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Funding Acknowledgements Type of funding sources: None. Introduction From the beginning, the use of X-ray (XR) has been a critical component in both the guidance and development of arrhythmia ablation procedures. Despite the development of non-fluoroscopic navigators, the single-shot techniques for atrial fibrillation ablation procedures still rely almost exclusively on the use of XR. Recently, the Heliostar® irrigated radiofrequency balloon has been developed, which can be completely visualized on the Carto 3® navigation system. This special feature makes it possible to minimise the use of XR in this type of procedure or even suppress it. We present our first experience after the implementation of a "zero-XR" protocol for this procedure. Objectives The aim of this study was to demonstrate that "zero-XR" ablation of atrial fibrillation with Heliostar® radiofrequency balloon is possible and safe. Methods This is a single-centre study. Consecutively 22 patients with paroxysmal (63.6%) or persistent (36.4%) atrial fibrillation underwent pulmonary vein isolation by irrigated radiofrequency balloon (Heliostar®). Eight of the cases were performed without fluoroscopy, supported by the navigation system and intracardiac ultrasound, and the remaining 14 were performed without limitation of the use of XR. Clinical, echocardiographic and technical data were collected from all 22 patients. All cases were performed under general anaesthesia, with the Carto 3® navigation system. Mapping was performed in sinus rhythm whenever possible. Results 100% isolation of the veins was achieved, with 62.1% first pass isolation in the non-XR group versus 56.4% in the XR group (non-significant difference). The vein with the highest percentage of first pass isolations was the left inferior vein in both groups. There were no complications in either group. Procedure times were similar (left atrial dwell time of 32 minutes in the non-XR group and 40 minutes in the XR group, non-significant difference), although the mapping time was slightly shorter in the non-XR group (9,9±5 non-XR vs 16±6.9, p=0.04). There was also no difference in the mean time to isolation from the start of radiofrequency application in each vein (10.6 seconds in the non-XR group and 11 seconds in the XR group, p=0.75). The non-XR group had a higher number of patients with left main trunk, but the XR group had a higher percentage of patients with persistent forms of atrial fibrillation. Left atrial size was normal in most patients, and ventricular function was preserved, with no differences between the two groups. Conclusion Pulmonary vein isolation with the Heliostar® radiofrequency balloon without XR is possible and safe, with similar efficacy and first pass isolation rate, similar procedure time and no relevant complications in our series.

Introduction In Spain over the last two decades, cesarean section (CS) rates have increased from 15 to 25% in the Public Health Sector and from 28 to 38% in the private sector. There are multiples causes for this rise, which are often unclear. The aim of our study is to collect and analyze all the CS rates data from a hospital network of the 42 Quironsalud Hospitals (private sector) and to assess its distribution regarding the different types of hospitals and patient characteristics. Material and methods An observational retrospective study between 2017 and 2018 was performed. Hospitals are classified into three groups: large hospitals (11), medium hospitals (17) and small hospitals (14). The cesarean section rate was measured by patient categorization into three groups: total deliveries, low risk cesarean sections and low risk cesarean sections without previous cesarean delivery. Results We analyzed 62,685 deliveries: 42,987 were vaginal deliveries (68.6%) and 19,698 CS (31.4%). The mean age for the total number of deliveries was 34.18 years old, whilst the mean age for the low-risk group was 34.12. Of the 19,698 CS, 18.36% (3618) were in high-risk population and 81.63% (16,080) in low risk population. 69.54% (11,183) of the low-risk CS were in patients without a previous CS. Conclusions The overall rate of CS in the Quironsalud group is slightly higher than the one from the Public Healthcare. The older maternal age as well as the hospital resources involved in the delivery attendance can explain this difference.

Introduction From the outset, the use of Xray (XR) has been a critical component in both the guidance and development of arrhythmia ablation procedures. At present however, due to the complex nature of electrophysiology procedures, the use of XR in isolation is not sufficient to ensure procedural success. Subsequently, the use of non-fluoroscopic virtual mapping systems is essential. Currently, given the evolution of this technology and its essential nature for procedural guidance, it is worth asking whether the use of XR is indeed still necessary in the modern era. The objective of this study was to demonstrate that “zero-XR” ablation of complex arrhythmias such as atrial fibrillation is both possible and safe. Methods Between 2020 and 2021, a total of 116 patients admitted for pulmonary vein ablation were included in the study. Amongst these, 41 patients were prospectively included at our centre, in a protocol for point-by-point ablation of pulmonary veins without fluoroscopy, “zero-XR”. In addition to the non-fluoroscopic mapping system, the transseptal puncture was monitored by intracardiac ultrasound in all cases. The objective of the ablation was the complete isolation of the pulmonary veins. In some patients, at the discretion of the operator, the ablation of other substrates was added. For the remaining 75 patients in the study, the ablation was performed using conventional techniques without the limitation of the use of XR. The mean follow up was 12 months. Results The baseline characteristics of the patients, as well as the description of the procedure, are shown in the Table. There were no differences in the acute success rate or procedure time between the two groups. There was only one complication related to the procedure in the non-XR group consisting of pericardial effusion without cardiac tamponade. Regarding the recurrence rate at 12 months, it was higher in the group with fluoroscopy, without reaching statistical significance [n=0 in the group without fluoroscopy, n=2 (2.7%) in the group with fluoroscopy, p=0.15]. Conclusion In our series, point-by-point ablation of atrial fibrillation without fluoroscopy proved to be a safe and feasible technique, with similar success rates when compared to conventional procedures using XR. Funding Acknowledgement Type of funding sources: None.

