The Wintertime Southern Hemisphere Split Jet: Structure, Variability, and Evolution

A persistent feature of the Southern Hemisphere upper-level time-mean flow is the presence of a split jet across the South Pacific east of Australia during the austral winter. The split jet is composed of the subtropical jet (STJ) on its equatorward branch and the polar front jet (PFJ) on its poleward branch. The NCEP-NCAR reanalysis is used to investigate the structure and evolution of the split jet. Results show that the presence/absence of the PFJ determines the degree of split flow, given that the STJ is a quasi-steady feature. A split-flow index (SFI) is developed to quantify the variability of the split jet, in which negative values represent strong split flow and positive values nonsplit flow. Correlations with teleconnection indices are investigated, with the SFI positively correlated to the Southern Oscillation index and negatively correlated to the Antarctic oscillation. The SFI is used to construct composites of heights, temperature, and wind for split-flow and non-split-flow days. The composites reveal that relatively cold conditions occur in the South Pacific in association with non-split-flow regimes, and split-flow regimes occur when relatively warm conditions prevail. In the latter situation cold air bottled up over Antarctica helps to augment the background tropospheric thickness gradient between Antarctica and the lower latitudes with a resulting increase in the thermal wind and the PFJ. It is surmised that frequent cold surges out of Antarctica moving into the South Pacific are associated with non-split-flow regimes. In this context, the variability of the split jet responds to large-scale baroclinic processes and is further modulated by synoptic-scale disturbances

Risk Factors of Inadequate Colposcopy After Large Loop Excision of the Transformation Zone: A Prospective Cohort Study

International audienceObjective: The aim of the study was to identify the risk factors of post-large loop excision of the transformation zone (LLETZ) inadequate colposcopy. Materials and Methods: From December 2013 to July 2014, a total of 157 patients who had a LLETZ performed for the treatment of high-grade intraepithelial lesion with fully visible cervical squamocolumnar junction were included. All procedures were performed using semicircular loops. The use of colposcopy made during each procedure was systematically documented. Dimensions and volume of LLETZ specimens were measured at the time of procedure, before formaldehyde fixation. All participants were invited for a follow-up colposcopy 3 to 6 months after LLETZ. Primary end point was the diagnosis of post-LLETZ inadequate colposcopy, defined by a not fully visible cervical squamocolumnar junction and/or cervical stenosis. Results: Colposcopies were performed in a mean (SD) delay of 136 (88) days and were inadequate in 22 (14%) cases. Factors found to significantly increase the probability of post-LLETZ inadequate colposcopy were a history of previous excisional cervical therapy [adjusted odds ratio (aOR) = 4.29, 95% CI = 1.12-16.37, p = .033] and the thickness of the specimen (aOR = 3.12, 95% CI = 1.02-9.60, p = .047). The use of colpos-copy for the guidance of LLETZ was statistically associated with a decrease in the risk of post-LLETZ inadequate colposcopy (aOR = 0.19, 95% CI = 0.04-0.80, p = .024) as the achievement of negative endocervical margins (aOR = 0.26, 95% CI = 0.08-0.86, p = .027). Conclusions: Although the risk of post-LLETZ inadequate colpos-copy is increased in patients with history of excisional therapy and with the thickness of the excised specimen, it could be reduced with the use of colposcopic guidance and the achievement of negative endocervical margins. L arge loop excision of the transformation zone (LLETZ) is a routine procedure worldwide, because it is the first-line treatment of high-grade intraepithelial lesion (HSIL) of the cervix. Quality criteria for optimal LLETZ include the completeness of excision with the achievement of negative margins, while producing the minimal excised volume and depth of excision to minimize subsequent obstetrical and neonatal morbidity. 1,2 Obtaining negative margins is important, because incomplete excision exposes women to a significant risk of posttreatment residual and/or recurrent disease, particularly when the lesion involves the endo-cervical canal. 3,4 However, this risk remains higher to the general female population, even when negative margins are achieved. Women who had had a LLETZ remain therefore exposed to a 3-to 4-fold increased risk of developing subsequent cervical cancer at least for 20 years. 5-8 Thus, prolonged and careful post-LLETZ follow-up is mandatory, whatsoever the margins status. For the last decade, the value of human papillomavirus testing has been demonstrated in this indication. Although a negative human papillomavirus test has now been admitted as the best test of cure for patients, colposcopy remains needed when this test is found to be positive. 9-12 Although being the key examination in this indication, the accuracy of colposcopy performed after previous excisional therapy of HSIL is however questionable because the healing process might result in changes in the appearance of the transformation zone (TZ). However, the main limitation of post-LLETZ colposcopic examination is the possibility of inadequate colposcopy due to the inability to visualize the entire TZ. Known risk factors for inadequate colposcopy include age, severity of lesion, and estrogen status of the patient. 13 However, inadequate colposcopy is also one of the main adverse effects of excisional therapies of the cervix, including LLETZ. 13 However, data on the precise risk factors for inadequate colposcopy after LLETZ are limited because most studies have focused on the sole risk of cervical stenosis without considering the position and visibility of the squamocolumnar junction. 14-17 This point is however crucial because it is clinically essential to identify how post-LLETZ inadequate colposcopy could be avoided, thus preserving the possibility for the follow-up of these women

