects minimum temperatures, with average values of ~ 0.30±0.18 °C at a distance of 1 m; then, in order to quantify the instrumental effect on the measurement, data was filtered by applying a Generalized Additive Model, selecting only times when the effect is more intense (during nights, in presence of low winds coming from the road), and the road siting effect has been calculated by modelling the maximum temperature differences by using Extreme Values Analysis. The 1-year return value on 10-min measurements is 1.22±0.30 °C at 1 m from the road, with a gradual decline (~ 0.1 °C/m), while an extrapolation to 100-year return level gives a value of 1.71±0.79 °C. Analysis also show the possibility of calculating an asymptotic upper limit to these values, providing there are enough data to lower the associated uncertainties. These results, published in the International Journal of Climatology (Coppa et al 2021, https://doi.org/10.1002/joc.7044) is a first step towards a redefinition of the weather station classification scheme of WMO/CIMO Guide #8, together with building and tree effects experiments which have been run in parallel with the road siting experiment here presented and which will be presented elsewhere. Raw data is also available at Zenodo.org (Coppa et al 2020, https://doi.org/10.5281/ZENODO.4300299)

The demand for remote advice has expanded since the advent of information and communication technology. This study aims to evaluate the use of asynchronous tele-expertise (ASTE) in providing a quality expert opinion in the field of obstetric ultrasound.Requests for expert opinions on pregnant patients were considered retrospectively over a 24-month period (01/09/2018 to 01/21/2020). All patients were initially seen in consultation with a midwife sonographer, located in Hyères, 82km from the expert's centre. In the event of unusual images, including one or more malformations on ultrasound screening, a second opinion was necessary. Responses were characterized as follows : possible or impossible to analyse images; ASTE alone or combined with a face-to-face consultation; and absence or presence of unusual images. Unusual images were classified as normal variants or recognised malformations. We analysed the outcomes of these pregnancies and assessed concordance between prenatal advice and postnatal outcome.During the study period, we identified 174 referrals from 141 patients. Requests for advice were made by 3/174 (1.7%), 69/174 (39.7%), and 102/174 (58.6%) in the first, second, and third trimester of pregnancy, respectively. Overall, 115/141 (81.6%), 21/141 (14.9%), 4/141 (2.8%), and 1/141 (0.7%) patients were provided with one, two, three, and five opinions, respectively. In total, 37/141 (26.2%) patients required a face-to-face consultation, resulting in 38/174 (21.8%) opinions (one patient was seen twice). At least one unusual image was found for 27/141 (19.2%) patients and no unusual images were reported for 114/141 (80.8%) patients. Analysis of the pregnancy outcomes revealed a perfect correlation between prenatal advice and postnatal data, both for cases with unusual images and those without.The preliminary results of our study reveal that ASTE is safe in terms of enabling an expert to answer a precise question formulated by a screener when confronted with images deemed to be unusual. Using this mode of communication, a tailored healthcare pathway may be defined for the mother and her foetus. This new type of practice cannot exist without establishing a genuine relationship of trust between the person requesting the opinion and the person who is asked to provide the opinion.

Background: The detection rate of congenital heart defects is barely acceptable. Since 2016, the French National Conference on Obstetrical and Foetal Ultrasound updated its recommendations by the inclusion of an examination of the left ventricular outflow tract (LVOT) in the second and third trimester of pregnancy. Objectives: This study aimed on the one hand to evaluate the practices related to the realization of the LVOT in the setting of fetal echocardiography in low-risk populations, and on the other hand to study the possible modifications of the practices secondary to the introduction of quality criteria. Study Design: We conducted a multicentric, retrospective and prospective, descriptive, longitudinal study divided into three distinct periods: before 2016, in 2017, and in 2020. Seven quality criteria were investigated and rated from 0 to 1 for LVOT screening. Files were randomly selected from three centers, then average total and specific scores were calculated. Results: LVOT images were present in ultrasound reports in more than 93% of cases. Before 2016, the average quality score was 5.49/7 (95% CI: 5.36-5.62), in 2017 5.91/7 (95% CI: 5.80-6.03), and in 2020 5.70/7 (95% CI: 5.58-5.82) for the three centers. There was no significant difference following the introduction of the quality criteria; 2017 vs. 2020, p = 0.054. Kappa coefficients of the inter- and intra-operator variables were all within 0.601 and 1. Conclusion: Left ventricular outflow tract images were present in most of ultrasound reports. The introduction of the proposed quality criteria is not associated with a significant change in practice.