International audience; OBJECTIVES: The overall death toll from COVID-19 in Africa is reported to be low but there is little individual-level evidence on the severity of the disease. This study examined the clinical spectrum and outcome of patients monitored in COVID-19 care centres (CCCs) in two West-African countries. METHODS: Burkina Faso and Guinea set up referral CCCs to hospitalise all symptomatic SARS-CoV-2 carriers, regardless of the severity of their symptoms. Data collected from hospitalised patients by November 2020 are presented. RESULT: A total of 1,805 patients (64% men, median age 41 years) were admitted with COVID-19. Symptoms lasted for a median of 7 days (IQR 4-11). During hospitalisation, 443 (25%) had a SpO2 < 94% at least once, 237 (13%) received oxygen and 266 (15%) took corticosteroids. Mortality was 5% overall, and 1%, 5% and 14% in patients aged

Summary Background Lassa fever is a viral haemorrhagic fever endemic in parts of west Africa. New treatments are needed to decrease mortality, but pretrial reference data on the disease characteristics are scarce. We aimed to document baseline characteristics and outcomes for patients hospitalised with Lassa fever in Nigeria. Methods We did a prospective cohort study (LASCOPE) at the Federal Medical Centre in Owo, Nigeria. All patients admitted with confirmed Lassa fever were invited to participate and asked to give informed consent. Patients of all ages, including newborn infants, were eligible for inclusion, as were pregnant women. All participants received standard supportive care and intravenous ribavirin according to Nigeria Centre for Disease Control guidelines and underwent systematic biological monitoring for 30 days. Patients' characteristics, care received, mortality, and associated factors were recorded using standard WHO forms. We used univariable and multivariable logistic regression models to investigate an association between baseline characteristics and mortality at day 30. Findings Between April 5, 2018, and March 15, 2020, 534 patients with confirmed Lassa fever were admitted to hospital, of whom 510 (96%) gave consent and were included in the analysis. The cohort included 258 (51%) male patients, 252 (49%) female patients, 426 (84%) adults, and 84 (16%) children (younger than 18 years). The median time between first symptoms and hospital admission was 8 days (IQR 7–13). At baseline, 176 (38%) of 466 patients had a Lassa fever RT-PCR cycle threshold (Ct) lower than 30. From admission to end of follow-up, 120 (25%) of 484 reached a National Early Warning Score (second version; NEWS2) of 7 or higher, 67 (14%) of 495 reached a Kidney Disease–Improving Global Outcome (KDIGO) stage of 2 or higher, and 41 (8%) of 510 underwent dialysis. All patients received ribavirin for a median of 10 days (IQR 9–13). 62 (12%) patients died (57 [13%] adults and five [6%] children). The median time to death was 3 days (1–6). The baseline factors independently associated with mortality were the following: age 45 years or older (adjusted odds ratio 16·30, 95% CI 5·31–50·30), NEWS2 of 7 or higher (4·79, 1·75–13·10), KDIGO grade 2 or higher (7·52, 2·66–21·20), plasma alanine aminotransferase 3 or more times the upper limit of normal (4·96, 1·69–14·60), and Lassa fever RT-PCR Ct value lower than 30 (4·65, 1·50–14·50). Interpretation Our findings comprehensively document clinical and biological characteristics of patients with Lassa fever and their relationship with mortality, providing prospective estimates that could be useful for designing future therapeutic trials. Such trials comparing new Lassa fever treatments to a standard of care should take no more than 15% as the reference mortality rate and consider adopting a combination of mortality and need for dialysis as the primary endpoint. Funding Institut National de la Sante et de la Recherche Medicale, University of Oxford, EU, UK Department for International Development, Wellcome Trust, French Ministry of Foreign Affairs, Agence Nationale de Recherches sur le SIDA et les hepatites virales, French National Research Institute for Sustainable Development.

Studies to prevent gestational diabetes (GDM) have shown the best results when lifestyle measures have been applied early in pregnancy. We aimed to investigate whether first-trimester fasting plasma glucose (FPG) could predict GDM risk and adverse pregnancy outcomes. A retrospective analysis of prospectively collected data from singleton pregnancies who were attended at our hospital between 2008 and 2018 (n = 27,198) was performed. We included patients with a recorded first-trimester FPG and complete pregnancy data (n = 6845). Patients under 18, with pregestational diabetes or reproductive techniques, were excluded. First-trimester FPG was evaluated as a continuous variable and divided into quartiles. GDM was diagnosed by NDDG criteria. The relationship between first- and second-trimester glucose > 92 mg/dL was also investigated. The relationship between FPG and pregnancy outcomes was assessed in 6150 patients who did not have GDM. Maternal age was 34.2 ± 3.9 years, BMI 23.1 ± 3.7 kg/m2 and mean FPG 83.0 ± 7.3 mg/dL. Glucose quartiles were: ≤ 78, 79–83, 84–87 and ≥ 88 mg/dL. First-trimester FPG predicted the risk of GDM (7%, 8%, 10.2% and 16% in each quartile, p 92 mg/dL (2.6%, 3.8%, 6.3% and 11.4% in each quartile, p

Introduction: Few to no literature on ergonomic risk assessment focus on gamers and musculoskeletal pain. While there is evidence on the ergonomic risks in mobile gaming, console gaming, and exergaming, there is none particular for first-person shooter games where accuracy and speed of mouse movements are important. The objective of the study is to assess the ergonomic risk and identify its association to the commonly reported musculoskeletal pain of first-person shooter computer gamers. Methods: The Rapid Upper Limb Assessment was used to determine the ergonomic risk of 10 gamers using a single chosen frame from 30-minute videos taken while playing a first-person shooter game. The Nordic Musculoskeletal Questionnaire was used to identify commonly reported musculoskeletal pain. Fisher Exact Test was performed to quantify the relationship between these variables. Results: The level of musculoskeletal disorder risk resulted with 80-90% having medium risk and 10-20% having very high risk. Low back and neck pain are the most prevalent pain present in 60% and 50% of the participants respectively. No significant relationship was found between the variables with P values of 0.40 for the left view and 0.13 for the right view. Discussion: Other factors outside the scope of the study should also be considered such as pain external to gaming, duration of gaming hours, amount of rest periods, and participants’ age. The study provides a protocol that future studies may reference for gaming, specifically in an online setting. However, the relationship between ergonomic risk and commonly reported musculoskeletal pain is found to be statistically insignificant.