Experiences of using vedolizumab in the treatment of inflammatory bowel disease in the East Midlands UK – a retrospective observational study

PurposeClinical trials have demonstrated efficacy of vedolizumab in ulcerative colitis (UC) and Crohn’s disease (CD). Further real-world data is needed to inform clinical practice. The primary outcome was to assess corticosteroid-free and clinical remission after vedolizumab initiation. Secondary outcomes included effect on disease activity scores, biochemical markers, concomitant drug use, endoscopic remission, surgical intervention, hospital admissions and adverse events.Materials and methodsA multi-centre retrospective observational study was conducted with patients initiated on vedolizumab across seven UK hospitals 1/11/14-30/11/16. Clinical disease activity was assessed using the partial Mayo Scores (pMS) and Harvey Bradshaw Index (HBI). Clinical remission was defined as HBI [less than] 4 or pMS [less than]2 with a combined stool frequency and rectal bleeding sub score of [less than] 1. Clinical response was defined as ≥2-point decrease from baseline in pMS and ≥3-point decrease from baseline in HBI.ResultsOne hundred ninety-two patients were included in the final analysis. 45% of UC and 10% of CD patients were anti-TNF naive. Over the observation period corticosteroid-free remission rates for UC and CD were 46% and 45%, while clinical remission rates were 52% and 44%, respectively. Time to corticosteroid free remission for UC and CD was 17.6 [IQR: 8.7–29.6] and 14.1 [QR: 6.0–21.7] weeks, respectively. Time to clinical response for UC was 9.4 [IQR: 5.7–15.4] and CD was 9.5 [IQR: 6.1–18.2] weeks. There was a substantial decrease in the concomitant use of immunomodulators and a similar decrease in concomitant corticosteroid use over the study period. ConclusionsResults in this predominately anti-TNF experienced population mirror other published real-world data, demonstrating good clinical effectiveness and a comparable safety profile

Tumor-responsive, multifunctional CAR-NK cells cooperate with impaired autophagy to infiltrate and target glioblastoma

Tumor antigen heterogeneity, a severely immunosuppressive tumor microenvironment (TME) and lymphopenia resulting in inadequate immune intratumoral trafficking have rendered glioblastoma (GBM) highly resistant to therapy. As a result, GBM immunotherapies have failed to demonstrate sustained clinical improvements in patient overall survival (OS). To overcome these obstacles, here we describe a novel, sophisticated combinatorial platform for GBM: the first multifunctional immunotherapy based on genetically-engineered, human NK cells bearing multiple anti-tumor functions, including local tumor responsiveness, that addresses key drivers of GBM resistance to therapy: antigen escape, poor immune cell homing, and immunometabolic reprogramming of immune responses. We engineered dual-specific CAR-NK cells to bear a third functional moiety that is activated in the GBM TME and addresses immunometabolic suppression of NK cell function: a tumor-specific, locally-released antibody fragment which can inhibit the activity of CD73 independently of CAR signaling and decrease the local concentration of adenosine. The multifunctional human NK cells targeted patient-derived GBM xenografts, demonstrated local tumor site specific activity in the tissue and potently suppressed adenosine production. We also unveil a complex reorganization of the immunological profile of GBM induced by inhibiting autophagy. Pharmacologic impairment of the autophagic process not only sensitized GBM to antigenic targeting by NK cells, but promoted a chemotactic profile favorable to NK infiltration. Taken together, our study demonstrates a promising new NK cell-based combinatorial strategy that can target multiple clinically-recognized mechanisms of GBM progression simultaneously

