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Phylodynamic analyses generate important and timely data to optimise public health response to SARS-CoV-2 outbreaks and epidemics. However, their implementation is hampered by the massive amount of sequence data and the difficulty to parameterise dedicated software packages. We introduce theCOVFlowpipeline, accessible athttps://gitlab.in2p3.fr/ete/CoV-flow, which allows a user to select sequences from the Global Initiative on Sharing Avian Influenza Data (GISAID) database according to user-specified criteria, to perform basic phylogenetic analyses, and to produce an XML file to be run in theBeast2software package. We illustrate the potential of this tool by studying two sets of sequences from the Delta variant in two French regions. This pipeline can facilitate the use of virus sequence data at the local level, for instance, to track the dynamics of a particular lineage or variant in a region of interest.

We analysed 131,478 SARS-CoV-2 variant screening tests performed in France from September 1st to December 18, 2021. Tests consistent with the presence of the Omicron variant exhibit significantly higher cycle threshold Ct values, which could indicate lower amounts of virus genetic material. We estimate that the transmission advantage of the Omicron variant over the Delta variant is +105% (95% confidence interval: 96-114%). Based on these data, we use mechanistic mathematical modelling to explore scenarios for early 2022.

Introduction/Background Occult discovery of invasive cervical cancer discovered after hysterectomy for non-malignant tumors is not uncommon. For patients presenting an incidental diagnosis of early stage invasive cervical cancer (FIGO Stages IA1-IB2), two possible strategies can be proposed: Adjuvant radiation Therapy with no tumor target or Radical Parametrectomy (RP) associated with upper vaginectomy and pelvic lymph node dissection. Methodology The procedure starts by incising the peritoneum on the lateral pelvic sidewall. Dissection is proceeded from the round ligament stump towards the ligated infundibulo-pelvic pedicle stump, followed by the development of the retroperitoneal space with the identification of the umbilical artery, the iliac vessels and laterally the psoas muscle with the genito-femoral nerve. Paravesical and pararectal spaces are developed down to the pelvic floor. A radical pelvic lymphadenectomy is performed bilaterally. Once lymph node involvement is excluded, we proceed to parametrectomy. Radical parametrectomy is started with the dissection from the posterior leaf of the broad ligament. The anterior division of the internal iliac artery (IIA) is identified and the uterine artery and vein are transected proximally at their origin using a vascular sealing system or Hem-O-Lok clips. The ureters are then mobilized from their attachments and separated from the medial leaf of the peritoneum down to the ureteral tunnel below the uterine artery and to their entrance into the bladder. Aided by the vaginal probe, the bladder peritoneum is incised, and the bladder is dissected and mobilized inferiorly down to the middle third of the vagina. After dissection of the bladder pillar, the vesico-vaginal space is joined to the paravesical space, completely separating the bladder from the anterior vaginal wall. In cases of anatomical distortion or bladder adhesions, instillation of 300cc of saline solution associated with Methylene blue dye in the bladder might be required to guide the dissection. Posteriorly, the peritoneum is incised at the level of the cul-de-sac of Douglas and the rectovaginal space is developed isolating the uterosacral ligaments. The proximal parametrium and para-vaginal tissues are finally dissected as in a Type B1 Querleu Morrow radical hysterectomy. The same procedure is performed on both sides. A circular incision is made about 3 cm below the vaginal cuff aided by upward vaginal traction. Results When compared to Radiation therapy RP presents a lower rate of late complications, making it the preferred approach to treat younger patients. Traditionally performed via laparotomy, minimally invasive approach is now proven feasible and effective. Conclusion This article presents a focused anatomic review and describes the surgical technique of the five-port robotic assisted radical parametrectomy. Disclosures Eric Lambaudie and Gilles Houvenaeghle report grants and personal fees from Intuitive Surgical, outside the submitted work. The other authors have no other conflicts of interest to declare.