In Situ Reconstruction in Native and Prosthetic Aortic Infections Using Cryopreserved Arterial Allografts

ObjectivesTo evaluate overall survival and complications of cryopreserved arterial allografts in aortic graft infections and infected aortic aneurysms.MethodsA retrospective review of consecutive patients was conducted with native or prosthetic aortic infections, who underwent local debridement and in situ implantation of a cryopreserved aortic allograft from September 2004 to June 2012 at the Henri Mondor University Hospital. Patient characteristics, indications for allograft implantation, perioperative events, bacteriological data, and events related to follow-up were identified. The primary outcome was overall survival. Overall survival was estimated using the Kaplan–Meier method. Predictors of postoperative mortality were identified using uni- and multivariate analysis with a Cox proportional hazard regression.ResultsDuring the study period, 54 patients (45 [83%] men, mean age 66.2 ± 10.2 years) underwent aortic reconstruction using cryopreserved allografts. Indications were native aortic infection in 17 patients and prosthetic graft infection in 37 patients, including seven aortoenteric fistulae. Twelve aortic reconstructions (22%) were performed as emergency procedures. The median duration of follow-up was 12.1 months (range 0.4–83.6). The 30-day mortality rate was 28%. The overall mortality rate was 39% at a median follow-up of 12.1 months. Early significant postoperative complications occurred in 52% of patients. The graft-related mortality rate was 7%. The graft-related complication rate was 19%. During follow-up, there were two recurrences of aortic infection and two recurrences of allograft limb occlusion. Multivariate survival analysis identified age, chronic renal disease, prosthetic infection, emergent procedure, and coronary disease as independent predictors for postoperative mortality.ConclusionThis experience with cryopreserved aortic allografts in aortic reconstructions shows an unsatisfactory 30-day survival rate, as well as a substantial early graft-related complication rate. Longer follow-up is needed in order to support the preferential use of cryopreserved allografts based on their long-term behavior

Urban mobility plan environmental impacts assessment: a methodology including socio-economic consequences - The Eval-PDU project

International audienceThe project objective is to develop an optimized methodology to assess the environmental impacts of urban mobility plans (UMP, in French PDU), taking into account their social and economic consequences. The main proposed methodology is based on a systemic approach: multi-factor (air quality, noise, energy consumption, greenhouse gas emission) numerical simulations with a chain of physically-based models, based on alternative and comparative scenarios. The social and economic consequences of these alternative simulations are assessed by means of econometric models. Two alternative approaches are explored: (i) the use of composite environmental indicators to correlate the sources to the impacts, especially health impacts, and (ii) the analysis of sample surveys on what makes inhabitants' quality of life, well-being and territorial satisfaction and on citizens' behavioral changes linked to transport offer changes

Clin Infect Dis

Background: New options for first-line treatment of HIV-2 infection are needed. We evaluated an integrase inhibitor (raltegravir)-containing regimen. Methods: ART-naive adults infected with HIV-2 only and history of CDC group B or C event, or a CD4 count 50 cells/muL/year over the past 3 years, or a confirmed plasma HIV-2 RNA (pVL) >/=100 copies (cp)/mL were eligible for this non-comparative trial. The composite primary endpoint was survival at 48 weeks (W48) without any of the following: CD4 gain from baseline /=40 cp/mL from W24, raltegravir permanent discontinuation, incident B or C event. HIV-2 ultrasensitive pVL (uspVL) and total DNA were assessed using "in-house" PCR assays. Results: Baseline median CD4 count of 30 enrolled individuals (67% women) was 436 cells/microL (InterQuartile Range[IQR] 314- 507); pVL was >/=40 cp/mL in 20/30 (67%); uspVL was >/=5 cp/mL in 23/25 (92%); total DNA was >6 cp/PCR in 8/25 (32%). At W48, the composite endpoint of success was reached in 12/30 (40%; 95% Confidence Interval 22.7 to 59.4). Failure was mainly due to CD4 gain 6 cp/PCR in 3/26 (12%). Median CD4 gain was +87 cells/microL (IQR +38- +213, n=28). No serious adverse reaction was reported. Conclusion: Raltegravir-containing cART is a safe option for first line treatment of HIV-2 infection, yielding a comparable success rate to protease inhibitors. UspVL and total DNA were undetectable in the vast majority of participants