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Impact du parcours de soins des foetus en retard de croissance intra-utérin sur l’implémentation des recommandations en pratique clinique et sur le pronostic néonatal

The aim of OPGREN 0 was to identify the prevalence of FGR diagnosis in our wards and study the impact of the 2013 published French guidelines on the detection rate of FGR. Over a seven-year period, and among 31 052 newborns, 1 020 (3,3%) infants were identified as FGR and met the inclusion criteria. The detection rate of FGR was similar before and after publication of the French Guidelines related to FGR in 2013. Indeed, 50,8% (201/395) FGR were diagnosed between 2011-2013 versus 52,6% (245/465) between 2015-2017 (p=0,59). The aim of OPGREN 1 was to evaluate the impact of antenatal management of IUGR according to the French recommendations (CNGOF) on the neonatal prognosis of IUGR fetuses. From the same historical cohort of 31,052 children, born at the Femme Mère Enfant hospital (Lyon, France) between January 1, 2011 and December 31, 2017, we selected the population of IUGR fetuses. The minimum evidence-based care (MEC) in the antenatal management of fetuses with IUGR was defined according to the CNGOF recommendations and neonatal prognosis of early and late IUGR fetuses were assessed based on whether or not they received MEC. The neonatal prognosis was defined according to a composite criterion that included neonatal morbidity and mortality. A total of 1,020 fetuses with IUGR were studied. The application of MEC showed an improvement in the neonatal prognosis of early IUGR (p=0.003), and an improvement in the neonatal prognosis of IUGR born before 32 weeks (p=0.03). Multivariate analysis confirmed the results showing an increase of neonatal morbi-mortality in the absence of MEC in early onset IUGR with OR 1.79 (95% CI 1.2-3.19). The objective of OPGREN 2 was to evaluate the impact of a standardized healthcare pathway on the implementation of the recommended clinical practice in the antenatal management of IUGR fetuses, in comparison to a traditional pathway. The quality of the implementation of practice has been defined whether or not minimum evidence-based care (MEC), defined according to the French recommendations (CNGOF), has been implemented. Between 2015 and 2017, 120 fetuses were followed within the traditional pathway and 125 within the IUGR pathway. The standardized pathway resulted in a higher rate of MEC (86,4%) when compared to IUGR fetuses followed-up in the traditional pathway (27,5% (OR* 20 (95% CI 10.0-39.7). Among early-onset-IUGR: 31% received MEC in the traditional pathway versus 83% in the standardized pathway (p<0.001). Among late-onset-IUGR: 22% received MEC in the traditional pathway versus 92% in the standardized pathway (p<0.001). The provided care in the standardized pathway resulted in an increase of complete antenatal corticosteroid therapy (92,8 %) when compared to the traditional pathway (50.0 %; p<0.001) and a reduction of the rate of caesarean sections before labor for non-reassuring fetal heart rate (15%) when compared to the traditional pathway (41.3% p=0.007). We selected over the study period between 2015 and 2017, all fetuses small-for-gestational-age (SGA) as defined by the CNGOF recommendations. The IATROPAG study compared the rate of obstetrical intervention in SGA followed in the traditional versus the standardized pathway. It confirmed the absence of a higher iatrogenic rate of obstetrical intervention in the traditional pathway when compared to the traditional one. Overall, the standardized pathway resulted in a significant improvement of neonatal prognosis in early-IUGR, based on better implementation recommendations in clinical practice without increasing the rate of obstetrical interventions in SGA fetuses. An evaluation within the AURORE network could confirm these findings and identify the failing link responsible for poor implementation of the recommendations in clinical practice.Les modalités de surveillance des fœtus en RCIU sont parfois