Remote ischemic conditioning (RIC) and the GLP-1 analog exenatide activate different cardioprotective pathways and may have additive effects on infarct size (IS). Here, we aimed to assess the efficacy of RIC as compared with sham procedure, and of exenatide, as compared with placebo, and the interaction between both, to reduce IS in humans. We designed a two-by-two factorial, randomized controlled, blinded, multicenter, clinical trial. Patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention (PPCI) within 6 h of symptoms were randomized to RIC or sham procedure and exenatide or matching placebo. The primary outcome was IS measured by late gadolinium enhancement in cardiac magnetic resonance performed 3-7 days after PPCI. The secondary outcomes were myocardial salvage index, transmurality index, left ventricular ejection fraction and relative microvascular obstruction volume. A total of 378 patients were randomly allocated, and after applying exclusion criteria, 222 patients were available for analysis. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. IS was similar between groups for the RIC (24 ± 11.8% in the RIC group vs 23.7 ± 10.9% in the sham group, P = 0.827) and the exenatide hypotheses (25.1 ± 11.5% in the exenatide group vs 22.5 ± 10.9% in the placebo group, P = 0.092). There were no effects with either RIC or exenatide on the secondary outcomes. Unexpected adverse events or side effects of RIC and exenatide were not observed. In conclusion, neither RIC nor exenatide, or its combination, were able to reduce IS in STEMI patients when administered as an adjunct to PPCI. The trial was sponsored with a Grant from Instituto de Salud Carlos III (PIE 13/00027) and a Grant from Generalitat de Catalunya (PERIS SLT/2381/2016). The sponsors have not been involved in the design, conduct, collection, analysis, interpretation of the data, nor in the preparation, review or approval of the manuscript Sí

Ainda que a indústria da construção civil tenha desenvolvido metodologias para o controle da qualidade de obras, ainda há falhas no gerenciamento da qualidade, principalmente em relação ao controle dos processos e produtos. A implantação do conjunto de práticas conhecido como Lean Six Sigma (LSS) pode proporcionar melhoria na eficiência dos processos reduzindo os desperdícios. O objetivo desta pesquisa é propor uma estrutura de avaliação de possível aplicação do LSS por meio de um questionário estruturado seguindo a formatação do ciclo DMAIC (Define, Measure, Analyse, Improve, Control). O questionário foi aplicado a profissionais responsáveis pelo gerenciamento de obras e pelo setor da qualidade em duas construtoras. Os resultados demonstraram que as empresas contatadas possuem o domínio da fase de definição de atividades, clientes e requisições, porém há possibilidade de implementação de ações e ferramentas aplicadas para o desenvolvimento de processos e produtos. Sendo assim, a pesquisa contribui para elencar os principais gargalos nos modelos de gerenciamento aplicados por empresas construtoras segundo a prática LSS.

No momento atual, acontece a Quarta Revolução Industrial, na qual os meios digital, físico e biológico se unem formando a Indústria 4.0. Grande parte da indústria da construção civil se manteve atrasada em relação aos movimentos de modernização. No entanto, existe uma parcela dessa indústria que considera imprescindível a busca de novas tecnologias e metodologias de gestão que visem a eficiência de seus processos. O presente trabalho analisou como a Tecnologia de Informação e Comunicação (TIC) pode ser utilizada a fim de atingir impactos positivos na gestão de obras. Devido à sua importância no armazenamento de dados e comunicação dentro da construção civil, foi selecionado o documento do Diário de Obras para estudo comparativo entre três programas computacionais, visando averiguar o atendimento de parâmetros identificados. Concluiu-se, que os programas analisados atendem satisfatoriamente sua função de TIC, significando um avanço para substituição do tradicional registro no Diário de Obras da forma escrita para a forma virtual.

Background Strategies to improve prenatal detection of small-for-gestational age (SGA) neonates are necessary because its association with poorer perinatal outcome. This study evaluated, in pregnancies with first trimester high risk of early preeclampsia, the performance of a third trimester screening for SGA combining biophysical and biochemical markers. Methods This is a prospective longitudinal study on 378 singleton pregnancies identified at high risk of early preeclampsia according to a first trimester multiparametric algorithm with the cutoff corresponding to 15% false positive rate. This cohort included 50 cases that delivered SGA neonates with birthweight Results For a 15% FPR, a model that combines maternal characteristics, estimated fetal weight, mean uterine artery pulsatility index and placental growth factor achieved a detection rate (DR) of 56% with a negative predictive value of 92.2%. The area under receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval (CI), 0.72–0.86). The DR of a model including maternal characteristics, estimated fetal weight and mean uterine artery pulsatility index was 54% (AUC, 0.77 (95% CI, 0.70–0.84)). The DR of a model that includes maternal characteristics and placental growth factor achieved a similar performance (DR 56%, AUC 0.75, 95% CI (0.67–0.83)). Conclusions The performance of screening for SGA neonates at early third trimester combining biophysical and biochemical markers in a high-risk population is poor. However, a high negative predictive value could help in reducing maternal anxiety, avoid iatrogenic interventions and propose a specific plan for higher risk patients.

