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Macrosomia in neonates of diabetic women is a risk factor for neonatal hypoglycemia, with an over-risk for asymmetric macrosomia. This study aimed to study the association between anthropometric measurements and hypoglycemia in neonates of mothers treated for gestational diabetes. This is a secondary analysis of the INDAO trial study conducted between May 2012 and November 2016 in 13 French tertiary care university hospitals in 890 pregnant women with gestational diabetes treated with either insulin or glyburide. Neonatal anthropometric measurements were birthweight and weight-length ratio (WLR, defined as birth weight/length). Neonatal hypoglycemia was defined as capillary blood glucose below 36 mg/dL (2 mmol/L) or below 45 mg/dL (2.5 mmol/L) associated with clinical signs after 2 h of life. Their relationships were modeled with logistic regressions using fractional polynomials. Extreme categories of birthweight or WLR adjusted for gestational age at birth and sex were defined as Z-score -1.28 or 1.28. These categories were compared to Z-score between -1.28 and 1.28 by estimating odds ratios and confidence intervals for neonatal hypoglycemia. Neonatal hypoglycemia occurred in 9.1% of cases. The relationship between birthweight and WLR Z-scores and neonatal risk of hypoglycemia adjusted for maternal treatment was a U-shaped curve. Adjusted odds ratios for the risk of hypoglycemia were 9.6 (95% CI 3.5, 26.8) and 2.3 (95% CI 1.1, 4.9) for WLR Z-score below -1.28 and above 1.28, respectively, compared with WLR Z-score between -1.28 and 1.28. Conclusion: Birthweight Z-score was associated with the risk of neonatal hypoglycemia in neonates from mothers treated for gestational diabetes. The risk of neonatal hypoglycemia was increased for both extreme birthweight Z-scores, regardless of maternal treatment. Small for gestational age neonates of diabetic mothers require special attention for the risk of neonatal hypoglycemia. What is Known: • Macrosomia in neonates of diabetic women is a risk factor for neonatal hypoglycemia, with an over-risk for asymmetric macrosomia. Few retrospective studies have assessed the risk for neonatal hypoglycemia among small for gestational age neonates born to diabetic mothers. What is New: • The risk of neonatal hypoglycemia among neonates of diabetic mothers increased for both low and high weight-length ratio, regardless of maternal medicinal treatment, gestational age at birth, and sex of the newborn.

The rise in the number of cesarean sections (CS) is a major health public problem which concerns nearly all countries. It is suggested that the Ten Group Classification System be adapted to a procedure of audit/feedback cycles, which could have an effect on CS practice. Therefore, we aimed to study changes in CS rates between maternity wards in a perinatal network after implementation of the Ten Group Classification System in an audit with feedback.This was a retrospective pre-post study of all births from 1 January 2012 to 31 December 2018, in a French perinatal network of 10 maternity wards in the Yvelines district of France. All live births occurring at a gestational age ≥24 weeks in the network were included. During the pre-period (1 January 2012 to 31 December 2014), the audit and feedback provided only overall CS rates. During the post-period (1 January 2015 to 31 December 2018), CS rates for each Robson Ten Group Classification System group were provided. Regression models, adjusted for maternal characteristics and maternity ward, were used to compare CS rates globally and for each group of the system. Variability of CS rates between maternity wards was analyzed using the coefficients of variation.There were 51 082 women who delivered during the pre-period and 63 964 during the post-period. The overall CS rate did not decrease (24.5% during the pre-period vs 25.1% during the post-period). There were no significant differences in CS rates for any group of the Ten Group Classification System after adjustment for maternity, maternal age and sociodemographic characteristics, nor did audit implementation decrease CS rate variability between maternity wards or within groups of the system.Implementation of an audit-and-feedback cycle using the Ten Group Classification System did not decrease either CS rates or variability between maternity wards.

International audience; Introduction: Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED).Methods: Our study was an epidemiologic analysis and a cost study of the cohort drawn from the clinical trial GUERANDE, conducted in 24 French pediatric EDs. Infants of 6 weeks to 12 months of age presenting at pediatric EDs with a first episode of bronchiolitis were eligible. The costs considered were collected from a societal viewpoint, according to the recommendations of the French National Health Authority.Results: A total of 777 infants were included with a median age of 4 months. A total of 57% were hospitalized during the month following the first consultation in the ED, including 28 (3.6%) in an intensive care unit. The mean length of stay was 4.2 days (SD = 3.7). The average time to relief of all symptoms was 13 days (SD = 7). Average total cost per patient was €1919 (95% confidence interval: 1756-2138) from a societal perspective, mostly due to hospitalization cost. The estimated annual cost of bronchiolitis in infants was evaluated to be between €160 and €273 million in France.Discussion: Bronchiolitis represent a high cost for the health care system and broadly for society, with hospitalizations costs being the main cost driver. Thus significant investments should be made to develop innovative therapies, to reduce the number of hospitalizations and length of stay.

The purpose of this study is to clarify the relationship between having a chronic condition (CC) and several types of risky sexual behaviour (RSB) among adolescents and young adults. We used data from a multicentre cross-sectional study carried out on 14,431 adolescents from 137 French schools. Logistic regression was used to assess the association between several types of RSB and CCs among the 2680 participants aged 17 years or over who reported sexual intercourse. Survival analysis was conducted to assess the association between CCs and age at first sexual intercourse across the whole sample. Analyses were conducted separately by gender with and without adjustment for the parents' education level, early menarche and subjective wellbeing (relationship with mother and father, depression, perceived health status and liking school). Among boys, having a CC was associated with a higher risk of RSB in both univariate (OR: 1.58 [95% CI: 1.10-2.27]) and multivariate analyses (aOR: 1.62 [95% CI: 1.11-2.38]). Among girls, the association between chronic condition and RSB in univariate analysis was non-significant (OR: 1.30 [95% CI: 0.97-1.76]) and disappeared after adjustment on subjective wellbeing (aOR: 1.08 [95% CI: 0.78-1.49]). There was no association between CC and age at first sexual intercourse. Conclusion: There were major gender differences. Boys with a CC were more prone to engage in RSB independent of their subjective wellbeing, whereas in girls, subjective wellbeing seemed to mediate the relationship between CC and RSB. Clinicians should be aware of those gender differences in order to deliver preventive strategies regarding sexuality that target both genders. What is Known: • Young people with chronic conditions have a higher likelihood of engaging in risky sexual behaviour. • Engaging in such behaviours can be much more costly, as it can weaken their underlying state of health. What is New: • We found major gender differences. Boys were more prone to engage in risky behaviour independent of their subjective wellbeing, whereas in girls, it seemed to play an important role. • By understanding how risky sexual behaviour differs according to gender, clinicians can deliver prevention messages that target both genders.

