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Wald HL, Bandle B, Richard A, Min S. Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/529079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).Design.Diagnostic accuracy study.Setting.A 425-bed university hospital.Subjects.A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods.An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results.Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.Conclusion.The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.Infect Control Hosp Epidemiol2014;35(6):685–691
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Kirsten AM, Richard A, Tanase AM, Weihua C, Hosoe M, Hederer B. P251 Efficacy And Safety Of Once-daily Indacaterol/mometasone Compared With Twice-daily Salmeterol/fluticasone In Patients With Moderate To Very Severe Copd. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tajeddine R, Rambaux N, Lainey V, Charnoz S, Richard A, Rivoldini A, Noyelles B. Constraints on Mimas' interior from Cassini ISS libration measurements. Science 2014; 346:322-4. [PMID: 25324382 DOI: 10.1126/science.1255299] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Like our Moon, the majority of the solar system's satellites are locked in a 1:1 spin-orbit resonance; on average, these satellites show the same face toward the planet at a constant rotation rate equal to the satellite's orbital rate. In addition to the uniform rotational motion, physical librations (oscillations about an equilibrium) also occur. The librations may contain signatures of the satellite's internal properties. Using stereophotogrammetry on Cassini Image Science Subsystem (ISS) images, we measured longitudinal physical forced librations of Saturn's moon Mimas. Our measurements confirm all the libration amplitudes calculated from the orbital dynamics, with one exception. This amplitude depends mainly on Mimas' internal structure and has an observed value of twice the predicted one, assuming hydrostatic equilibrium. After considering various possible interior models of Mimas, we argue that the satellite has either a large nonhydrostatic interior, or a hydrostatic one with an internal ocean beneath a thick icy shell.
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Richard A, Faeh D, Rohrmann S, Braun J, Tarnutzer S, Bopp M. 947: Italianity is associated with lower risk of prostate cancer mortality in Switzerland. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Popa T, Milani P, Richard A, Brochard V, Tranchant C, Rothwell J, Vidailhet M, Meunier S, Roze E. P926: On the neurophysiology of myoclonus-dystonia and why it stands apart from other primary dystonia. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wald HL, Bandle B, Richard A, Min S. Accuracy of electronic surveillance of catheter-associated urinary tract infection at an academic medical center. Infect Control Hosp Epidemiol 2014; 35:685-91. [PMID: 24799645 DOI: 10.1086/676429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs). DESIGN Diagnostic accuracy study. SETTING A 425-bed university hospital. SUBJECTS A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI. METHODS An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated. RESULTS Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71. CONCLUSION The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.
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Richard A, Rohrmann S, Zhang L, Eichholzer M, Basaria S, Selvin E, Dobs AS, Kanarek N, Menke A, Nelson WG, Platz EA. Racial variation in sex steroid hormone concentration in black and white men: a meta-analysis. Andrology 2014; 2:428-35. [PMID: 24648111 DOI: 10.1111/j.2047-2927.2014.00206.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/28/2014] [Accepted: 02/16/2014] [Indexed: 11/29/2022]
Abstract
Sex steroid hormones are associated with chronic diseases and mortality with risk associations that differ between racial and ethnic groups. However, it is currently unclear whether sex steroid hormone levels differ between black and white men. The aim of this study was to assess racial variation in circulating testosterone, free testosterone, sex hormone-binding globulin (SHBG) and estradiol levels in men. We searched PubMed for articles comparing circulating hormones in black and white men. A meta-analysis was performed using weighted mean differences (WMD) to compare hormones levels between black and white men. Fifteen eligible studies were identified; three did not report adjusted means. After age adjustment, free testosterone levels were significantly higher in black than in white men (WMD = 4.07 pg/mL, 95% CI 1.26, 6.88). Depending on the free testosterone concentration in white men, this WMD translates into a racial difference ranging from 2.5 to 4.9%. Total testosterone (WMD = 0.10 ng/mL, 95% CI -0.02, 0.22), estradiol (WMD = 0.67 pg/mL, 95% CI -0.04, 1.38) and SHBG (WMD = -0.45 nmol/L, 95% CI -1.75, 0.85) concentrations did not differ comparing blacks with whites. After adjustment for age, black men have a modestly but significantly 2.5 to 4.9% higher free testosterone level than white men. Based on previous studies on effects of sex steroid hormones on risk of chronic diseases or mortality, this modest difference is unlikely to explain racial differences in disease risk.