Background Lassa Fever (LF), is a severe viral disease prevalent in Western Africa. It is classified as a priority disease by the World Health Organization (WHO). Ribavirin is the recommended therapy despite weak evidence of its efficacy. Promising therapeutic agents are becoming available for evaluation in human. Before launching therapeutic trials, we need data on the evolution of the disease under the best possible conditions of care. Methods We have initiated a prospective study in Nigeria to better understand the clinical course and prognostic factors of LF while implementing high quality standardized care. Inclusion criteria are: suspected or confirmed LF and informed consent. Participants are followed 60 days from admission and receive free of charge standardized supportive care and biological monitoring, as well as intravenous ribavirin for those with confirmed LF. Data are collected using standardized case report forms (CRF). Primary and secondary outcomes are fatality and severe morbidity, with special focus on acute kidney dysfunction and pregnancy complications. Factors associated with outcomes will be investigated. Results The cohort is planned for 3 years. Inclusions started in April 2018 at the Federal Medical Center Owo in Ondo State. A second site will open in Nigeria in 2020 and discussions are underway to open a site in Benin. 150 to 200 new participants are expected per year. Conclusions This cohort will: provide evidence to standardize LF case management; provide key inputs to design future clinical trials of novel therapeutics; and establish clinical research teams capable of conducting such trials in LF-endemic areas. Study registration The LASCOPE study was registered on ClinicalTrial.gov (NCT03655561).

espanolSe presenta un caso clinico en el que se rehabilita a una paciente con maxilar superior atrofico mediante una combinacion de implantes cigomaticos, colocados mediante una aproximacion exteriorizada, e implantes anteriores convencionales palatinizados. Se realizo un procedimiento de regeneracion osea guiada alrededor de los implantes cigomaticos para obtener un mayor grosor de la cortical vestibular y palatina alrededor de los implantes del maxilar superior y mejorar el pronostico. A un ano de la carga protesica, el hueso periimplantario se mantiene estable. EnglishA clinical case is presented in which a patient with atrophic upper jaw is rehabilitated by a combination of zygomatic implants, placed using an exteriorized approach, and conventional palatalized anterior implants. A guided bone regeneration procedure is performed around the zygomatic implants to obtain a greater thickness of the facial bone and improve the prognosis. One year after loading, the peri-implant bone remains stable.

Introduction En Afrique, bien que le nombre total de décès dus a la COVID-19 semble plus faible quand dans les pays du nord, il existe peu de données sur la gravité de la maladie. Nous rapportons ici le tableau clinique et l’issue chez les malades infectés par le SARS-CoV-2 et suivis dans les centres de traitement COVID-19 (CTC) de deux pays d’Afrique de l’Ouest. Matériels et méthodes Le Burkina Faso et la Guinée ont mis en place trois CTC de référence pour hospitaliser tous les malades infectés par le SARS-CoV-2, quelle que soit leur gravité. Nous présentons les données recueillies auprès de ces patients symptomatiques hospitalisés dans ces trois CTC, entre mars et novembre 2020. Les données ont été collectées à l’aide du formulaire de déclaration des cas de COVID-19 de l’OMS. Une régression logistique a été réalisée pour analyser l’association entre l’évolution défavorable et les caractéristiques cliniques à l’admission. Résultats Au total, 1805 patients (1151 [64 %] hommes, âge médian 41 ans, 22 % [388] ≥ 60) ont été admis avec un COVID-19 confirmé. La durée médiane entre le début des symptômes et l’admission en CTC était de 7 jours (IQR : 4–11). Les symptômes principaux à l’admission était l’asthénie (748, 41 %) et la toux (833, 46 %) et près de la moitié des patients (867, 48 %) présentaient une forme légère de la maladie. Au cours de l’hospitalisation, 443 (25 %) patients ont présenté au moins une fois une SpO2

The hyperglycemia and adverse pregnancy outcome study demonstrated a continuous association between fasting plasma glucose (FPG) levels below those diagnostic of diabetes and adverse neonatal outcomes. We aimed to investigate whether the same association was found in a Mediterranean population. A retrospective analysis of singleton pregnancies attended at our Hospital between 2008 and 2015 (n = 5203). FPG was evaluated in the second trimester, and it was divided into 7 categories (1

Introduction Alors que la dixieme epidemie de maladie a virus Ebola (MVE) en Republique Democratique du Congo (RDC) est en cours, deux immunotherapies a base d’anticorps monoclonaux (mAbs) specifiques du virus Ebola (EBOV), le Mab114 et le Regeneron, ont montre une efficacite sur la diminution de la letalite chez les patients atteints de MVE. La vaccination par le vaccin rVSV-ZEBOV-GP a permis de limiter la propagation de l’epidemie. Cependant, l’efficacite du vaccin n’est pas immediate mais tributaire du delai de production d’un titre protecteur d’anticorps vaccinaux neutralisants. Sur les sites de Beni, Katwa et Mambassa, un protocole de prophylaxie post-exposition (PPE) par mAbs a ete mis en place pour les contacts a risque viral eleve, dans le cadre d’un usage compassionnel. Materiels et methodes Le critere d’eligibilite a la PPE reposait sur le contact a un risque viral intermediaire (contact avec la peau uniquement) ou eleve (contact avec la peau lesee) avec un patient infecte par EBOV. Les participants ont recu par voie parenterale le Regeneron ou le Mab114. Une MVE a ete ecartee par evaluation clinique et negativite de la RT-PCR a j0. Un examen clinique et une RT-PCR ont ete effectuees entre j14 et j21. Resultats Au 13 fevrier 2020, 80 participants ont ete inclus avec un âge median de 32 ans (IIQ : 22–40), 54 % masculin. Parmi eux, 47 (59 %) etaient des contacts a risque eleve, 53 (66 %) etaient des personnels de sante. Sur les 55/78 (70 %) qui ont declare avoir recu le vaccin, 23 (41 %) se souvenaient de leur date de vaccination, et le delai median entre la vaccination et le contact a risque etait de 151 jours (min : 16, max : 428), dont 9 (39 %) vaccines depuis plus de 12 mois. La majorite, 65 (80 %) ont recu le Mab114 et 15 (20 %) le Regeneron. Deux patients ont presente un syndrome grippal dans les 48 h suivant l’administration du produit, et 2 autres a 21 jours de l’administration. Pour les 60 (75 %) avec un resultat entre j14 et j21 (15 perdus de vue, 5 en attente de resultat), 100 % des RT-PCR sont negatives. Conclusion Compte tenu de l’absence d’immunisation vaccinale dans les 10 jours suivant l’administration du vaccin, de la difficulte de suivre les personnes-contact en communaute, et de la bonne tolerance et facilite d’administration de ces produits, il parait faisable et ethique d’integrer la PPE par mAbs dans les mesures de prevention de MVE, et de la proposer aux contacts a risque viral eleve. La perspective de l’evaluation de la PPE en cas d’exposition a risque sous-entend plusieurs etapes : – l’adaptation de definition du contact a haut risque, integrant notamment le statut clinique et la charge virale du patient-source ; – l’evaluation de l’interaction entre la reponse vaccinale au vaccin et l’administration de mAbs ciblant le meme epitope viral ; – la conduite d’un un essai clinique mene lors d’une prochaine epidemie.