Homogenization is an important step to improve the quality of long-term observational data sets and estimate climatic trends. In this work, we use the GNSSseg/GNSSfast segmentation packages that were developed by Quarello et al., 2020, for the detection of abrupt changes in the mean of Integrated Water Vapour (IWV) data derived from GNSS measurements. The method works on the difference of the IWV time series (GNSS – reference) in order to cancel out the common climatic variations and enhance the discontinuities due to the inhomogeneities in the GNSS series. This segmentation method accounts for changes in the variance on fixed intervals (monthly) and a periodic bias (annual) due to representativeness differences between GNSS and the reference (in our case, a global atmospheric reanalysis). The goal of this study is to analyze the sensitivity of the segmentation method to the data properties, particularly the GNSS data processing method. Two reprocessed GNSS solutions are considered: IGS repro1, covering the period 1995-2010, and CODE REPRO2015 + OPER, covering the period 1994-2018. Next, the impact of the length of time series and missing data are investigated. Finally, the use of two different reference series is considered (ERA-Interim and ERA5 reanalyses).The segmentation results are screened for outliers (multiple detections occurring within a distance of 80 days) and validated with respect to known equipment changes (from GNSS metadata). The impact of the data properties is analyzed by comparing the number and position of detected change-points and the fraction of validated change-points. The influence of the variance of the IWV difference series and the magnitude of the periodic bias is examined. Finally, the results are compared in terms of estimated linear trends taking the detected change-points into account.From the multiple comparisons, we found that about 30 % of change points are similar when the GNSS processing method changed, while 60 % are similar when the CODE series is shortened to match the length of the repro1 series. These tests highlight that the segmentation results are processing-dependent and are affected by the length of the series. The impact of the data properties on the IWV trends and associated uncertainties are also quantified. Besides, it is important to note that the best segmentation result is found when the ERA5 reanalysis is used as a reference.

Persistent thrombocytopenia is a common complication after allogeneic hematopoietic stem cell transplantation (HSCT). While the use of thrombopoietin receptor agonists was retrospectively investigated in adults, data in pediatric posttransplant thrombocytopenia are lacking. We evaluated the safety and efficacy of eltrombopag in nine children with platelet transfusion-dependent persistent thrombocytopenia after HSCT. Eltrombopag was started at a median of 147 days after allo-SCT and continued for a median period of 64 days, the starting dose being 50mg per day. The therapy was well tolerated. After a median time of treatment of 36 days, eight patients (88%) reached sustained platelets count>50000/μL.

Patients given allogeneic hematopoietic stem cell transplantation (alloHSCT) present an increased incidence of long-term toxicities that can be attributed to the preparative regimen. We retrospectively analyzed in a population of 670 children receiving allo-HSCT for acute leukemia the occurrence of different late effects in function of the choice made between total body irradiation (TBI) and busulfan, as part of the preparative regimen. In univariable analysis, we found that patients treated with TBI developed cataract in 24% of the cases compared with 4% in patients treated with BU (p = 0.0001) and that the incidence of secondary malignant neoplasia (SMN) was higher in patients treated with TBI (18%) as compared with those prepared to the allograft with a Bu-based regimen (0%) (p = 0.019). Conditioning regimen did not show a statistically significant correlation with the occurrence of all the other investigated late effects. In multivariable analysis, TBI remained associated with the occurrence of cataracts (Relative Risk: 0.33 p = 0.012) and secondary malignancies (Relative Risk 3.96 × 10e−6 p < 0.001); however, other variables, as GvHD and disease type, were also correlated with these long-term sequels, indicating that in our study population the preparative regimen is not the only factor influencing the incidence of these complications.

Facial cleft are the most frequent craniofacial anomalies with an incidence of one for 1000 births, all births combined, and require specialized multidisciplinary care. Since 2005, the systematic realization of two ultrasound views (nose-lip and profile) is recommended for the exploration of the fetal face in the 2nd trimester of pregnancy. Application of these recommendations should allow screening of the majority of cleft lip and palate. However, cleft palates, without labiomaxillary involvement, are currently largely underdiagnosed at prenatal ultrasound, although they can be associated with a syndromic diagnosis in up to 30% of cases. The aim of this work is to describe, from embryology to surgical consultation, the complete ultrasound examination of a fetus with a classic facial cleft.