Objective: The magnitude and direction of effects on pregnancy outcomes of the lockdown imposed during COVID-19 have been uncertain and debated. Therefore, we aimed to quantify delivery and perinatal outcomes during the first nationwide lockdown due to the COVID-19 pandemic compared with the same durations of time for the pre- and post-lockdown periods. Study design: This was a retrospective cohort study of six university hospital maternity units distributed across France, each of which serves as the obstetric care referral unit within its respective perinatal network. Maternal and perinatal outcomes were compared between the lockdown period and same-duration (i.e., 55-day) periods before and after the 2020 lockdown (pre-lockdown: 22 January–16 March; lockdown: 17 March–10 May; post-lockdown: 11 May–4 July). We compared the overall rates of Caesarean delivery (CD), pre-labor CD, labor induction, operative vaginal delivery, severe postpartum hemorrhage (≥1 L), severe perineal tear, maternal transfusion, and neonatal mortality and morbidity (1- and 5-min Apgar scores < 7), hypoxia and anoxia (umbilical arterial pH < 7.20 or

Objective : To study changes in caesarean delivery (CD) rates between maternity wards in a perinatal network after implementation of the Ten Group Classification System (TGCS) in an audit with feedback. Design A retrospective pre–post study of all births from 1 January 2012 to 31 December 2018. Setting A French perinatal network of 10 maternity wards in the Yvelines district of France. Population All live births of gestational age ≥24 weeks in the network. Methods During the pre-period (1 January 2012 to 31 December 2014), the audit and feedback provided only overall CD rates. During the post-period (1 January 2015 to 31 December 2018), CD rates for each TGCS group were provided. Regression models, adjusted for maternal characteristics and maternity ward, were used to compare CD rates globally and for each TGCS group. Variability of CD rates between maternity wards was analysed using the coefficients of variation. Main outcome measure CD rates. Results There were 51 082 women who delivered during the pre-period and 63 964 during the post-period. The overall CD rate did not decrease (24.5% during the pre-period versus 25.1% during the post-period). There were no significant differences in CD rates for any TGCS group after adjustment for maternity, maternal age and socio-demographic characteristics. Nor did audit implementation decrease CD rate variability between maternity wards or within TGCS groups. Conclusion Implementation of an audit-and-feedback cycle using the TGCS did not decrease either CD rates or variability between maternity wards.

Objective: To study the risk of CD for each gestational week among ongoing pregnancies of nulliparous women at term. Design: A retrospective, population-based cohort study from January 1, 2016, through December 31, 2017 Setting: a French perinatal network of the Yvelines district, France Population: 11 308 nulliparous women with a singleton fetus in a cephalic presentation and delivered at term (≥37-week +0 day) Methods: for each week of gestation at term, we defined ongoing pregnancies as all pregnancies undelivered at the start of each week. Regression models adjusted by maternal characteristics and hospital status were used to compare the CD risk between ongoing pregnancies and the pregnancies delivered the preceding week. The same methods were applied to subgroups defined by the mode of labor onset. Main outcome measure: The caesarean delivery rate (CD) Results: Ongoing pregnancies > 40 weeks+0 days were associated with a higher risk of CD compared with pregnancies delivered the previous week: 24.3% in ongoing pregnancies ≥ 40 weeks +0 days versus 19.9% in deliveries between 39 weeks +0 days and 39 weeks+6 days (Odd ratio adjusted of 1.28, 95%CI [1.15-1.44]; 30.4% in ongoing pregnancies ≥ 41 weeks +0 days versus 19.6% in deliveries between 40 weeks +0 days and 40 weeks+6 days (OR 1.73, 95%CI [1.51-1.96]). This was also shown for all modes of labor onset and in every maternity unit. Conclusions: CD rates increased starting at 40 weeks +0 days in ongoing pregnancies, regardless of the mode of labor onset.

