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Yves Flattet,1 Nicolas Garin,1,2 Jacques Serratrice,1 Arnaud Perrier,1 Jérome Stirnemann,1 Sebastian Carballo1 1Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva, 2Service of Internal Medicine, Riviera Chablais Hospital, Monthey, Switzerland Background: Acute exacerbations are the leading causes of hospitalization and mortality in patients with COPD. Prognostic tools for patients with chronic COPD exist, but there are scarce data regarding acute exacerbations. We aimed to identify the prognostic factors of death and readmission after exacerbation of COPD.Methods: This was a retrospective study conducted in the Department of Internal Medicine of Geneva University Hospitals. All patients admitted to the hospital with a diagnosis of exacerbation of COPD between 2008 and 2011 were included. The studied variables included comorbidities, Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classification, and biological and clinical parameters. The main outcome was death or readmission during a 5-year follow-up. The secondary outcome was death. Survival analysis was performed (log-rank and Cox).Results: We identified a total of 359 patients (195 men and 164 women, average age 72 years). During 5-year follow-up, 242 patients died or were hospitalized for the exacerbation of COPD. In multivariate analysis, age (hazard ratio [HR] 1.03, 95% CI 1.02–1.05; P

Objective: To report our experience of fetal aortic valvuloplasty (FAV) for critical aortic stenosis (AS), with a focus on the postnatal evolution of the patients. Methods: This was a retrospective study including all fetuses with critical AS which underwent FAV in a single center between January 2011 and June 2022. FAV was performed under ultrasound guidance. Technical success was based upon balloon inflation across the aortic valve and improvement of the antegrade aortic flow across the aortic valve. At birth, a biventricular circulation (BVC) strategy was decided assuming the left ventricular (LV) systolic and diastolic function would ensure the systemic circulation. Results: Sixty‐three FAV procedures were performed in 58 fetuses, at a median (range) gestational age of 26.2 (20.3–32.2) weeks. The procedure was technically successful in 50/58 (86.2%) fetuses. There were 11/58 (19.0%) cases of in‐utero demise and 9/58 (15.5%) terminations of pregnancy. No patient was liveborn after an unsuccessful procedure. Thirty‐eight (65.5%) infants were liveborn, at a median (range) gestational age of 38.1 (29.0–40.6) weeks, of whom 21 (55.3%) required prostaglandin treatment. Twenty‐eight of the 38 (73.7%) liveborn children (48.3% of the study population) entered the BVC pathway at birth. Among them, 20 (71.4%) required an aortic valvuloplasty procedure at birth (11 (55.0%) percutaneous balloon, nine (45.0%) surgical) and eight (28.6%) did not require any treatment at birth, but, of these, five (62.5%) underwent surgical valvuloplasty between day 26 and day 1200 of age. Eleven (39.3%) of the infants with BVC at birth required a second intervention and four (14.3%) of them required a third intervention. Two (7.1%) infants who entered the BVC pathway at birth underwent conversion to univentricular circulation (UVC). None of the surviving children with BVC developed pulmonary hypertension. The overall survival rate in those with BVC at birth was 22/28 (78.6%) at a median (range) follow‐up of 23.3 (2.0–112.6) months. Ten of the 58 (17.2%) patients had UVC at birth. Among these, six (60.0%) received compassionate care from birth and four (40.0%) underwent surgery. Three of the 10 patients who had UVC at birth were still alive at the latest follow‐up assessment, at a median (range) gestational age of 24.3 (8.3–48.7) months. Conclusions: FAV for critical AS led to increase of antegrade aortic flow in 86.2% of fetuses, with BVC being achieved in 48.3% (73.7% of the liveborn cases). Among patients with BVC at birth, the rate of reintervention was high, but 78.6% of these children were alive at the latest evaluation. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