ObjectiveScreening for genital infection (GI), bacterial vaginosis (BV), sexually transmitted infection (STI) and asymptomatic carriage of group B streptococcus (GBS) in pregnant women is a common reason for medical appointments. Objectives were first to determine the non-inferiority of vaginal self-sampling compared with vaginal/cervical classical sampling to screen for GIs, bacterial vaginosis (BV), STIs, and GBS asymptomatic carriage in pregnant women; second to determine the feasibility of vaginal self-sampling.MethodsVaginal self-sampling (VSS) and vaginal/cervical classical sampling (VCS) of 1027 women were collected by health care professionals and simultaneously carried out on each patient. Bacterial infection, yeast infection, Chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium, Trichomonas vaginalis and Herpes simplex virus types were systematically screened in both paired VSS and VCS samples.ResultsStatistical tests supported the non-inferiority of VSS compared with VCS. Agreements between VCS and VSS remained high regardless of the type of studied infection. VSS had successful diagnostic performances, especially for Predictive negative value (PNV) (over 90%) for all studied infections. Most participants (84%) recommended the use of VSS.ConclusionsThis study remains the most exhaustive in screening for GI, BV, STI agents and asymptomatic GBS carriage. Given its efficacy and acceptability, VSS seems to be a viable alternative to classic physician sampling among women in the general population. This study provides evidence that vaginal self-sampling can be used as a universal specimen for detection of lower genital tract infections in women.Study Identification numberID-RCB 2014-A01250-4

Background & aim Screening for genital infection (GI) such as bacterial vaginosis (BV) and yeast infection, for sexually transmitted infection (STI), and for asymptomatic carriage of group B streptococcus (GBS) in pregnant women are common reason for medical appointments. The diagnosis and control of GIs, STIs, and GBS are major issues, for fertility and overall well-being of affected women. Conventional testing is performed using vaginal/cervical classical sampling (VCS); this procedure requires pelvic examination performed by health care professionals which raises concerns among women. Vaginal-self-sampling (VSS), as an alternative to VCS, might capture more women. The aim was first to show non-inferiority of VSS compared with VCS to screen for GIs, STIs, and GBS; second to determine the feasibility of VSS. Methods VSS and VCS from 1027 women were collected by health care professionals and simultaneously carried out on each patient. GIs, STIs, and GBS were systematically screened in both paired VSS and VCS samples. Non-inferiority of VSS compared with VCS was assessed using z statistic for binomial proportions. Results Prevalence of GIs were 39.7% using VSS and 38.1% using VCS (p = 0.0016). Prevalence of STIs was 8.5% (VSS) vs 8.1% (VCS) (p = 0.0087). Prevalence of GBS was 13.4% (VSS) and 11.5% (VCS) (p = 0.0001). Most participants (84%) recommended the use of VSS. Conclusions This study shows that VSS was not inferior to VCS for the detection of GIs, STIs, and GBS. This study provides evidence that VSS can be used as a universal specimen for detection of lower genital tract infections in women. Study identification number ID-RCB 2014-A01250-4.

Diamond Blackfan anemia (DBA) is predominantly an autosomal dominant inherited red cell aplasia primarily caused by pathogenic germline variants in ribosomal protein genes. DBA due to pathogenic RPL35A variants has been associated with large 3q29 deletions and phenotypes not common in DBA. We conducted a multi-institutional genotypephenotype study of 45 patients with DBA associated with pathogenic RPL35A germline variants and curated the variant data on 21 additional cases from the literature. Genotype-phenotype analyses were conducted comparing patients with large deletions versus all other pathogenic variants in RPL35A. Twenty-two of the 45 cases had large deletions in RPL35A. After adjusting for multiple tests, a statistically significant association was observed between patients with a large deletion and steroid-resistant anemia, neutropenia, craniofacial abnormalities, chronic gastrointestinal problems, and intellectual disabilities (P

With the purpose of revising World Meteorological Organization's Commission for Instruments and Methods of Observation (WMO/CIMO) Guide #8 on weather stations siting, an experiment to evaluate metrologically the maximum influence of a paved road on 2-m air temperature measurements (“road siting effect”) has been designed, installed and run in Italy. It consists of a 100-m long array of seven measurement stations, at increasing distances from a local road, equipped with shielded Pt100 thermometers and ancillary sensors. Data coming from 1 year of observations have been analysed for daily climatological metrics, finding that the road mostly effects minimum temperatures, with average values of ~0.30 ± 0.18 °C at a distance of 1 m; then, in order to quantify the instrumental effect on the measurement, data were filtered by applying a generalized additive model, selecting only times when the effect is more intense (during nights, in presence of low winds coming from the road), and the road siting effect has been calculated by modelling the maximum temperature differences by using extreme values analysis. The 1-year return value on 10-min measurements is 1.22 ± 0.30 °C at 1 m from the road, with a gradual decline (~0.1 °C·m−1), while an extrapolation to 100-year return level gives a value of 1.71 ± 0.79 °C with a decline rate of about 0.17 °C·m−1. This is a first step towards a redefinition of the weather station classification scheme of WMO/CIMO Guide #8, together with building and tree effects experiments which have been run in parallel with the road siting experiment here presented and which will be presented elsewhere.

