Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.
Mechanical valve conduit replacement of the aortic root is a durable and appropriate procedure for aortic root dilatation with or without aortic aortic insufficiency. But this procedure may sacrifice an anatomically salvageable aortic valve and requires a life-long anticoagulation with its attendant thromboembolic versus haemorrhagic risks, which is not ideal for young active patients. Recently, two techniques of aortic root replacement with aortic valve sparing have been described, based on experimental data. The first one is Yacoub's procedure (1983), where the correction of the aortic root is performed by correcting the sinotubular junction and replacement of the aortic sinuses with an appropriately tailored Dacron graft (remodelling). The second technique was described by David (1992). In this one, the aortic root reconstruction is performed by reimplanting the aortic valve in a tubular Dacron graft (reimplantation). Since 1993, we have been interested in these procedures and the aim of this study was to examine the perioperative and intermediate term results of these techniques. From 1993 to 1998, 14 patients had either reimplantation of the aortic valve (3 patients) or remodelling of the aortic root (11 patients). Patients' ages ranged from 17 to 57 years (40.2 +/- 7.9 years). Four patients had Marfan's syndrome (29%). There were 11 cases of aortic insufficiency, three 1+ (21.4%), 3+ (21.4%), seven 2+ (50%) and one 3+ (7.2%). All the patients had morphologically normal aortic leaflets. The mean diameter of the sinuses was 57 +/- 4 mm. There was no acute or chronic dissection. The left ventricular function was measured as the percentage of the fractional shortening of the left ventricular diameter. The mean of the fractional shortening was 38.3 +/- 4%. There was no mortality and all patients underwent early and late follow-up echocardiography. The 14 patients have only mild or no insufficiency, which has not progressed in any patient. No other valve-related complication has occurred. Aortic valve-sparing replacement of the aortic root is an excellent procedure for patients with aortic root dilatation and anatomically salvageable valves. The long-term results are still unknown but it seems an attractive alternative to composite replacement of the aortic valve and descending aorta. Morbidity and mortality rates are very low, even lower than a Bentall procedure, while the savings in cost and human lives due to the absence of a mechanical valve prosthesis are significant.
Abstract Background We previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15–20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in ~ 80% of cases. Methods We report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded. Results No gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7 , with an OR of 27.68 (95%CI 1.5–528.7, P = 1.1 × 10 −4 ) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR = 3.70[95%CI 1.3–8.2], P = 2.1 × 10 −4 ). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR = 19.65[95%CI 2.1–2635.4], P = 3.4 × 10 −3 ), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR = 4.40[9%CI 2.3–8.4], P = 7.7 × 10 −8 ). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD] = 43.3 [20.3] years) than the other patients (56.0 [17.3] years; P = 1.68 × 10 −5 ). Conclusions Rare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old.
Abstract Background: Early childhood growth and development is critical for long term health. Emerging science spotlights the significance of optimal gut microbiome and bone development during this period. The aim of the Bone And MicroBiOme Onset (BAMBOO) study is to determine age-appropriate trajectories for microbiome maturation and bone development, and to identify the influence of dietary factors in the process. This paper is to describe the rationale and study design, and reports study progress. Methods: BAMBOO is an ongoing prospective observational cohort study conducted in Tianjin, China. Children who meet the following requirements are invited to participate in this study: 1) full-term gestational birth (≥ 37 and ≤ 42 weeks); 2) singleton; and 3) signed informed consent by infant’s parents (or his/her legally accepted representative) and agree to fulfill the requirements of the study protocol. The exclusion criteria include pregnancy complication (such as pre-eclampsia, gestational diabetes), bowel disease, or currently participating or having participated in another clinical trial within 4 weeks prior to the start of this cohort. The study is composed of two groups of children: Group 1 includes children from birth to 12 months of age; group 2 includes children from 6 to 36 months of age. Questionnaires are used at different timepoints to collect information on infant feeding practice, medical history, concomitant medication, adverse events/serious adverse events and development benchmarks. Concurrent anthropometric measurements include length/height, weight, and bone measurements. Children’s dietary intake data are collected using 3-day-food diaries. Biological samples (stool, urine, and breastmilk) are also collected at different timepoints. Discussion: Recruitment of Bamboo started in September 2021 and is still ongoing. Data quality assessment and method validation have been conducted using early available samples. This study will provide unprecedented insights on early life microbiome maturation and bone development in Chinese infants and toddlers, and the impact of diet. The results may contribute to evidence-based policy making and inform nutrition healthcare programs for infants and toddlers aiming to benefit long-term health. Trial registration No.: ChiCTR2100049972 (August 16 th , 2021)
The first conservative surgical procedures of the native aortic valve in annular dilatation were performed by Yacoub and David [1, 2]. These so-called remodelling and inclusion procedures provided hope for a normal life without long-term anticoagulant therapy for patients with Marfan's syndrome, with protection from the complication of an acute dissection of the ascending aorta. The authors reported their experience in the Archives des Maladies du Coeur et des Vaisseaux in 1999, with excellent results [3]. However, a certain number of cases are encountered in which the Yacoub and David procedures cannot be performed because of the presence of a pseudo-bicuspid valve, isolated asymmetrical dilatation of the non-coronary sinus or acute dissection of the aorta without dilatation of the aortic root. In these forms, the authors have developed a technique of remodelling the aortic root with conservation of the native valve by resecting the ascending aorta and non-coronary sinus, rather than carrying out a Bentall procedure. Twenty-nine cases of this type have been treated in this way for three different indications: aneurysm of the ascending aorta with bicuspid aortic valve, aneurysm of the ascending aorta with aortic insufficiency and extension to the posterior sinus, and type A acute dissection of the aorta.
Heart transplantation remains the best treatment for terminal heat failure. Ischemic and idiopathic cardiomyopathies are the main indications. Contraindications are due to immunosuppressive treatment and fixed pulmonary hypertension. After clinical evaluation, the patient is put on the waiting list controlled by the French Biomedicine Agency. Acute rejection had decrease due to the improvement of immunosuppressive treatments. The incidence of severe acute rejection is 5%. Chronic rejection is the main cause of morbidity and mortality. The rate at 5 years is about 40-50%. Survival at one year is 80%. The rate of mortality per year is 4%. Survival at 5 and 10 years are respectively 65 and 50%.
Sternal wound infection (SWI) after cardiac surgery remains an important problem. Prediction of pathogens involved in such infection could guide antibiotics. From April 1, 2006 to December 31, 2008, retrospectively, we evaluated the diagnostic value of preoperative methicillinsensible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or multi-drug resistant Gram-negative bacillus (MDRGNB) carriage to predict same-pathogens involved in postoperative SWI. All patients referred for elective cardiac surgery were screened using multisite (nares, axillae, rectal) sampling at admission to detect MSSA, MRSA, and MDRGNB. Of the 1895 patients addressed, 425 patients (22.4%) were colonized at admission. Preoperative carriers more frequently developed SWI than non-carriers, respectively, 11% vs. 5.5% (P<0.05). Because of the small sample, MDRGNB carriers could not be analyzed. For prediction of MSSA SWI with preoperative MSSA carriage, the area under the receiver operating characteristic (ROC) curve was 0.720 (95% confidence interval (CI), 0.364 –0.796) and 0.710 (95% CI, 0.623–0.787) for prediction of MRSA SWI with preoperative MRSA carriage. Preoperative MSSA carriage is frequent but preoperative MRSA or MDRGNB carriage remains infrequent. The ability of preoperative carriage to predict a same-pathogen–postoperative SWI was low and should not be used to guide empirical antibiotherapy. 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