ObjectiveEstimated fetal weight (EFW) and fetal biometry are complementary measures used to screen for fetal growth disturbances. Our aim was to provide international EFW standards to complement the INTERGROWTH-21st Fetal Growth Standards that are available for use worldwide.MethodsWomen with an accurate gestational-age assessment, who were enrolled in the prospective, international, multicenter, population-based Fetal Growth Longitudinal Study (FGLS) and INTERBIO-21st Fetal Study (FS), two components of the INTERGROWTH-21st Project, had ultrasound scans every 5 weeks from 9-14 weeks' until 40 weeks' gestation. At each visit, measurements of fetal head circumference (HC), biparietal diameter, occipitofrontal diameter, abdominal circumference (AC) and femur length (FL) were obtained blindly by dedicated research sonographers using standardized methods and identical ultrasound machines. Birth weight was measured within 12 h of delivery by dedicated research anthropometrists using standardized methods and identical electronic scales. Live babies without any congenital abnormality, who were born within 14 days of the last ultrasound scan, were selected for inclusion. As most births occurred at around 40 weeks' gestation, we constructed a bootstrap model selection and estimation procedure based on resampling of the complete dataset under an approximately uniform distribution of birth weight, thus enriching the sample size at extremes of fetal sizes, to achieve consistent estimates across the full range of fetal weight. We constructed reference centiles using second-degree fractional polynomial models.ResultsOf the overall population, 2404 babies were born within 14 days of the last ultrasound scan. Mean time between the last scan and birth was 7.7 (range, 0-14) days and was uniformly distributed. Birth weight was best estimated as a function of AC and HC (without FL) as log(EFW) = 5.084820 - 54.06633 × (AC/100)3  - 95.80076 × (AC/100)3  × log(AC/100) + 3.136370 × (HC/100), where EFW is in g and AC and HC are in cm. All other measures, gestational age, symphysis-fundus height, amniotic fluid indices and interactions between biometric measures and gestational age, were not retained in the selection process because they did not improve the prediction of EFW. Applying the formula to FGLS biometric data (n = 4231) enabled gestational age-specific EFW tables to be constructed. At term, the EFW centiles matched those of the INTERGROWTH-21st Newborn Size Standards but, at

Myelomeningocele (MMC) is a congenital defect of the spine characterised by meningeal and spinal cord protrusion through the open vertebral arches. This defect causes progressive prenatal damage of the spinal cord, leading to lifelong handicap. Although mid‐trimester surgical repair may reduce part of the handicap, an earlier and less invasive approach would further improve the prognosis, possibly minimising maternal and foetal risks. Several studies have proposed an alternative approach to surgical repair by covering the defect with a patch and protecting the exposed neural tissue. Our study aims to elaborate on a waterproof and biodegradable bioactive patch for MMC prenatal foetal repair. We developed a double‐layer patch that can provide a waterproof coverage for the spinal cord, with a bioactive side, conducive to cell proliferation, and an antiadhesive side to avoid its attachment to the medulla. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the outcome of monochorionic diamniotic (MCDA) twins complicated by Type‐II selective fetal growth restriction (sFGR) who underwent fetoscopic laser photocoagulation and to validate a previously proposed subclassification system for Type‐II sFGR in a large multicenter cohort. Methods: This retrospective multicenter cohort study included all MCDA twins complicated by Type‐II sFGR who underwent laser photocoagulation of placental anastomoses at four large tertiary fetal‐care centers between 2006 and 2020. Cases were subclassified according to a recently proposed system based on Doppler evaluation of the ductus venosus (DV) and middle cerebral artery (MCA) into Type‐IIA (normal DV flow and MCA peak systolic velocity (PSV) of the growth‐restricted fetus) or Type‐IIB (absent or reversed flow in the DV during atrial contraction and/or MCA‐PSV ≥ 1.5 multiples of the median of the growth‐restricted fetus). Demographic characteristics and pregnancy outcomes were compared between the groups. Data are presented as mean ± SD or n (%) as appropriate. P‐values < 0.05 were considered statistically significant. Results: A total of 98 patients with MCDA twins met our inclusion criteria, with 56 subclassified as Type IIA and 42 as Type IIB. Demographic characteristics were similar between the groups; however, Type‐IIB cases had a significantly earlier gestational age at diagnosis and at laser surgery, as well as larger intertwin estimated fetal weight discordance, which may be a reflection of disease severity. Postnatal survival of the growth‐restricted fetus to 30 days of age was significantly lower in Type‐IIB compared to Type‐IIA cases (23.8% vs 46.4%; P = 0.034). Conclusions: In MCDA twins complicated by Type‐II sFGR and treated with laser photocoagulation of placental anastomoses, preoperative Doppler assessment of the DV and MCA helped identify a subset of patients at increased risk of demise of the growth‐restricted fetus following intervention. This study provides valuable information for guiding surgical management and patient counseling. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article discusses the performance of an artificial intelligence (AI) software in automatically detecting anatomical structures and characteristics on fetal ultrasound images. The study collected 643 fetal ultrasound exams from various centers in North America and Europe. The AI software showed high sensitivity and specificity in detecting different anatomical structures, such as fetal brain, thorax and heart, CRL/NT/Profile, placenta, and sex. The findings suggest that this AI software could be a valuable tool in supporting fetal ultrasound practitioners by providing objective evaluation of captured images for quality assessment. [Extracted from the article]