The long series of integrated water vapor content (IWV) measured by GNSS are affected by inhomogeneities linked to changes in the instrumentation, the environment and the data processing procedure. The homogenization of these series is a crucial step for applications in climatology, e.g. estimating the trend and decennial variability. Due to the high natural variability of IWV, segmentation must be applied to IWVdifferences between GNSS observations and a reference which in our application is currently the ERA-Interim reanalysis. We have developed a segmentation method dedicated to the detection of abrupt changes in the mean which takes into account a periodic bias and a heterogeneous variance in these data. The algorithm first calculates the monthly variance with a robust estimator. Then, it estimates the number of breaks fixed iteratively (i) the variable bias and (ii) the positions of the break points and the means of thesignal, this for all the numbers of breaks tested. In a maximum likelihood approach thise stimation is carried out and it is based on the dynamic programming algorithm which is the only one to provide the exact solution in a reasonable time. Finally, the optimal number of change-points is chosen using a penalized model selection method. Four penalty criteria are proposed. The method was tested and optimized using numerical simulations and applied to IWV GNSS data for 120 stations in the global IGS network for the period from January 1995 to December 2010. The results on this data were validated using IGS metadata. The method is implemented and distributed in the form of an R package GNSSseg available on th CRAN.; Les series longues de contenu integre en vapeur d’eau (CIVE) mesurees par GNSS sont affectees par des inhomogeneites liees aux changements de l’instrumentation,de l’environnement et de la procedure de traitement des donnees. L’homogeneisation de ces series est une ́etape cruciale pour les applications en climatologie.Du fait de la forte variabilite naturelle du CIVE, la segmentation doit etre appliquee sur des differences de CIVE entre les observations GNSS et une reference qui dans notre application est actuellement la reanalyseERA-Interim. Nous avons developpe une methode de segmentation dediee à la detection de changements abrupts dans la moyenne qui prend en compte un biais periodique et une variance heterogene dans ces donnees. L’algorithme calcule dans un premier temps la variance mensuelle avec un estimateur robuste. Ensuite, il estime à nombre de ruptures fixe de maniere iterative (i) le biais periodique et (ii) les positions des points de rupture et les moyennes du signal, pour tous les nombres de ruptures testes. Cette estimation est realisee au sens du maximum de vraisemblance et s’appuie sur l’algorithme de programmation dynamique qui est le seul à fournir la solution exacte en un temps raisonnable.Finalement, le nombre optimal de ruptures est choisi à l’aide d’une methode de selection de modele penalisee.La methode a ́ete testee et optimisee à l’aide de simulations numeriques et appliquee aux donnees de CIVE GNSS pour 120 stations du reseau IGS. Enfin, les informations de segmentation sont incluses dans un a algorithme de régression linéaire qui est utilisé pour estimer les tendances.La méthode est implémentée dans le package R GNSSseg disponible sur le CRAN.

The long series of integrated water vapor content (IWV) measured by GNSS are affected by inhomogeneities linked to changes in the instrumentation, the environment and the data processing procedure. The homogenization of these series is a crucial step for applications in climatology, e.g. estimating the trend and decennial variability. Due to the high natural variability of IWV, segmentation must be applied to IWVdifferences between GNSS observations and a reference which in our application is currently the ERA-Interim reanalysis. We have developed a segmentation method dedicated to the detection of abrupt changes in the mean which takes into account a periodic bias and a heterogeneous variance in these data. The algorithm first calculates the monthly variance with a robust estimator. Then, it estimates the number of breaks fixed iteratively (i) the variable bias and (ii) the positions of the break points and the means of thesignal, this for all the numbers of breaks tested. In a maximum likelihood approach thise stimation is carried out and it is based on the dynamic programming algorithm which is the only one to provide the exact solution in a reasonable time. Finally, the optimal number of change-points is chosen using a penalized model selection method. Four penalty criteria are proposed. The method was tested and optimized using numerical simulations and applied to IWV GNSS data for 120 stations in the global IGS network for the period from January 1995 to December 2010. The results on this data were validated using IGS metadata. The method is implemented and distributed in the form of an R package GNSSseg available on th CRAN.; Les series longues de contenu integre en vapeur d’eau (CIVE) mesurees par GNSS sont affectees par des inhomogeneites liees aux changements de l’instrumentation,de l’environnement et de la procedure de traitement des donnees. L’homogeneisation de ces series est une ́etape cruciale pour les applications en climatologie.Du fait de la forte variabilite naturelle du CIVE, la segmentation doit etre appliquee sur des differences de CIVE entre les observations GNSS et une reference qui dans notre application est actuellement la reanalyseERA-Interim. Nous avons developpe une methode de segmentation dediee à la detection de changements abrupts dans la moyenne qui prend en compte un biais periodique et une variance heterogene dans ces donnees. L’algorithme calcule dans un premier temps la variance mensuelle avec un estimateur robuste. Ensuite, il estime à nombre de ruptures fixe de maniere iterative (i) le biais periodique et (ii) les positions des points de rupture et les moyennes du signal, pour tous les nombres de ruptures testes. Cette estimation est realisee au sens du maximum de vraisemblance et s’appuie sur l’algorithme de programmation dynamique qui est le seul à fournir la solution exacte en un temps raisonnable.Finalement, le nombre optimal de ruptures est choisi à l’aide d’une methode de selection de modele penalisee.La methode a ́ete testee et optimisee à l’aide de simulations numeriques et appliquee aux donnees de CIVE GNSS pour 120 stations du reseau IGS. Enfin, les informations de segmentation sont incluses dans un a algorithme de régression linéaire qui est utilisé pour estimer les tendances.La méthode est implémentée dans le package R GNSSseg disponible sur le CRAN.