Study question Are French national health insurance data reliable for studying the use of medical contraception? Summary answer Health insurance data produce a measurement of contraceptive use consistent with population-based survey data, which affords new opportunities for studying contraception. What is known already Medical contraception is a major public health issue as most women of reproductive age use it. It is usually studied through population-based surveys. However, such surveys are conducted only every 10 years, and analyses are limited by their sample size. French national health insurance data provide comprehensive and time-continuous information on each reimbursed contraceptive. However, because these data have been collected for a different purpose (reimbursement), their relevance for measuring the use of contraceptives needs to be assessed. Study design, size, duration Two sources were analysed. First, a cross-sectional cohort was extracted from the health insurance database, which includes all health reimbursements (such as those for medical contraceptives) and covers 98% of the French population, including 14 million women aged 15–49. Secondly, we used the last French survey on contraception, a cross-sectional study including 4,508 women aged 15–49 interviewed by phone. Participants/materials, setting, methods From both sources, we selected all women aged 15–49 living in metropolitan France. We identified the last medical contraceptive purchased by each woman between 2014 and 2019. The woman was then classified as currently using this contraceptive if the recommended duration of use for this contraceptive was still ongoing on 31 December 2019. Prevalences were compared to those observed in the population based survey. Main results and the role of chance Among the 14.3 million women aged 15–49 living in metropolitan France covered by the health insurance, 26.0% were using the pill, 17.4% an IUD (7.6% hormonal IUD; 9.9% copper IUD), and 3.1% an etonogestrel implant. These proportions are very close to and not statistically different from those observed in the population-based survey (26.2% for the pill, 18.4% IUD, and 3.1% implant). Contraceptive use varied widely with women’s age. At ages 20–24, the most widely used contraceptive was the pill (42.2%), and very few long-acting contraceptives were used (7.6% IUD; 4.9% implant). At ages 30–34, the pill was less frequently used (21.6%) and IUD more frequently used (copper IUD: 15.79%; hormonal IUD: 7.06%). Limitations, reasons for caution It cannot be ruled out that some contraceptives were purchased but never used and that a few women stopped using the contraceptive before the end of its recommended duration. Wider implications of the findings: To our knowledge, this study is the first to estimate prevalence for Copper IUD and for hormonal IUD in France. Using the national health insurance database, it is now possible to monitor the use of each type of medical contraceptive over time in a reliable population-based approach. Trial registration number Not applicable

Study question What is the burden of early infertility care drop-out in the context of full reimbursement of infertility care and are medical practices associated with drop-out? Summary answer Medical practices seem associated with early infertility care drop-out whose burden remains high despite the equality of care policy in France What is known already More than half of couples drop out of their infertility treatment before pregnancy. Direct costs of infertility care are widely cited as the major barrier to continuation of care. In France, infertility treatments are fully reimbursed. Data from US IVF centres have shown a high estimated drop-out from the beginning and at each step of infertility treatment. Some studies have suggested a difference in medical practices during infertility care between couples who have dropped out and couples who have continued care Study design, size, duration Cohort study of all women aged 18–49 years who started infertility treatment between January–August 2016 in mainland France with a private practitioner and who had not been successfully treated at a 24-month follow-up. Participants/materials, setting, methods The cohort was based on the French national health insurance and hospital databases that exhaustively record reimbursed healthcare. Infertility treatment included ovarian induction by gonadotropin and clomifene. Outcome was infertility care drop-out within 3 months after starting treatment. Stratified analyses were performed based on the first treatment prescribed, with three categories: clomifene prescribed by a general practitioner, clomifene by a gynaecologist or gonadotropin by a gynaecologist Main results and the role of chance Among women unsuccessfully treated by ovarian induction, 31.1% dropped out of infertility care within 3 months. Women who started treatment with a general practitioner were more frequently socially disadvantaged (40.6%), less closely monitored (ultrasound and hormonal tests had not been done in 53.6% and 64.8%, respectively) and dropped out more frequently (46.8%). Where the prescriber of treatment was a gynaecologist, older age (35–39 and 40–43 years) was associated with higher probability of early drop-out with OR 1.5 (95% CI 1.3–1.7) and 2.2 (95% CI 1.9–2.5) for gonadotropins and 1.2 (95% CI 1.1–1.3) and 1.9 (95% CI 1.7–2.2) for clomifene. Disadvantaged social status was associated with higher early infertility care drop-out, whereas good monitoring was associated with a lower probability of early drop-out in all three categories of treatments and prescribers Limitations, reasons for caution These medical and administrative data did not allow us to explore medical practices in greater depth, notably the doctor-patient relationship Wider implications of the findings: This is the first estimation of early infertility care drop-out in a general population where treatment is fully reimbursed, exploring the implication of medical practices in early drop-out. Better access to good medical practices is needed for less socially advantaged people, beyond the current equality of care policy in France. Trial registration number N/A

Background: To assess changes in the number and profile of in utero transfer requests during the first lockdown. Methods: An observational, retrospective, cohort study. All pregnant women, from the Paris area (France), for whom a request for in utero transfer to the transfer unit was made during the first lockdown in France (from 17 March to 10 May 2020) or during a mirror period (years 2016 to 2019) were included. We compared the numbers and proportions of various indications for in utero transfer, the rates of in utero transfer acceptance and the proportion of outborn deliveries. Results: 206 transfer requests were made during the lockdown versus 227, 236, 204 and 228 in 2016, 2017, 2018 and 2019, respectively. The relative proportion of requests for threatened preterm births and for fetal growth restriction decreased from 45% in the mirror period to 37% and from 8 to 3%, respectively. The transfer acceptance rates and outborn deliveries did not differ between time periods. Conclusions: Although a reduction in in utero transfer requests was observed for certain indications, the first lockdown was not associated with a decrease in acceptance rates nor in an increase in outborn births of pregnancies with a high risk of prematurity in the Paris area.

Energy production machinery is one of the main subjects of current engineering research. Manufacturers and users are seeking to increase the performance of these machines and, thus, to extend the maintenance intervals as far as possible. It is therefore essential to predict their behavior according to their wear to schedule maintenance operations. This work aims to present data allowing the comparison of numerical results to physical behavior. The essential parameters of the bearing (temperature, pressure, friction) are measured, varying the operating conditions in terms of speed and load. Whatever the operating condition, scratches induce a strong modification of the pressure field, which is reduced close to zero in the zone facing the scratch. The most detrimental case is that with multiple scratches, which significantly reduces the load-carrying capacity of the bearing. In this case, the maximum pressure in the bearing mid-plane increases by more than 50% and the maximum temperature by more than 15 K.