discordantes. A l’ère où l’utilisation des bonnes pratiques cliniques basées sur des preuves a démontré une amélioration considérable de la survie néonatale sans morbidité sévère, les fœtus en RCIU étaient moins susceptibles de recevoir ces soins optimaux. L’objectif de OPGREN 0 était d'identifier la prévalence du diagnostic des RCIU au sein d’une maternité de type 3 à Lyon et d'étudier l'impact des recommandations françaises publiées en 2013 sur le taux de détection des RCIU. Entre 2011-2017, 1 020 (3,3 %) nouveau-nés ont été identifiés comme RCIU et ont rempli les critères d'inclusion. Le taux de détection des RCIU était similaire avant et après la publication des recommandations françaises publiées en 2013. En effet, 50,8% (201/395) des RCIU ont été diagnostiqués entre 2011-2013 contre 52,6% (245/465) entre 2015-2017 (p=0,59). L’objectif d’OPGREN 1 était d'évaluer l'impact de l’implémentation des recommandations prénatale relatives à la gestion du RCIU du collège français des gynécologues et obstétriciens (CNGOF) sur le pronostic néonatal des fœtus du RCIU. A partir des recommandations du CNGOF, nous avons défini l’ensemble des soins minimaux requis (SMR) attendus dans la prise en charge prénatale des RCIU, et avons évalué l’impact de l’implémentation de ces recommandations sur le pronostic néonatal des fœtus RCIU précoces et tardifs. Le pronostic néonatal a été apprécié selon un critère composite incluant la morbidité et la mortalité néonatales. L'application des SMR a montré une amélioration du pronostic néonatal des RCIU précoces (p=0,003), et une amélioration du pronostic néonatal des RCIU nés avant 32 semaines d’aménorrhée (p=0,03). Une analyse multivariée a confirmé les résultats montrant une augmentation de la morbi-mortalité néonatale en l'absence des SMR chez les RCIU précoce avec un OR de 1,79 (IC à 95 % 1,2-3,19). L'objectif de OPGREN 2 était d’évaluer l'impact d'un parcours standardisé sur l’implémentation des recommandations dans la prise en charge prénatale des fœtus RCIU, en comparaison à un parcours traditionnel. Nous avons évalué le taux de réalisation des SMR définis dans OPGREN 1 dans le parcours standardisé par rapport au parcours traditionnel. Entre 2015-2017, 120 fœtus ont été suivis dans le parcours traditionnel et 125 dans le parcours standardisé. Le parcours RCIU a donné lieu à un taux plus élevé de SMR (86,4 %) par rapport au parcours traditionnel (27,5 %) (OR* 20 (95 % IC 10,0-39,7). Parmi les RCIU précoces, 31 % ont reçu les SMR au sein du parcours traditionnel contre 83 % dans le parcours standardisé (p<0,001). Chez les RCIU tardifs, 22 % ont reçu les SMR dans le parcours traditionnel contre 92 % dans le parcours standardisé (p<0,001). Le parcours standardisé a entraîné une augmentation de la corticothérapie prénatale complète en cas de naissance <34 semaines d’aménorrhée (92,8 %) par rapport au parcours traditionnel (50,0 % ; p<0,001) et une réduction du taux de césarienne avant travail pour anomalie du rythme cardiaque fœtale (15 %) par rapport au parcours traditionnel (41,3 % p=0,007). Nous avons sélectionné entre 2015 et 2017 tous les fœtus petit-pour-l’âge-gestationnel (PAG) et avons comparé le taux d’intervention obstétricale dans le parcours traditionnel par rapport au parcours standardisé. L’étude IATROPAG confirme l’absence d’une iatrogénie obstétricale supérieure dans le parcours standardisé par rapport au parcours classique. Au total, le parcours standardisé a permis un meilleur pronostic néonatal chez les fœtus en RCIU précoce, compte tenu d’une meilleure implémentation des recommandations pour la pratique clinique sans augmentation de la iatrogénie obstétricale dans la population des faux positifs du dépistage. Une évaluation au sein des différents types de maternité du réseau périnatal AURORE permettrait d’identifier le maillon défaillant, responsable d’une mauvaise implémentation des recommandations

Impact of the perinatal healthcare pathway for intrauterine growth restricted fetuses on the implementation of clinical practice guidelines and on neonatal prognosis