Vessel healing seems to be associated with stent strut coverage at an early post-implantation stage and is potentially related to stent thrombosis ([1][1]). We report the results of a randomized controlled trial to assess the timing and degree of intracoronary healing of 2 different sirolimus

Studies to prevent gestational diabetes (GDM) have shown the best results when lifestyle measures have been applied early in pregnancy. We aimed to investigate whether first-trimester fasting plasma glucose (FPG) could predict GDM risk and adverse pregnancy outcomes.A retrospective analysis of prospectively collected data from singleton pregnancies who were attended at our hospital between 2008 and 2018 (n = 27,198) was performed. We included patients with a recorded first-trimester FPG and complete pregnancy data (n = 6845). Patients under 18, with pregestational diabetes or reproductive techniques, were excluded. First-trimester FPG was evaluated as a continuous variable and divided into quartiles. GDM was diagnosed by NDDG criteria. The relationship between first- and second-trimester glucose 92 mg/dL was also investigated. The relationship between FPG and pregnancy outcomes was assessed in 6150 patients who did not have GDM.Maternal age was 34.2 ± 3.9 years, BMI 23.1 ± 3.7 kg/mFirst-trimester FPG is an early marker of GDM and LGA.

Introduction L’Est de la Republique Democratique du Congo (RDC) a ete touche par une epidemie de maladie a virus Ebola (MVE) d’une ampleur sans precedent en 2019. Le taux de letalite reste eleve malgre l’acces a des traitements innovants. Materiels et methodes La cohorte Ebola VIrus STAndard de soin (EVISTA) est une etude observationnelle retrospective decrivant la presentation clinique, biologique et le standard de soin prodigue aux patients dans trois centres de traitement Ebola (CTE) dans les provinces du Nord-Kivu et de l’Ituri. Les patients admis avec une PCR positive etaient eligibles. Resultats Sur 711 patients atteints de MVE inclus entre aout 2018 et decembre 2019, 33 % (175/533) ont declare avoir ete vaccines, dont 69 % moins de 10 jours avant leur admission. A l’admission, 31 % (208/667) avaient une frequence cardiaque ≥ 110/min, 10 % (63/602) une SpO2 5 N, et 36 % (200/549) une insuffisance renale aigue (IRA) de niveau KDIGO 3. La letalite globale s’elevait a 45 % (322 deces), avec un delai median entre l’admission et le deces de 3 jours (IIQ : 1–5). Avec une IRA a l’admission, la mortalite etait de 54 % (107/200), elle etait de 95 % (100/105) pour ceux avec une IRA persistante (> 50 % des mesures classees KDIGO 3). Un traitement specifique a ete administre chez 89 % (621/695) des patients dans un cadre compassionnel ou d’ECR. De maniere innovante, 240 patients ont recu une oxygenotherapie et 101 une transfusion sanguine. Cent quatre-vingt-seize patients ont beneficie de la pose d’une sonde urinaire et 44 de la pose d’une sonde gastrique. Quinze patients ont pu etre monitores sur le plan cardiovasculaire a l’aide d’une echographie guidant le remplissage. La pose d’un catheter osseux en vue du remplissage vasculaire a ete realise chez 7 patients. Parmi les 33 femmes enceintes, 14 (42 %) ont survecu, et 6 accouchements ont donne lieu a une naissance vivante dont un nouveau-ne contamine qui a survecu. En tout, ce sont 85 enfants de moins de 5 ans qui ont ete inclus dans la cohorte, dont 6 nouveau-nes ( Conclusion L’acces a un traitement specifique de la MVE ne permet pas de diminuer drastiquement la letalite chez les patients severes. En revanche, l’augmentation du niveau du standard de soin est un outil essentiel pour ameliorer la prise en charge des defaillances systemiques. En 2020, cet objectif de moyens est facilite par l’utilisation de chambres individuelles bio-securisees permettant une meilleure prise en charge des patients atteints de MVE, y compris en termes de soins de reanimation, tout en maintenant le niveau majeur de protection des professionnels de sante de premiere ligne.