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Richard A, El Helou A, Meunier S, Welter ML. Rôle du cervelet et de l’aire motrice supplémentaire dans le contrôle postural durant l’initiation de la marche chez les sujets sains : une étude pilote. Neurophysiol Clin 2014. [DOI: 10.1016/j.neucli.2013.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Richard A, O'Rourke J, Rubin JF. External fluorescence retention of calcein-marked juvenile brown trout Salmo trutta raised in natural and artificial environments. JOURNAL OF FISH BIOLOGY 2014; 84:73-84. [PMID: 24245818 DOI: 10.1111/jfb.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/16/2013] [Indexed: 06/02/2023]
Abstract
The fluorescence retention and intensity of juvenile brown trout Salmo trutta marked during their first summer were monitored in a hatchery and in four natural streams. A handheld detector was used for direct examination. In the hatchery, three marking treatments (T) were compared: 3·5 min in a 0·5% calcein solution (T0·5-3·5), 7 min in a 0·5% calcein solution (T0·5-7) and 3·5 min in a 1% calcein solution (T1-3·5). The fish were raised indoors for 11 months and then outdoors until 18 months. The fluorescence retention rate was 100% in all treatments at 11 months, although T1-3·5 showed the highest mean fluorescence intensity, followed by T0·5-7 and T0·5-3·5. The fluorescence intensity was not correlated with the final total length (L(T)) of the fish in two treatments, although it significantly decreased with increasing L(T) in T1-3·5. At 18 months, <30% of the fish were still slightly fluorescent, suggesting a negative effect of sunlight exposure. In stream studies, the fluorescence intensity did not significantly differ according to final L(T); an overall mean ± s.d. retention rate of 70·7 ± 26·6% was measured at 12 months with a decrease to 48·6 ± 24·6% at 24 months. Significant differences amongst streams and within reaches of the same stream were observed. Because of a significant positive effect of the shading index on the fluorescence intensity, the use of calcein should be restricted to streams unexposed to direct sunlight. Consequently, the marking method would be reliable for 1 year monitoring studies in shaded streams.
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Richard A, Debaty G, Pommier P, Koch FX, Briot R, Loizzo F, Carpentier F, Danel V, Maignan M. Fréquence et facteurs de risque des Smur de seconde intention dans les intoxications médicamenteuses volontaires. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-013-0388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Richard A, Welter ML, Meunier S. P 190. Role of the cerebellum and the supplementary motor area in anticipatory postural adjustments in humans. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Richard A, Gallet B, Comoz F, Louvet S, Michel M, Verneuil L, Cribier B, Dompmartin A. [Eruptive collagenoma]. Ann Dermatol Venereol 2013; 140:69-71. [PMID: 23328367 DOI: 10.1016/j.annder.2012.10.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/24/2012] [Indexed: 11/26/2022]
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Heringa MF, DeCarlo PF, Chirico R, Lauber A, Doberer A, Good J, Nussbaumer T, Keller A, Burtscher H, Richard A, Miljevic B, Prevot ASH, Baltensperger U. Time-resolved characterization of primary emissions from residential wood combustion appliances. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2012; 46:11418-11425. [PMID: 22970884 DOI: 10.1021/es301654w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Primary emissions from a log wood burner and a pellet boiler were characterized by online measurements of the organic aerosol (OA) using a high-resolution time-of-flight aerosol mass spectrometer (HR-TOF-AMS) and of black carbon (BC). The OA and BC concentrations measured during the burning cycle of the log wood burner, batch wise fueled with wood logs, were highly variable and generally dominated by BC. The emissions of the pellet burner had, besides inorganic material, a high fraction of OA and a minor contribution of BC. However, during artificially induced poor burning BC was the dominating species with ∼80% of the measured mass. The elemental O:C ratio of the OA was generally found in the range of 0.2-0.5 during the startup phase or after reloading of the log wood burner. During the burnout or smoldering phase, O:C ratios increased up to 1.6-1.7, which is similar to the ratios found for the pellet boiler during stable burning conditions and higher than the O:C ratios observed for highly aged ambient OA. The organic emissions of both burners have a very similar H:C ratio at a given O:C ratio and therefore fall on the same line in the Van Krevelen diagram.