International audience; Glyburide is mainly metabolized by the cytochrome P450 2C9 (CYP2C9) enzyme and enters the liver via the transporter OATP1B3. The variants OATP1B3*4 (699 G>A; rs7311358) and CYP2C9*2 and *3 are known to have a significant influence on the hepatic uptake and metabolism of glyburide, with lower clearance than in the wild type. In an ancillary study of the INDAO trial, we selected 117 pregnant women with gestational diabetes treated by glyburide and assessed the role of the combined CYP2C9 and OATP1B3 genetic polymorphisms in hypoglycemia and glycemic control. Three groups were constituted: (1) the wild-type genotype group (wild-type allele genotype for both CYP2C9*1 and OATP1B3*1 (699G)), (2) the intermediate group (carriers of CYP2C9*2 allele or OATP1B3*4 (699G>A) heterozygous), and (3) the variant group (carriers of CYP2C9*3 allele and/or OATP1B3*4 (699G>A) homozygous variant). We found that the risk of hypoglycemia was significantly higher in the variant genotype at the second week of treatment: 20.0% (4/20) vs. 8.1% (3/37) in the intermediate group and 4.1% (2/49) in the wild-type genotype group (P = 0.03). The last daily dose of glyburide during pregnancy was lower for patients in the variant genotype group: 4.7 mg (SD 3.5) vs. 8.7 mg (SD 5.7) in the wild-type group and 5.7 mg (SD 3.7) in the intermediate group (P

Background To promote their sexual and reproductive health and rights, women need full access to contraception and choice of contraceptive method. Precarious women may have difficulties in accessing contraception even in developed countries with widespread health insurance coverage. It is difficult to explore this issue through national surveys that often include too few precarious women. We aimed to compare contraceptive use among precarious and non-precarious women based on the exhaustive French health insurance database. Methods The French health insurance database covers 98% of the population living in France and includes all healthcare reimbursements. Contraceptives are partly reimbursed by the national health insurance. For people in a precarious situation, they are fully reimbursed by a specific system called universal health coverage. We selected all women aged 15-49 years living in metropolitan France in 2019. We compared the prevalence of use of each contraceptive method: pill, hormonal intra-uterine device (IUD), copper IUD and implant, between precarious and non-precarious women. Results Among the study population of 14 million women, 11% were in a precarious situation. Fewer precarious women used contraceptives (31%) than non-precarious women (44%, p < 0.001). When using a contraceptive, precarious women used a different method than non-precarious women: under the age of 30 years, they used the pill much less and implants more often; above 35 years, they used hormonal IUDs less often and the pill and implants more often. Conclusions Although in France contraceptives are fully reimbursed for precarious women, they used fewer and different contraceptives than non-precarious women. Social inequalities may exist even in such a favorable national context. Further research should explore barriers that precarious women may encounter in accessing and choosing their contraception. Key messages Although French national health insurance fully covers contraceptives for precarious women, their use of contraceptives is much lower (31% versus 44%), suggesting possible social inequalities. When using contraception, precarious women do not use the same methods as non-precarious women, suggesting possible differences in their contraceptive choice or differences in medical practice.

Ex-poro-hydrodynamic (XPHD) lubrication is a biomimetic-inspired lubrication mechanism consisting of self-sustained fluid films generated within highly compressible porous layers imbibed with liquids, whose solid phase induces compressive elastic forces that are negligible compared to the hydrodynamic forces generated inside the porous medium. This work focuses on the performance of XPHD lubrication in the context of tangential movement, adapted to the case of thrust bearings at low and medium rotational speeds. An in-depth study of a pre-selected porous material (polyurethane foam) was carried out in order to determine the physical characteristics and the crucial parameters for XPHD lubrication, namely the porosity and the permeability. The paper also proposes a theoretical and numerical model of XPHD lubrication. Classical lubrication assumptions are used, and flow within the porous medium is predicted using a new form of the Reynolds equation. A specially developed test rig allows for an experimental study of the XPHD lubrication mechanism. Finally, a comparison of the modeling and experimental results is presented.

Objectives. To measure trends in infertility treatment use between 2008 and 2017 in France using data from the national health insurance system. Methods. Between 2008 and 2017, we observed a representative national sample of nearly 1% of all women aged 20 to 49 years who were affiliated with the main health insurance scheme in France (more than 100 000 women observed each year). We exhaustively recorded all health care reimbursed to these women. Results. Among women aged 20 to 49 years, 1.25% were treated for infertility each year. Logistic regression analysis showed a significant interaction between age and year of treatment use (P Conclusions. Women aged 34 years or older were increasingly treated for infertility between 2008 and 2017. Public Health Implications. Treatment efficiency decreases strongly with a woman’s age, presenting a challenge for medical infertility care.

Cell-free DNA (cfDNA) as a primary screening test has been available for years but few studies have addressed this option in a prospective manner. The question is of interest after reports that maternal serum screening (MSS) is less accurate for pregnancies resulting from assisted reproduction technologies (ART) than for spontaneous pregnancies (SP). A prospective interventional study was designed to address the performances of cfDNA compared with MSS in pregnancies with or without ART. Each patient was offered both MSS and cfDNA testing. The primary analysis cohort ultimately included 794 patients with a spontaneous pregnancy (SP) (n = 472) or pregnancy obtained after ART (n = 322). Overall, the false-positive rate and positive predictive value were 6.6% and 8.8% for MSS but 0% and 100% for cfDNA. MSS false-positive rate and positive predictive values were clearly poorer in the ART group (11.7% and 2.6%) than in the SP group (3.2% and 21.1%). The global rates of invasive procedures were 1.9% (15/794) with cfDNA but 8.4% (65/794) if MSS alone was proposed. cfDNA achieved better performance than MSS in both spontaneous and ART pregnancies, thus decreasing the number of invasive procedures. Our findings suggest that cfDNA should be considered for primary screening, especially in pregnancies obtained after ART.