Early identification of women with an increased risk for preeclampsia is of utmost importance to minimize adverse perinatal events. Models developed until now (mainly multiparametric algorithms) are thought to be overfitted to the derivation population, which may affect their reliability when applied to other populations. Options allowing adaptation to a variety of populations are needed.The objective of the study was to assess the performance of a first-trimester multivariate Gaussian distribution model including maternal characteristics and biophysical/biochemical parameters for screening of early-onset preeclampsia (delivery34 weeks of gestation) in a routine care low-risk setting.Early-onset preeclampsia screening was undertaken in a prospective cohort of singleton pregnancies undergoing routine first-trimester screening (8 weeks 0/7 days to 13 weeks 6/7 days of gestation), mainly using a 2-step scheme, at 2 hospitals from March 2014 to September 2017. A multivariate Gaussian distribution model including maternal characteristics (a priori risk), serum pregnancy-associated plasma protein-A and placental growth factor assessed at 8 weeks 0/7 days to 13 weeks 6/7 days and mean arterial pressure and uterine artery pulsatility index measured at 11.0-13.6 weeks was used.A total of 7908 pregnancies underwent examination, of which 6893 were included in the analysis. Incidence of global preeclampsia was 2.3% (n = 161), while of early-onset preeclampsia was 0.2% (n = 17). The combination of maternal characteristics, biophysical parameters, and placental growth factor showed the best detection rate, which was 59% for a 5% false-positive rate and 94% for a 10% false-positive rate (area under the curve, 0.96, 95% confidence interval, 0.94-0.98). The addition of placental growth factor to biophysical markers significantly improved the detection rate from 59% to 94%.The multivariate Gaussian distribution model including maternal factors, early placental growth factor determination (at 8 weeks 0/7 days to 13 weeks 6/7 days), and biophysical variables (mean arterial pressure and uterine artery pulsatility index) at 11 weeks 0/7 days to 13 weeks 6/7 days is a feasible tool for early-onset preeclampsia screening in the routine care setting. Performance of this model should be compared with predicting models based on regression analysis.

International audience; Euclid is a major ESA mission for the study of dark energy planned to launch in 2021. Euclid will probe the expansion history of the Universe using weak lensing and baryonic acoustic oscillations probes. A survey of 15,000 deg2 of the sky with the instrument NISP (Near-Infrared Spectro-Photometer), in the 900 – 2100 nm band, will give both the photometric and spectrometric redshifts of tens of millions of galaxies. The 16 H2RG detectors of the NISP focal plane array are still being characterized at CPPM (Marseille). Already 16 out of 20 flight detectors have been tested and a straightforward analysis done. Performance of the dedicated test benches – in particular control of flux and temperature – as well as an overview of the test flow will be presented. This paper will present methods and some preliminary results on two detectors focusing on the determination of a per pixel conversion gain.

International audience; Euclid is an ESA mission to map the geometry of the Dark Universe with a planned launch date in 2021.1 Two primary cosmological probes, weak gravitational lensing and baryonic acoustic oscillations, are implemented through a VISible imager (VIS) and a Near-Infrared Spectrometer and Photometer (NISP).2 The ground characterization of the NISP Flight Sensor Chip Systems (SCS) followed by the pixel response calibration aims to produce all informations to correct and control the accuracy of the signal. This work reports on the ground characterization of the NISP detector chain. The detector and electrical effects are likely to generate statistical fluctuations and systematic errors on the final flux measurement. The analysis strategies to maintain the pixel relative response accuracy within 1% is proposed in this work. The Euclid NISP test ow is presented and the main concerns of the detector chain calibration, such as non-linearity, charge trapping and de-trapping are discussed on the basis of the analysis of the flight detectors characterization data.

Electric propulsion is now a successful method for primary and secondary propulsion of deep space long-duration missions and for geosynchronous satellite attitude control. The Plasma Physics Laboratory of UnB has been developing a permanent magnet Hall thruster (PHALL) for the UNIESPACO program, part of the Brazilian space activities program (PNAE) since 2004. The idea of using an array of permanent magnets, instead of an electromagnet, to produce a radial magnetic field inside the plasma channel of the thruster is very significant. It allows the development of a Hall thruster with power consumption low enough to be used in small- and medium-size satellites. The PHALL project consists on plasma source design, construction and characterization of the Hall-type propulsion engine using several plasma diagnostics sensors. PHALL is based on a plasma source in which a Hall current is generated inside a cylindrical channel with an axial electric field produced by a ring anode and a radial magnetic field produced by permanent magnets. In this work, a brief description of the plasma propulsion engine, its diagnostics instrumentation and measured plasma parameters with a focus for possible applications of PHALL on orbit transfer maneuvering for future Brazilian geostationary satellite space missions is shown. More specifically, we will show plasma density and temperature space profiles inside and outside the thruster channel, ion temperature measurements based on Doppler broadening of spectral lines and ion energy measurements. Based on the measured plasma parameters we construct an aptitude figure of the PHALL. It contains the specific impulse, total thrust, propellant flow rate and power consumption necessary for orbit raising of satellites. Based on previous studies of geosynchronous satellite orbit positioning we perform numerical simulations of satellite orbit raising from an altitude of 700–36,000 km using a PHALL operating in the 100–500 mN thrust range. To perform these calculations integration techniques were used. The main simulation parameters were orbit raising time, fuel mass, total satellite mass, thrust and exhaust velocity. We conclude by comparing our results with results obtained with known space missions performed with Hall thrusters.

To evaluate non-invasive prenatal testing (NIPT) of cell-free DNA (cfDNA) as a screening method for major chromosomal anomalies (CA) in a clinical setting.From January to December 2013, Panorama™ test or Harmony™ prenatal test were offered as advanced NIPT, in addition to first-trimester combined screening in singleton pregnancies.The cohort included 333 pregnant women with a mean maternal age (MA) of 37 years who underwent testing at a mean gestational age of 14.6 weeks. Eighty-four percent were low-risk pregnancies. Results were provided in 97.3% of patients at a mean reporting time of 12.9 calendar days. Repeat sampling was performed in six cases and results were obtained in five of them. No results were provided in four cases. Four cases of Down syndrome were detected and there was one discordant result of Turner syndrome. We found no statistical differences between commercial tests except in reporting time, fetal fraction and MA. The cfDNA fraction was statistically associated with test type, maternal weight, BMI and log βhCG levels.NIPT has the potential to be a highly effective screening method for major CA in a clinical setting.