This article discusses a new bioinformatics research tool that is being developed to identify genes involved in prenatal syndromes based on ultrasound phenotypes. The tool uses an internal database that links ultrasound fetal phenotypes to genes curated by experts in prenatal diagnosis of rare diseases. The tool was tested on 10 cases of CHARGE Syndrome and accurately identified the gene and syndrome in 90% of the cases. Comparative analyses with other available solutions showed that the research tool outperformed other apps in finding the correct gene and/or syndrome. The article concludes that early gene detection of rare syndromes can be significantly improved using research tools specifically designed for prenatal phenotypes. [Extracted from the article]

This article discusses the performance of an artificial intelligence (AI) software in automatically detecting standard planes in fetal ultrasound exams. The study collected 692 fetal ultrasound exams from various centers in North America and Europe. The AI software demonstrated high performance in identifying standard planes, which could support practitioners in their clinical practice by evaluating exam completeness in real-time. The sensitivity of the AI software for labeling standard planes ranged from 0.914 to 0.937. [Extracted from the article]

This article discusses the use of artificial intelligence (AI) software in the early detection of spina bifida (SB) during the first trimester of pregnancy. The software was tested on a dataset of ultrasound scans and was found to have a high sensitivity for detecting SB by identifying the absence of certain structures in the images. The study suggests that AI software could improve the quality of examinations and make SB screening more accessible. The authors of the article are R. Besson, N. Fries, C. Morisset, V. Debavelaere, E. Spaggiari, Y. Oyelese, R. Chaoui, J. Stirnemann, and Y. Ville. [Extracted from the article]

This article discusses the assessment of the fetal sylvian fissure (SF) in the context of cortical abnormalities detection during prenatal ultrasound. The study compares the accuracy of different techniques for evaluating the SF on the axial plane in normal cases and fetuses with confirmed malformation of cortical development (MCD). The results show that subjective evaluation of the SF is more accurate in predicting the presence or absence of MCD compared to objective methods. The study suggests that there is currently no accepted standard method for assessing the SF by prenatal ultrasound. [Extracted from the article]

This article discusses the challenges of predicting the postnatal outcomes of congenital cytomegalovirus (CMV) infection during pregnancy. The study evaluated the effectiveness of prenatal assessment, including different machine learning techniques, in predicting symptoms at birth and long-term sequelae. The research involved a large cohort of pregnant women who were referred for fetal infection following maternal infection in early pregnancy. The results suggest that prenatal imaging and early prenatal treatment, particularly in cases with mild prenatal findings, can influence the prognosis of infected fetuses. [Extracted from the article]

This article discusses the potential use of artificial intelligence (AI) software in screening for transposition of great arteries (TGA) during fetal ultrasound exams. The AI software was trained on a large database of non-pathological images and images of diagnosed TGA cases. The software demonstrated high sensitivity in detecting signs of TGA, reaching 98% sensitivity in the training database and 88% sensitivity in the validation database. However, further testing on independent databases is needed to assess the software's robustness, and the true clinical benefit of such an alert system still needs to be evaluated. [Extracted from the article]