International audience; Most of the investigations on thrust bearings were performed under a steady-state condition and this regime is now well understood. Contrary to this, the behavior during the first period of start-up is sparsely studied. Start-ups of thrust bearings are critical periods where a mixed lubrication regime occurs. This regime can be detrimental for the lifetime of the system. It is usually mentioned in the literature that the textures act as micro reservoirs which can be beneficial to help lift-up during start-up. This is an intuitive hypothesis and there are no experimental results to prove it. This study uses an experimental approach in order to analyze the behavior of different kinds of thrust bearings with fixed geometry. It mainly focuses on the capability of textured thrust bearings to lift up during start-up. This study shows that only specific texture geometry can help the formation of a fluid film. The results are compared to those obtained with classical geometries like tapered land, pocketed and untextured flat-land thrust bearings. The original results show a relatively good ability of flat-land thrust bearings to generate a lift-up during the start-up period.An experimental device is used to measure, at high frequency, the friction torque as well as the electrical resistance across the fluid film to determine the lubrication regime. The comparative analysis allows us to explain the factors which modify the contact.

OBJECTIVE Congenital diaphragmatic hernia (CDH) is a severe anomaly. The observed-to-expected lung-area-to-head-circumference ratio (o/e-LHR) has been shown to provide a useful prediction of subsequent survival of fetuses with CDH in referral centers with expertise and a large caseload. However, the accuracy of o/e-LHR measurements in general fetal medicine units with less expertise is not well known. The aim of this study was to evaluate the capacity of o/e-LHR to provide a useful prediction of mortality of fetuses with CDH when the measurement is performed in fetal medicine units with different levels of expertise. METHODS Between January 2008 and November 2013, 305 live births with expectantly managed left-sided isolated CDH were recorded in the database of the French National Center for Rare Diseases (31 centers) and followed up after birth. Centers were grouped into two categories according to their mean annual CDH caseload over the study period: large centers with an average of ≥ 14 cases and smaller centers with

International audience; Aims: The recommended first-line treatment for women with gestational diabetes mellitus (GDM) in the case of failure of diet is insulin. Recent results suggest that there is a potential role for glyburide therapy and highlight the need for better knowledge of glycaemic control with glyburide. The objective of this study was to describe and quantify in women with GDM the quality of glycaemic control, including the risk of maternal hypoglycaemia and of therapy failure. Methods: This is a secondary analysis of the French INDAO non-inferiority trial from 2012 to 2016, in which 890 women with GDM randomized to receive glyburide or insulin treatment were compared for perinatal outcomes. Blood glucose concentrations were assessed prospectively during pregnancy. Optimal glycaemic control was defined as less than 20% of blood glucose values exceeding the targets. Results: More than 50% of the women had optimal glycaemic control with glyburide, similar to that with insulin. Around 40% of the women had at least one episode of hypoglycaemia, more than with insulin. However, those hypoglycaemic episodes were mostly moderate and the rate of severe hypoglycaemia decreased significantly during the course of the trial. Failure of glyburide treatment (switch to insulin therapy) occurred in 18% of women and had few predictors. However, when failure occurred, glycaemic control was improved after switching to insulin. Conclusions: Glyburide is an effective treatment for reaching glycaemic goals during pregnancy in women with GDM. The risk of maternal hypoglycaemia may be minimized by clinical practice experience. These findings could be taken into account in the management of GDM.

The lifespan of journal bearings is directly related to the operating conditions they have to face and reducing their maintenance intervals allows one to have a clear idea about their performance when issues occur. The presence of scratches on one of its surfaces degrades the performance of a journal bearing. These effects have already been assessed in experiments, however, numerical studies on this subject are still scarce. This work develops a numerical thermohydrodynamic (THD) program using the finite volume method to simulate the effects of scratches on the performance of journal bearings. To test the validity of the program, the numerical results are compared with the scientific literature and with experimental measurements conducted using the Pprime Institute journal bearing test rig. Some minor discrepancies are observed, but the overall results are in good agreement.

Surface texturing the friction faces of a mechanical seal reduces friction as well as leakage and wear, where dimples machined on the surface enhance the formation of a full lubricating film in the seal interface. Numerical simulation is used to determine the optimal surface texturing for the investigated operating conditions of the seal. The geometry of the dimples introduced in the model assume a perfect shape, but machining causes the dimple shapes to be imperfect in terms of the roughness in the dimples, absence of sharp angles, deformed boundaries, and so on. The effect of the real geometry must be considered to confirm that surface texturing will provide the desired results. In the present work, surface texturing is performed using low-temperature plasma coupled with a thermo-chemical surface treatment on stainless steel sealing rings. The real dimple shapes are analysed and considered within the hydrodynamic lubrication model. The influence of different types of defects is studied. It is shown that there is a limit above which surface imperfections dispel the texture's positive effects. Controlling the dimple shapes is important when performing surface texturing.

Because maternal serum markers (pregnancy-associated plasma protein A, human chorionic gonadotropin free β subunit, and alpha-fetoprotein) used for Down syndrome (DS) screening have been described as predictors of obstetrical complications and because assisted reproductive technology (ART) pregnancies are known to be at increased risk for obstetrical complications, it is unclear whether or not correction factors should be applied to the calculated risk of DS. The purpose of this study was to evaluate DS maternal serum markers in oocyte donation (OD) and ART pregnancies in comparison with natural pregnancies.Multicenter retrospective 2010 to 2013 study in singleton pregnancies was used. First- and second-trimester DS screenings in 614 OD and 1921 ART pregnancies versus 7268 natural pregnancies are compared.There was a significant increase in hCGβ in the OD group for both trimesters (first trimester: 1.28 MoM vs 1.02; P .001 and second trimester: 1.32 MoM vs 1 MoM; P .001). Pregnancy-associated plasma protein A was significantly lower in the ART group (0.92 and 1.02 MoM P .001).Maternal serum markers for DS screening are significantly modified in ART and OD pregnancies. Because these markers are also markers for obstetrical complications, the rationale for applying correction factors is questionable.