Introduction La fievre de Lassa (FL) est une maladie emergente dont la letalite reste elevee. Les donnees disponibles sont anciennes et/ou retrospectives. Afin d’actualiser les connaissances et d’aider a l’amelioration de sa prise en charge, nous menons une etude de cohorte prospective ayant pour objectif de mieux decrire la maladie et ses facteurs pronostiques. Materiels et methodes Tous les patients admis pour une FL suspectee ou confirmee dans un centre de traitement situe en zone endemique sont eligibles. Les non-cas (RT-PCR Lassa finalement negative) constituent un groupe controle. Apres consentement, des informations concernant les habitudes de vie, l’histoire de la maladie et la prise en charge sont collectees jusqu’au soixantieme jour apres l’admission. Les patients ont acces a un standard de soins optimise : ribavirine, antipaludiques, antibiotiques, traitements symptomatiques, oxygenotherapie, dialyse et biologie. Les resultats preliminaires concernant les participants cas confirmes (RT-PCR Lassa positive) inclus entre le 5 avril et le 12 decembre 2018 sont presentes ici. Resultats Parmi 40 cas confirmes, 29 avaient complete leur sejour hospitalier au moment de l’analyse. On comptait 2 deces (mortalite hospitaliere 7 %) ; 3 dialyses (10 %, dont 1 deces) ; 5 patients ayant recu de l’oxygene (17 %) ; 4 ayant recu une transfusion (14 %) ; un nouveau-ne de 6 semaines survivant ; aucune femme enceinte. Les signes et symptomes les plus frequents au cours du sejour etaient : fievre (55 %), tachycardie (62 %), hypotension (82 %) ou hypertension arterielle (46 %), douleurs abdominales (48 %), cephalees (44 %), nausees/vomissements (31 %), vertiges (28 %), hematurie (24 %), SpO2 115 μmol/L chez 14 (47 %). Six (20 %) ont evolue jusqu’au stade KDIGO ≥ 2 (« acute kidney injury ») dont 4 jusqu’au stade KDIGO 3 (« acute kidney failure ») ces derniers ayant tous ete dialyses sauf un decede avant d’avoir pu l’etre. La mortalite etait de 50 % chez les patients KDIGO 3 et nulle chez les autres (p = 0,01). Les transaminases, dosees chez 30 patients, etaient superieures a 3 N chez 7 (23 %) dont la mortalite etait plus elevee (p = 0,05). La presence de saignements (41 %) n’etait pas associee a une surmortalite. La duree mediane de la viremie Lassa detectable etait de 9 jours (IIQ 7–18,5, etendue 4–64). Conclusion La mortalite hospitaliere de la FL apparait plus faible que precedement decrite, probablement en raison d’efforts soutenus en termes de prise en charge symptomatique. Les atteintes renale et neurologique semblent associes a la mortalite. L’extension dans le temps et l’espace de cette cohorte permettra d’affiner ces resultats preliminaires.

After decades of research with a wide range of putative methodologies, at last a commercially viable technique has emerged for the noninvasive prenatal testing (NIPT) for the most common fetal aneuploidies, the massively parallel shotgun sequencing (MPSS). Recently, a number of groups have validated this technology to accurately detect most common trisomies as early as the 10th week of pregnancy with results available 1 to 2 weeks after maternal sampling. Several molecular techniques have been proposed for the detection of trisomies 21, 18 and 13, mainly by two different approaches in analyzing the cell-free fetal (cff) DNA: quantitative and singlenucleotide polymorphism (SNP)-based methods. Among them and to address some of the limitations of counting techniques, a new method called NATUS algorithm (Next-generation Aneuploidy Testing Using SNPs) has been recently introduced. This approach, as a targeted and noncounting technique, offers numerous advantages, although more evidence is needed from large prospective studies. Published studies have demonstrated that diagnostic parameters of NIPT are better than those of the current first trimester prenatal screening risk assessment for fetal trisomy 21. NIPT of trisomy 21 by MPS with or without preselection of chromosomes is promising and likely to replace the prenatal serum screening test that is currently combined with nuchal translucency measurement in the first trimester of pregnancy. However, before NIPT can be introduced as a screening test, more evidence is needed from large prospective diagnostic accuracy studies in first trimester pregnancies. How to cite this article Gabriel CC, Echevarria M, Rodríguez M, Serra B. Noninvasive Prenatal Testing for Fetal Aneuploidy. Donald School J Ultrasound Obstet Gynecol 2013;7(4):443-452.

The most frequently involved antigen in severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the human platelet antigen 1a. Platelets express the HLA-A and B antigens on their membrane and some studies report that maternal anti-HLA class I antibody can also cause FNAIT. We report here a very unusual case of a first twin pregnancy produced in vitro by oocyte and semen donation where the mother developed markedly elevated HLA antibodies, in the absence of anti-platelet or anti-neutrophil antibodies, that provoked in one of the twins a profound thrombocytopenia and intracranial hemorrhage and a mild thrombocytopenia and neutropenia in the second twin lasting until the fourth month of life. In addition, anti-D alloimmunization provoked hemolytic disease of the newborn with intrauterus anemia detected in the first twin and post-natal anemia in the second twin that required red blood cell transfusion and phototherapy. We hypothesize that the complete HLA-incompatible twin pregnancy due to the oocyte donation might have contributed to the severity of the clinical manifestations.