Les modalités de surveillance des fœtus en RCIU sont parfois discordantes. A l’ère où l’utilisation des bonnes pratiques cliniques basées sur des preuves a démontré une amélioration considérable de la survie néonatale sans morbidité sévère, les fœtus en RCIU étaient moins susceptibles de recevoir ces soins optimaux. L’objectif de OPGREN 0 était d'identifier la prévalence du diagnostic des RCIU au sein d’une maternité de type 3 à Lyon et d'étudier l'impact des recommandations françaises publiées en 2013 sur le taux de détection des RCIU. Entre 2011-2017, 1 020 (3,3 %) nouveau-nés ont été identifiés comme RCIU et ont rempli les critères d'inclusion. Le taux de détection des RCIU était similaire avant et après la publication des recommandations françaises publiées en 2013. En effet, 50,8% (201/395) des RCIU ont été diagnostiqués entre 2011-2013 contre 52,6% (245/465) entre 2015-2017 (p=0,59). L’objectif d’OPGREN 1 était d'évaluer l'impact de l’implémentation des recommandations prénatale relatives à la gestion du RCIU du collège français des gynécologues et obstétriciens (CNGOF) sur le pronostic néonatal des fœtus du RCIU. A partir des recommandations du CNGOF, nous avons défini l’ensemble des soins minimaux requis (SMR) attendus dans la prise en charge prénatale des RCIU, et avons évalué l’impact de l’implémentation de ces recommandations sur le pronostic néonatal des fœtus RCIU précoces et tardifs. Le pronostic néonatal a été apprécié selon un critère composite incluant la morbidité et la mortalité néonatales. L'application des SMR a montré une amélioration du pronostic néonatal des RCIU précoces (p=0,003), et une amélioration du pronostic néonatal des RCIU nés avant 32 semaines d’aménorrhée (p=0,03). Une analyse multivariée a confirmé les résultats montrant une augmentation de la morbi-mortalité néonatale en l'absence des SMR chez les RCIU précoce avec un OR de 1,79 (IC à 95 % 1,2-3,19). L'objectif de OPGREN 2 était d’évaluer l'impact d'un parcours standardisé sur l’implémentation des recommandations dans la prise en charge prénatale des fœtus RCIU, en comparaison à un parcours traditionnel. Nous avons évalué le taux de réalisation des SMR définis dans OPGREN 1 dans le parcours standardisé par rapport au parcours traditionnel. Entre 2015-2017, 120 fœtus ont été suivis dans le parcours traditionnel et 125 dans le parcours standardisé. Le parcours RCIU a donné lieu à un taux plus élevé de SMR (86,4 %) par rapport au parcours traditionnel (27,5 %) (OR* 20 (95 % IC 10,0-39,7). Parmi les RCIU précoces, 31 % ont reçu les SMR au sein du parcours traditionnel contre 83 % dans le parcours standardisé (p<0,001). Chez les RCIU tardifs, 22 % ont reçu les SMR dans le parcours traditionnel contre 92 % dans le parcours standardisé (p<0,001). Le parcours standardisé a entraîné une augmentation de la corticothérapie prénatale complète en cas de naissance <34 semaines d’aménorrhée (92,8 %) par rapport au parcours traditionnel (50,0 % ; p<0,001) et une réduction du taux de césarienne avant travail pour anomalie du rythme cardiaque fœtale (15 %) par rapport au parcours traditionnel (41,3 % p=0,007). Nous avons sélectionné entre 2015 et 2017 tous les fœtus petit-pour-l’âge-gestationnel (PAG) et avons comparé le taux d’intervention obstétricale dans le parcours traditionnel par rapport au parcours standardisé. L’étude IATROPAG confirme l’absence d’une iatrogénie obstétricale supérieure dans le parcours standardisé par rapport au parcours classique. Au total, le parcours standardisé a permis un meilleur pronostic néonatal chez les fœtus en RCIU précoce, compte tenu d’une meilleure implémentation des recommandations pour la pratique clinique sans augmentation de la iatrogénie obstétricale dans la population des faux positifs du dépistage. Une évaluation au sein des différents types de maternité du réseau périnatal AURORE permettrait d’identifier le maillon défaillant, responsable d’une mauvaise implémentation des recommandations.The aim of OPGREN 0 was to identify the prevalence of FGR diagnosis in our wards and study the impact of the 2013 published French guidelines on the detection rate of FGR. Over a seven-year period, and among 31 052 newborns, 1 020 (3,3%) infants were identified as FGR and met the inclusion criteria. The detection rate of FGR was similar before and after publication of the French Guidelines related to FGR in 