During maintenance operations of steam turbines, a common issue is the degradation of the supporting and guiding components for the rotating shafts due to the presence of scratches. To examine this issue, a numerical software program has been developed. In order to validate and complete the elaborated modeling, experimental tests have been carried out on the Pprime Institute test bench. A preloaded two-lobe journal bearing (diameter: 100 mm, length: 68.4 mm, preload: 0.524) lubricated with an ISO VG 46 mineral oil has been tested. Scratches were machined on the shaft at two axial locations and at different depths. Pressures and temperatures have been measured for several rotational speeds and applied loads. Seven configurations (one unscratched surface and six with a scratch) have been tested in order to evaluate the influence of a scratch on the performance of the bearing. It is found that the pressure profile is significantly affected by the presence of a scratch, whereas the temperature field i...

A few experimental studies suggest that atmospheric pollutants could affect the endocrine system, and in particular stress hormones and the hypothalamic-hypophyseal-ovarian axis, which could in turn influence menstrual cycle function. We aimed to study the possible short-term effects of atmospheric pollutants on the length of the follicular and luteal phases and on the duration of the menstrual cycle in humans. To do so, from a nation-wide study on couples’ fecundity, we recruited 184 women not using contraception who collected urine samples at least every other day during one menstrual cycle, from which a progesterone metabolite was assayed, allowing estimation of the duration of the follicular and luteal phases of the cycle. Atmospheric pollution (nitrogen dioxide and particulate matter with an aerodynamical diameter below 10 μm, PM10) levels were estimated from a dispersion model with a 1-km resolution combined with permanent monitoring stations measurements, allowing to estimate exposures in the 30-day, 1–10 and 11-30-day periods before the start of the menstrual cycle. Regression models allowed to quantify the change in cycle duration associated with atmospheric pollutants and adjusted for potential confounders. Follicular phase duration increased on average by 0.7 day (95% confidence interval, CI, 0.2; 1.3) for each increase by 10 μg/m3 in NO2 concentration averaged over the 30 days before the cycle and by 1.6 day (95% CI, 0.3; 2.9) for each increase by 10 μg/m3 in PM10. There was no strong evidence of associations of exposures in this time window with luteal phase or with total menstrual cycle durations (p > 0.2). Exposures in the 1–10 day period before the cycle start were also associated with increased follicular phase duration. This study is one of the first prospective studies to suggest short-term alterations in follicular phase duration following atmospheric pollutants exposure.

International audience

International audience; The aim of this study was to explore the achievement of parenthood 8 years after starting IVF, considering multiple pathways to parenthood during and after IVF treatment. Medical data on 6507 couples who began IVF between 2000 and 2002 were obtained from the databases of eight French IVF centres. Information on long-term outcome was available for participants in the 2008– 2010 postal survey. Multiple imputation methods were used to account for missing data. Eight years after starting IVF, 71% (95% CI 69 to 74) of treated couples had a child. This included 41% live births after IVF in the IVF centre, 7% live births after another treatment or after IVF in another centre, 12% live births after spontaneous conception and 11% adoptions. This study provides a longitudinal overview of paths to parenthood among couples successfully and unsuccessfully treated by IVF. These results should give hope to infertile couples as seven out of 10 couples finally became parents. However, IVF is not the only path to parenthood, and couples should be informed of the other possible avenues.

The fluid film pressure and temperature fields have been measured simultaneously under laboratory conditions at one land of a circumferential groove journal bearing (CGJB), together with friction torque and oil flow rate, during a time span from stand-still startup to the development of a thermally stabilized steady operating regime.A very fine measurement grid—that is, 216 pressure and 180 temperature points spread across the axial and circumferential directions—has been obtained by joining and synchronizing measurements from separate test runs while rigorously re-creating the test conditions.The study confirmed that the pressure field is established faster than the temperature field, that film rupture occurs both from cavitation nuclei downstream the minimum film thickness and through air ingestion from the environment. Furthermore, the high pressures in the convergent zone stabilize relatively quickly, whereas the low pressures in the divergent zone cavitated region require a longer time to sta...

International audience; Using the experience acquired within our lab in terms of both thermohydrodynamic (THD) and thermoelastohydrodynamic (TEHD) numerical simulations, a new THD code has been improved by adding the possibility of taking into account geometrical defects, and particularly scratches, which are often discovered by turbine users during maintenance operations. To examine this issue, two numerical codes were coupled to provide the TEHD analysis presented in this work. To validate the numerical results, experimental tests were conducted using the Pprime Institute bearing test rig. The performance of the same two-lobe journal bearing (preload 0.524) as used in a previous study, lubricated with ISO VG 46 oil, was evaluated. Scratches of different depths (varying as a function of the radial clearance) were directly machined onto the shaft. TEHD solutions and experimental data were compared for various rotational speeds and applied loads. Pressure and temperature comparisons for the three scratch depths show good correlation, and give the expected results for cases with a scratch. It was also found that the asymmetry in the pressure field created by the presence of a scratch led to a slight misalignment. The comparisons were improved by taking into account this misalignment, using the balance of momentum.

International audience; Mechanical face seals are used to avoid fluid leakage from pressurized zones to the environment in many rotating machineries. The initial research into the lubrication mechanism of these components was initiated several decades ago and numerous studies, both theoretical and experimental, have been carried out on the subject. Surface texturing has been of growing interest in recent years, but only a few studies have been devoted to textured mechanical face seals. Thus, the aim of the present work is to provide experimental, as well as theoretical, results with a comparison of smooth and textured seals. The temperatures of the seals are measured by means of infrared thermography. A 50% reduction in friction for the whole speed range and a reduction in the temperature rise of the sealing interface, attaining 40% at the highest speed values, are reported. Because it is not possible to measure the film thickness experimentally, a numerical thermoelastohydrodynamic model is used, taking into account the seal face deformations. A comparison between the experimental and theoretical temperatures allows the model to be validated. It is shown that, as expected, the film thickness increases with speed as a result of the pressure generated in the dimples. However, after a threshold, it starts to decrease because of the detrimental effect of thermal deformation. These results show that fluid solid coupling must be considered when designing the surface texture for a mechanical seal.