Euclid, a major ESA mission for the study of dark energy, will offer a large survey of tens of millions of galaxies thanks to its Near-Infrared Spectro-Photometer. For it to be successful, the 16 Teledyne's 2.3 μm cutoff 2048x2048 pixels IR HgCdTe detectors of the focal plane must show very high performances over more than 95% of pixels, in terms of median dark current, total noise, budget error on non-linearity after correction, residual dark due to latency effects and quantum efficiency. This will be verified through a thorough characterization of their performances, leading to the production of the pixel map calibration database for the Euclid mission. Characterization is challenging in many ways: each detector will have to be fully and accurately characterized in less than three weeks, with rather tight requirements: dark current at the 10-3 e-/s level with 10% accuracy, relative Pixel Response map better than 1%, obtained with an illumination flatness better than 1%, measurements alternating dark and high level illumination taking care of latency impacts. Due to statistics needs, very long runs (24h without interrupts) of scripted measurements would be executed. Systematics of the test bench should be at the end the limiting factor of the parameter measurement accuracy. Test plan, facilities with functionalities developed for those specific purposes and associated performances will be described.

International audience; Euclid mission is designed to understand the dark sector of the universe. Precise redshift measurements are provided by H2RG detectors. We propose an unbiased method of fitting the flux with Poisson distributed and correlated data, which has an analytic solution and provides a reliable quality factor - fundamental features to ensure the goals of the mission. We compare our method to other techniques of signal estimation and illustrate the anomaly detection on the flight-like detectors. Although our discussion is focused on Euclid NISP instrument, much of what is discussed will be of interest to any mission using similar near-infrared sensors. © (2016) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.

The Euclid mission objective is to understand why the expansion of the Universe is accelerating through by mapping the geometry of the dark Universe by investigating the distance-redshift relationship and tracing the evolution of cosmic structures. The Euclid project is part of ESA's Cosmic Vision program with its launch planned for 2020 (ref [1]). The NISP (Near Infrared Spectrometer and Photometer) is one of the two Euclid instruments and is operating in the near-IR spectral region (900- 2000nm) as a photometer and spectrometer. The instrument is composed of: - a cold (135K) optomechanical subsystem consisting of a Silicon carbide structure, an optical assembly (corrector and camera lens), a filter wheel mechanism, a grism wheel mechanism, a calibration unit and a thermal control system - a detection subsystem based on a mosaic of 16 HAWAII2RG cooled to 95K with their front-end readout electronic cooled to 140K, integrated on a mechanical focal plane structure made with molybdenum and aluminum. The detection subsystem is mounted on the optomechanical subsystem structure - a warm electronic subsystem (280K) composed of a data processing / detector control unit and of an instrument control unit that interfaces with the spacecraft via a 1553 bus for command and control and via Spacewire links for science data This presentation describes the architecture of the instrument at the end of the phase C (Detailed Design Review), the expected performance, the technological key challenges and preliminary test results obtained for different NISP subsystem breadboards and for the NISP Structural and Thermal model (STM). © (2016) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only. Copyright (2016) Society of Photo Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

Objective: To analyze trends in screening and invasive prenatal diagnosis of chromosome abnormalities (CA) over a 13-year period and correlate them to changes in the national prenatal screening policy. Methods: We retrospectively reviewed Down syndrome (DS) screening tests and fetal karyotypes obtained by prenatal invasive testing (IT) in our fetal medicine unit between January 1999 and December 2011. Results: A total of 24,226 prenatal screening tests for DS and 11,045 invasive procedures have been analyzed. Over a 13-year period, utilization of non-invasive screening methods has significantly increased from 57% to 89%. The percentage of invasive procedures has declined from 49% to 12%, although the percentage of IT performed for maternal anxiety has increased from 22% to 55%. The percentage of detected CA increased from 2.5% to 5.9%. Overall, 31 invasive procedures are needed to diagnose 1 abnormal case, being 23 procedures in medical indications and 241 procedures in non-medical indications. Conclusions: Our experience on screening and invasive prenatal diagnostic practice shows a decrease of the number of IT, with a parallel decline in medical indications. There is an increasing efficiency of prenatal screening program to detect CA. Despite the increasing screening policies, our population shows a growing request for prenatal IT. The a priori low risk population shows a not negligible residual risk for relevant CA. This observation challenges the current prenatal screening strategy focused on DS, showing that the residual risk is higher than the current cut-off used to indicate an invasive technique.

Objective To assess the onset and frequency of first interfetal contacts by 4D sonography. Subjects and methods Twenty twin pregnancies were scanned transvaginally between 56 (8 weeks) and 69 postmenstrual days (9+6 weeks) and onward transabdominally, at weekly intervals until 112 postmenstrual days (16 weeks). Scans were recorded on DVD and analyzed retrospectively. The moment of onset, type and frequency of intertwin contacts were assessed. Results First interhuman contacts were observed between 61 (8+5 weeks) and 68 (9+5 weeks) postmenstrual days. The frequency of different movements varied according to the gestational age. ‘Touch no reaction’ and ‘First reaction’ were common and frequent from 70 postmenstrual days (10 weeks) onward. ‘Slow body movements’ were more common than ‘Fast body movements’. ‘Complex contacts’ were more frequent at 94 postmenstrual days (13+3 weeks). Simple contacts diminished around 100 postmenstrual days (14+2 weeks). ‘Complex contacts’ and ‘diffuse interactions’ were more commonly observed between 105 (15 weeks) and 112 postmenstrual days (16 weeks). No significant differences were found when different gender combinations were compared. Conclusion Intertwin contacts start as soon as 8+5 weeks of gestation and complex or diffuse interactions are already seen at 15 to 16 weeks of gestation. How to cite this article Prats P, Serra B, Fournier S, Baulies S, Andonotopo W, Kurjak A. 4D Sonographic Assessment of Intertwin Contacts. Donald School J Ultrasound Obstet Gynecol 2012;6(2):154-159.