Adolescents with cancer face unique medical and psychosocial challenges and it is important for their doctors to understand the psychological manifestations of cancer diagnosis and treatment in this age group. Using patient dialogues, we describe how simultaneous participation of physicians and patients could help to give voice to patient needs, in particular concerning communication.

International audience; Background: The significant number of qualitative and quantitative ultrasound markers described for first-trimester screening of open spina bifida (OSB) and other posterior brain defects (oPBD) has resulted in their complex implementation and interpretation for a widespread screening and in a lack of consensus regarding diagnostic accuracy.Objectives: To assess and compare the accuracy of qualitative and quantitative cranial sonographic markers at 11-14 weeks of gestation for the detection of OSB and oPBD.Search strategy: A systematic literature search was performed in MEDLINE and COCHRANE from 2009 to April 2020.Selection criteria: Studies assessing the diagnostic accuracy of quantitative and/or qualitative ultrasound signs to predict OSB and oPBD were included. Cohort studies and case-control studies were also considered.Data collection and analysis: Two reviewers independently extracted data and assessed the risk of bias. The overall pooled estimate and a summary receiver operating characteristic curve was estimated for each subgroup (qualitative and quantitative assessment).Main results: Twenty-three studies were included in our meta-analysis. The pooled sensitivity and specificity for qualitative assessment were 76.5% and 99.6%, and for quantitative assessment were 84.5% and 96.3%, respectively; specificity for the qualitative ultrasound signs was significantly higher (P = 0.001). The overall sensitivity of cranial sonographic markers for the screening of oPBD was 76.7% and specificity was 97.5%.Conclusions: The qualitative approach demonstrated greater specificity, so this would appear to be more appropriate for daily screening, as a first-line tool, whereas the quantitative approach should be reserved for expert ultrasound.Tweetable abstract: This study highlights the relevance of first-trimester qualitative ultrasound signs in the screening of open spina bifida.

Whereas 90% of patients with Wilms tumor (WT) reach cure, approximately half of patients developing a recurrent tumor die of the disease. Therefore, to disclose events leading to recurrence represents a clinical need. To study paired primary/recurrent tumor samples, being aware of the intra-tumoral heterogeneity, might help finding these answers. We previously suggested that mutations in SIX1 and DROSHA underlie WT recurrence. With the aim to better investigate this scenario, we collected 19 paired primary/recurrent tumors and 10 primary tumors from relapsing patients and searched for mutations in the SIX1/2 genes and microRNA processing genes (miRNAPGs). We found SIX1 mutation in one case, miRNAPGs mutations in seven cases, and the co-occurrence of SIX1 and miRNAPG mutations in one case. We could observe that, whereas in primary tumors the mutations could be heterogeneously present, in all cases they were positively selected and homogeneously present in the recurrent disease, as also indicated by a “moderate” and “almost perfect” agreement (according to the Landis and Koch classification criteria) between paired samples. Analysis of SIX1/2 genes and miRNAPGs in 50 non-relapsing WTs disclosed SIX2 mutation in one case and miRNAPGs mutations in seven. A borderline statistically significant association was observed between miRNAPGs mutations and the occurrence of relapse (p value: 0.05). These data suggest that SIX1 and miRNAPGs mutations may provide an advantage during tumor progression to recurrence and can represent oncogenic drivers in WT development.