Background: Assessing menstrual cycle function in the general population using a non-invasive method is challenging, both in non-industrialized and industrialized countries.Subjects and methods: Th...

Importance Randomized trials have not focused on neonatal complications of glyburide for women with gestational diabetes. Objective To compare oral glyburide vs subcutaneous insulin in prevention of perinatal complications in newborns of women with gestational diabetes. Design, Settings, and Participants The Insulin Daonil trial (INDAO), a multicenter noninferiority randomized trial conducted between May 2012 and November 2016 (end of participant follow-up) in 13 tertiary care university hospitals in France including 914 women with singleton pregnancies and gestational diabetes diagnosed between 24 and 34 weeks of gestation. Interventions Women who required pharmacologic treatment after 10 days of dietary intervention were randomly assigned to receive glyburide (n=460) or insulin (n=454). The starting dosage for glyburide was 2.5 mg orally once per day and could be increased if necessary 4 days later by 2.5 mg and thereafter by 5 mg every 4 days in 2 morning and evening doses, up to a maximum of 20 mg/d. The starting dosage for insulin was 4 IU to 20 IU given subcutaneously 1 to 4 times per day as necessary and increased according to self-measured blood glucose concentrations. Main Outcomes and Measures The primary outcome was a composite criterion including macrosomia, neonatal hypoglycemia, and hyperbilirubinemia. The noninferiority margin was set at 7% based on a 1-sided 97.5% confidence interval. Results Among the 914 patients who were randomized (mean age, 32.8 [SD, 5.2] years), 98% completed the trial. In a per-protocol analysis, 367 and 442 women and their neonates were analyzed in the glyburide and insulin groups, respectively. The frequency of the primary outcome was 27.6% in the glyburide group and 23.4% in the insulin group, a difference of 4.2% (1-sided 97.5% CI, −∞ to 10.5%; P =.19). Conclusion and Relevance This study of women with gestational diabetes failed to show that use of glyburide compared with subcutaneous insulin does not result in a greater frequency of perinatal complications. These findings do not justify the use of glyburide as a first-line treatment. Trial Registration clinicaltrials.gov Identifier:NCT01731431

To evaluate the utility of noninvasive prenatal testing using cell-free circulating fetal DNA for detection of the three main autosomal fetal trisomies in the setting of ultrasonographically identified fetal anomalies.Nine hundred patients at risk for fetal aneuploidy with or without ultrasonography anomalies and who underwent invasive procedures were included in the study. Cell-free DNA analysis was performed by massive parallel sequencing during a multicenter, noninterventional, prospective study and the results were compared with a fetal karyotype.Among all 900 pregnancies, cell-free DNA identified 76 of 76 (100%) fetal Down syndrome, 22 of 25 (88%) trisomy 18, and 12 of 12 (100%) trisomy 13. In those with a normal ultrasonogram and normal cell-free DNA analysis, karyotype identified 2 of 483 (0.4%) additional aneuploidies other than trisomies 13, 18, and 21. In those with an abnormal ultrasonogram and a normal cell-free DNA analysis, there were 23 of 290 (7.9%) additional pathogenic karyotypes. These additional aneuploidies included sex chromosome abnormalities and triploidy. The rates of additional aneuploidies not identifiable by standard cell-free DNA screening in the two groups is significantly different at P.01.In women with fetal abnormalities by ultrasonography, the rate of pathogenic chromosome abnormalities missed by cell-free DNA was 8%. Noninvasive prenatal testing should not be offered to women with fetal abnormalities because a negative result is falsely reassuring.III.

In this work, a parametric study of a lubricated textured contact is carried out using a numerical model. The model solves the Reynolds equation coupled with a mass-conserving cavitation algorithm, and addresses the hydrodynamic lubrication of a mechanical seal with textured surfaces. Three shapes of texture (square, spherical cap, and triangle) are used, and the effect of the aspect ratio is also discussed for the case involving a triangular dimple. In order to estimate quantitatively the discretization error, the grid convergence index method is applied, considering several operating parameters (leakage, cavitation, load-carrying capacity) and using three grid levels: coarse (100 × 100), medium (200 × 200), and fine (400 × 400). As could be expected, grid convergence index analysis showed that there was a reduction in the discretization error when the grid system was refined. However, the study also showed that medium grid (200 × 200) solution has a grid convergence index of