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Moralès O, Richard A, Martin N, Mrizak D, Sénéchal M, Miroux C, Pancré V, Rommelaere J, Caillet-Fauquet P, de Launoit Y, Delhem N. Activation of a helper and not regulatory human CD4+ T cell response by oncolytic H-1 parvovirus. PLoS One 2012; 7:e32197. [PMID: 22359669 PMCID: PMC3281136 DOI: 10.1371/journal.pone.0032197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/24/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND H-1 parvovirus (H-1 PV), a rodent autonomous oncolytic parvovirus, has emerged as a novel class of promising anticancer agents, because of its ability to selectively find and destroy malignant cells. However, to probe H-1 PV multimodal antitumor potential one of the major prerequisites is to decipher H-1 PV direct interplay with human immune system, and so prevent any risk of impairment. METHODOLOGY/PRINCIPAL FINDINGS Non activated peripheral blood mononuclear cells (PBMCs) are not sensitive to H-1 PV cytotoxic effect. However, the virus impairs both activated PBMC proliferation ability and viability. This effect is related to H-1 PV infection as evidenced by Western blotting detection of H-1 PV main protein NS1. However, TCID50 experiments did not allow newly generated virions to be detected. Moreover, flow cytometry has shown that H-1 PV preferentially targets B lymphocytes. Despite seeming harmful at first sight, H-1 PV seems to affect very few NK cells and CD8+ T lymphocytes and, above all, clearly does not affect human neutrophils and one of the major CD4+ T lymphocyte subpopulation. Very interestingly, flow cytometry analysis and ELISA assays proved that it even activates human CD4+ T cells by increasing activation marker expression (CD69 and CD30) and both effective Th1 and Th2 cytokine secretion (IL-2, IFN-γ and IL-4). In addition, H-1 PV action does not come with any sign of immunosuppressive side effect. Finally, we have shown the efficiency of H-1 PV on xenotransplanted human nasopharyngeal carcinoma, in a SCID mouse model reconstituted with human PBMC. CONCLUSIONS/SIGNIFICANCE Our results show for the first time that a wild-type oncolytic virus impairs some immune cell subpopulations while directly activating a Helper CD4+ T cell response. Thus, our data open numerous gripping perspectives of investigation and strongly argue for the use of H-1 PV as an anticancer treatment.
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Richard A, Beck C, Zhang H, Lin C, Yang F, Jia H, Xu X, Wu Z, Jia F, Zhang S, Liu Z. Multi-neutron transfer coupling in sub-barrier32S +90,96Zr fusion reactions. EPJ WEB OF CONFERENCES 2011. [DOI: 10.1051/epjconf/20111708005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bastogne T, Tirand L, Gravier J, Bechet D, Morosini V, Pernot M, Frochot C, Richard A, Guillemin F, Barberi-Heyob M. Contributions of experiment designs in photodynamic therapy: Photosensitizer design, treatment analysis and optimization. Photodiagnosis Photodyn Ther 2011. [DOI: 10.1016/j.pdpdt.2011.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Denolle T, Dib M, Revault d'Allonnes F, Nicolas S, Richard A, Maillard J, Bourdet S, Marivain A, Auguste V, Bouvet C, Pichon G. 265 Effectiveness of therapeutic, dietetic and physical education within a network of care in secondary prevention among coronary patients: Educoeur Program. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041608.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Richard A, Churan J, Guitton D, Pack C. Pre-saccadic changes in visual motion discrimination. J Vis 2010. [DOI: 10.1167/7.9.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Churan J, Khawaja F, Tsui J, Richard A, Pack C. Effects of onset-transients on the perception of visual motion. J Vis 2010. [DOI: 10.1167/8.6.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Churan J, Richard A, Pack C, Guitton D. Temporal interaction between visual and saccade-related signals in perceptual localization. J Vis 2010. [DOI: 10.1167/7.9.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Richard A, Thompson B, Hess R, Aaen-Stockdale C, Pack C. Motion direction discrimination in strabismic amblyopia: Effects of stimulus contrast and size. J Vis 2010. [DOI: 10.1167/9.8.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Richard A, Churan J, Guitton D, Pack C. Perceptual compression during head-free gaze shifts: visual and extraretinal contributions. J Vis 2010. [DOI: 10.1167/8.6.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wizla P, Begue A, Loison I, Richard A, Caillet-Fauquet P, Stéhelin D. Ectopic expression of H-1 parvovirus NS1 protein induces alterations in actin filaments and cell death in human normal MRC-5 and transformed MRC-5 SV2 cells. Arch Virol 2010; 155:771-5. [PMID: 20237811 DOI: 10.1007/s00705-010-0637-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 02/09/2010] [Indexed: 11/28/2022]