2013. Indeed, 50,8% (201/395) FGR were diagnosed between 2011-2013 versus 52,6% (245/465) between 2015-2017 (p=0,59). The aim of OPGREN 1 was to evaluate the impact of antenatal management of IUGR according to the French recommendations (CNGOF) on the neonatal prognosis of IUGR fetuses. From the same historical cohort of 31,052 children, born at the Femme Mère Enfant hospital (Lyon, France) between January 1, 2011 and December 31, 2017, we selected the population of IUGR fetuses. The minimum evidence-based care (MEC) in the antenatal management of fetuses with IUGR was defined according to the CNGOF recommendations and neonatal prognosis of early and late IUGR fetuses were assessed based on whether or not they received MEC. The neonatal prognosis was defined according to a composite criterion that included neonatal morbidity and mortality. A total of 1,020 fetuses with IUGR were studied. The application of MEC showed an improvement in the neonatal prognosis of early IUGR (p=0.003), and an improvement in the neonatal prognosis of IUGR born before 32 weeks (p=0.03). Multivariate analysis confirmed the results showing an increase of neonatal morbi-mortality in the absence of MEC in early onset IUGR with OR 1.79 (95% CI 1.2-3.19). The objective of OPGREN 2 was to evaluate the impact of a standardized healthcare pathway on the implementation of the recommended clinical practice in the antenatal management of IUGR fetuses, in comparison to a traditional pathway. The quality of the implementation of practice has been defined whether or not minimum evidence-based care (MEC), defined according to the French recommendations (CNGOF), has been implemented. Between 2015 and 2017, 120 fetuses were followed within the traditional pathway and 125 within the IUGR pathway. The standardized pathway resulted in a higher rate of MEC (86,4%) when compared to IUGR fetuses followed-up in the traditional pathway (27,5% (OR* 20 (95% CI 10.0-39.7). Among early-onset-IUGR: 31% received MEC in the traditional pathway versus 83% in the standardized pathway (p<0.001). Among late-onset-IUGR: 22% received MEC in the traditional pathway versus 92% in the standardized pathway (p<0.001). The provided care in the standardized pathway resulted in an increase of complete antenatal corticosteroid therapy (92,8 %) when compared to the traditional pathway (50.0 %; p<0.001) and a reduction of the rate of caesarean sections before labor for non-reassuring fetal heart rate (15%) when compared to the traditional pathway (41.3% p=0.007). We selected over the study period between 2015 and 2017, all fetuses small-for-gestational-age (SGA) as defined by the CNGOF recommendations. The IATROPAG study compared the rate of obstetrical intervention in SGA followed in the traditional versus the standardized pathway. It confirmed the absence of a higher iatrogenic rate of obstetrical intervention in the traditional pathway when compared to the traditional one. Overall, the standardized pathway resulted in a significant improvement of neonatal prognosis in early-IUGR, based on better implementation recommendations in clinical practice without increasing the rate of obstetrical interventions in SGA fetuses. An evaluation within the AURORE network could confirm these findings and identify the failing link responsible for poor implementation of the recommendations in clinical practice

Spectrally-selective Time-resolved Emission through Fourier-filtering (STEF)

In this manuscript we demonstrate that directing the emitted photon stream from a fluorescent sample through a fixed path-length imbalanced Mach-Zehnder interferometer allows us to separate and resolve the dynamics of different emitters without the use of filtering optics. Our method, Spectrallyselective Time-resolved Emission through Fourier-filtering (STEF) takes advantage of a careful selection of interferometer position where one signal can be canceled (or enhanced) due to its unique spectral characteristics. STEF is straightforward to implement and provides a complementary approach to separate spectrally overlapped signals based on their coherence length and carrier frequency. We also discuss how one can implement STEF with an imperfect Mach-Zehnder interferometer, increasing the utility of this method, and demonstrate how Mach-Zehnder filtering can be used to image fluorophores in biologically relevant samples