International audience; The aim of our study was to compare the impact of maternal obesity on the incidence of medical complications of pregnancy in France and Canada. We performed a prospective comparative cohort study using French data, retrieved from a prospective cohort of singleton deliveries, and Canadian data retrieved from QUARISMA, a cluster-randomized controlled trial conducted in Quebec, both between 2009 and 2011. Outcomes studied included, hypertensive disorders of pregnancy (HDP), venous thromboembolism, stillbirth, caesarean delivery and macrosomia. The impact of obesity across both cohorts was studied using univariate and multivariate logistic regression analyses, adjusting for relevant confounders. The French and Canadian databases included 26,973 and 22,046 deliveries respectively, with obesity rates of 9.1% and 16% respectively (p < 0.001). In both cohorts, obesity was significantly associated with an increased rate of HDP, cesarean delivery, and macrosomia. However, in both cohorts the relationship between increasing body mass index and the incidence of medical complication of pregnancy was the same, regardless the outcome studied. In conclusion, obesity is a risk factor for adverse maternal and fetal outcomes in both cohorts. Similar trends of increased risk were noted in both cohorts even though obesity is more prevalent in Canada. The prevalence of obesity has dramatically increased over the past 30 years, especially in North America. This condition is now described as an " epidemic " , and has consistently been associated to adverse health outcomes such as cardiovascular disorders, metabolic disorders, the occurrence of certain cancers, as well as psychoso-cial problems 1. The impact of obesity on life expectancy is considerable: in nonsmoking Americans, obesity at 40 years of age is associated with a life expectancy reduction of 7.1 years for women and 5.8 years for men 2. In Canada, the rate of obesity among adult women of reproductive age has increased from 16% in 1997, to 23.9% in 2009 (+50%) whereas the increase has been 82% in the same period in France, from 8.3% to 15.1% 3–5. A similar trend has been observed in pregnant women: in 2009, 16% of women starting a pregnancy were obese in Canada, in comparison to 9.9% in France 6, 7. This expansion is both linked to a general trend of increasing obesity but also to an increase in the age of childbearing in recent years; indeed, obesity also increases with advancing maternal age 4, 7. Consequently, obesity appears to be more longstanding and more prevalent in Canada than in France. Definitions of obesity have varied widely over time. The most frequent definition utilized is based on the Body Mass Index (BMI), a simple measure of weight-for-height defined as the weight in kilograms divided by the square of the height in meters (kg/m 2). The ranges are independent of age, parity, smoking history, race and ethnic background 8–10. Given the growing prevalence of increased BMI and the difference in obesity rates between Canada and France, we aimed to study the relationship between obesity and the incidence of medical complications of pregnancy in those two countries. We therefore compared pregnancy outcomes according to BMI classes between the two countries, through a secondary analysis of data collected in two well-defined contemporaneous cohorts.

Textured surfaces are the subject of a great deal of research work in tribology, which mainly involves numerical studies of lubricated contacts. A variety of shapes and arrangements of textures can be found, these being as numerous as the different authors. Depending on the configuration, it has been shown that the presence of the texture can provide better lubrication efficiency through both a reduction of friction and an increase in load-carrying capacity. However, improving bearing performance implies a specific geometrical configuration for given operating conditions. The improvement in lubricated contact performance by texturing the active surface has been demonstrated using experimental studies concerning, for example, pin-on-disk, mechanical seal, camshaft, journal bearing, thrust bearing, and piston ring set-ups. The objective of the present experimental analysis is to provide, using local measurements, a better understanding of the influence of surface texturing on the steady-state behavior of thrust bearings. To achieve this goal, the experimental device is equipped with 80 sensors such as thermocouples and pressure transducers which allowed a proper assessment of the phenomenology at the film/pad interface. The tests are conducted on five hydrodynamic thrust bearings, among which four are textured. Results show that, for the studied configurations, the textured thrust bearings can help to reduce friction up to 30% at low loads while for heavy loads, their performance is equivalent or even lower than that of an untextured planar bearing.

Even when IVF is reimbursed by the social insurance system, as in France, high discontinuation rates have been reported and some patients drop out as soon as the first failed IVF cycle. This study aims to investigate medical factors associated with treatment discontinuation in an IVF centre after the first unsuccessful cycle. The study included 5135 couples recruited in eight French IVF centres and who had had an unsuccessful first IVF cycle in these centres in 2000–2002 (i.e. no live birth). Of these couples with a first failed IVF, 1337 did not have a second IVF in the centre (26%, ‘early discontinuation group’) and 3798 continued treatment with a second IVF in the centre. The characteristics of couples who discontinued IVF treatment were compared with those who continued using logistic regressions. Older women, women with duration of infertility >5years, with female factor or unexplained infertility, with 0 or 1 oocyte retrieved and no embryo transfer during the first IVF were more likely to discontinue treatment early. Risk of early discontinuation was associated with medical factors that are also well known to be associated with impaired chance of successful IVF.Even when IVF is reimbursed by the social insurance system, as in France, high discontinuation rates have been reported and some patients drop out as soon as the first failed IVF cycle. This study aims to investigate medical factors associated with treatment discontinuation in an IVF centre after the first unsuccessful cycle. The study included 5135 couples recruited in eight French IVF centres who had had an unsuccessful first IVF cycle in these centres in 2000–2002 (i.e. who remained childless after a first cycle). Of these couples with a first failed IVF, 1337 did not have a second IVF in the centre and 3798 continued treatment with a second IVF in the centre. The characteristics of couples who discontinued IVF treatment were compared with those who continued. After a first failed IVF cycle, more than one-quarter (26%) of couples discontinued IVF treatment. Older women, women with duration of infertility >5years, with female factor or unexplained infertility, with 0 or 1 oocyte retrieved and with no embryo transfer during the first IVF were more likely to discontinue treatment early. The risk of early discontinuation was associated with medical factors that are also well known to be associated with impaired chance of success during IVF treatment. A next step would be to examine whether the early discontinuation results from a decision of the couple themselves, from medical, psychological and/or social staff counselling or from some combination of all of these factors.

Objective To analyze the participation of the patients in a survey about prevention, according to their own medical (hypertension and inclusion during house call) and social (occupational class and birthplace) characteristics and characteristics related to the organization of their physicians' practice. Study Design and Setting Fifty-nine randomly recruited physicians from the Paris metropolitan area enrolled every consecutive patient seen during a 2-week period. Actual patient participation (responding to the telephonic questionnaire) was analyzed with a logistic mixed model separately for male and female patients. Results The participation rate among 4,106 eligible patients was 66.7% and varied among physicians (from 48.7% to 80.8% for the 10th and 90th percentiles of the distribution). Participation was better for higher occupational classes, patients included during office visits, men with hypertension, and women born in France. After controlling for all patient characteristics, participation was best if the physician saw at least some patients by appointment [odds ratio (OR), 2.12; 95% confidence interval (CI): 1.12, 4.01 for men and OR, 3.38; 95% CI: 1.72, 6.63 for women). This characteristic explained 14% of the variability between physicians for participation by men and 28% of that by women. Conclusion Cluster studies should take the characteristics of the health care providers into account in their design, particularly their practice organization.