Abstract
When grown in human cell lines, oncolytic H-1 parvovirus (H-1PV) replication preferentially occurs in transformed cells, which ultimately die upon infection. H-1PV-induced cytotoxicity is mainly due to P4 promoter-driven NS1 protein expression. Infection of untransformed cells generally does not induce deleterious effects because the P4 promoter is not activated. Here, we show that ectopic CMV-driven NS1 protein expression in normal human MRC-5 cells results in alterations of actin filaments and cell death, and both effects are prevented by a serine 473 mutation. The same substitution preserves actin filaments of transfected MRC-5 SV2 cells, that are MRC-5 transformed counterparts, but does not impair NS1-induced cytotoxicity.
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Salguero FJ, Richard A, Gough J, Long A, Weyer U, Cooley WA, Chambers MA, Lesellier S. Pelioid hepatocellular carcinoma in an adult Eurasian badger (Meles meles). J Comp Pathol 2009; 142:208-12. [PMID: 19683720 DOI: 10.1016/j.jcpa.2009.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 05/27/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
Abstract
A mass was identified within the left lateral lobe of the liver of a 10-year-old Eurasian badger (Meles meles). The mass was friable and multilobulated, with blood-filled spaces between the lobules. Microscopically, the lesion consisted of sheets and trabeculae of neoplastic hepatocytes often forming cystic spaces containing erythrocytes, fibrin and necrotic debris. The histological appearance was consistent with hepatocellular carcinoma (HCC). Immunohistochemically, the neoplastic cells expressed cytokeratin 18 but not von Willebrand factor. Multiple intranuclear (amphophilic or acidophilic) inclusion bodies were observed in hepatocytes at the junction between the tumour and normal hepatic tissue. HCCs have also been reported in other domestic and wild animals. As hepadnavirus infection has been associated with HCC in woodchucks, further histochemical and transmission electron microscopical studies were performed; however, these demonstrated that the inclusions consisted of lipid droplets and not viral particles. To our knowledge, this is the first report of a naturally occurring HCC in a Eurasian badger.
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Monsarrat N, Houfflin-Debarge V, Richard A, Launay D, Lambert M, Hatron PY, Subtil D, Deruelle P. [Fetal ultrasonography and Doppler in isolated congenital heart block]. ACTA ACUST UNITED AC 2009; 37:633-44. [PMID: 19586792 DOI: 10.1016/j.gyobfe.2009.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 05/18/2009] [Indexed: 12/23/2022]
Abstract
Isolated congenital heart block is linked to transplacental passage of maternal anti-SSA/Ro and/or anti-SSB/La antibodies that may be related to a connective tissue disease. Ultrasonography and Doppler are essential to screen fetus at risk. They allow the diagnosis of first- and second-degree blocks which are probably preliminary stages in conducting tissue's injury. In these situations, a maternal treatment by fluorinated steroids can be proposed because of its possible effect on partial blocks. However, these early signs of nodal injury can be lacking: some fetus present a complete heart block without previously detected less advanced block. Moreover, the significance of first-degree block is unclear since it could reverse spontaneously. Other markers of nodal injury would be valuable. In case of complete congenital heart block, ultrasonography is useful to detect congestive heart failure and help the obstetrical management when unfavorable prognostic signs occur.
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