Search

The results of a measurement campaign carried out to analyze the benefits of polarization and spatial diversity at the receiver for the L-band LMS propagation channel are presented. Polarization diversity measurements were carried out with a dual circular polarized antenna providing right-hand and left-hand circular polarization. Spatial diversity measurements were performed with two GPS antennas λ/2 apart. Satellite elevations within the range 1° to 80° in urban, suburban, rural, heavily wooded and lightly wooded environments were studied. Polarization diversity has showed to be the best option to reduce the effect of the deep fades.

International audience; OBJECTIVES: The aims of the study were to assess in patients with advanced HIV disease receiving antiretroviral therapy (ART) intensification with enfuvirtide (i) resistance at virological failure (VF), (ii) impact of baseline tropism on immunovirological response, and (iii) HIV-1 DNA tropism evolution during ART. METHODS: The ANRS 130 APOLLO randomized trial evaluated in naive patients the immunovirological impact of standard ART without (control arm) or with enfuvirtide. Tropism was determined on RNA and DNA by V3-loop sequencing interpreted using the Geno2Pheno algorithm. RESULTS: At baseline the median CD4 cell count was 30 cells/mm(3). Among the 170 patients assessable in this virological substudy, HIV-1 RNA tropism was as follows: 60% of viruses were R5 and 40% were R5X4/X4. HIV-1 DNA tropism was as follows: 54% were R5 and 46% were R5X4/X4. At week 24, 39% and 49% of patients experienced VF in the enfuvirtide and control arms, respectively. In the enfuvirtide arm, only resistance-associated mutations to enfuvirtide were detected. In the control arm, two patients displayed drug-resistant viruses at the time of VF. No impact of baseline tropism was observed on immunovirological response, regardless of the study arm. Among the 25 patients experiencing DNA tropism switch between baseline and week 24, 16 (64%) switched from R5 to R5X4/X4. These latter were mostly successfully suppressed patients receiving enfuvirtide and exhibiting poorer immunological response. CONCLUSIONS: Baseline RNA tropism had no impact on the immunovirological response. Drug resistance mutations were only detected for the fusion inhibitor. Finally, the mechanism of replenishment of the viral cellular reservoir with X4 viruses observed needs to be further analysed.

A combination of 2 nucleoside analogues and 1 protease inhibitor is usually recommended in postexposure prophylaxis. Because of the complex treatment schedule and frequent adverse effects, however, this regimen is often not completed. Therefore, since January 2000, we have used nevirapine (NVP), 200 mg/d, for only 4 days in combination with 2 nucleoside analogues for 1 month to improve adherence and completion rates. We present a 2-year retrospective analysis on 120 individuals who received this prophylaxis. Only 2 subjects stopped NVP because of a clinical event, whereas 10 interrupted the nucleoside analogues. We observed 3 (2.8%) of 104 slight alanine aminotransferase (ALT) increases in the first 2 weeks of treatment (grade 1). Three additional (month 1 or 3) ALT augmentations also occurred (also grade 1). No HIV or hepatitis C virus seroconversion occurred during follow-up. Twenty-nine (38.2%) of 76 individuals and 21 (47.7%) of 44 individuals were seen 3 months after nonoccupational and occupational exposure, respectively. We believe that such a short course (4 days) of 200-mg NVP treatment once a day in combination with 2 nucleoside analogues for 1 month is clinically and biologically safe.

Resume Nous avons evalue la seroprevalence, par des tests ELISA et RIBA de 2e generation, du virus de l'hepatite C (VHC) chez 308 patients seropositifs pour le virus de l'immunodeficience humaine (VIH). L'âge moyen est de 33,5 ans. La seroprevalence globale, en ELISA, est de 27,6 % (85 patients) et en RIBA de 19,5 %; elle est plus elevee chez les femmes (23/56 soit 41 %) par rapport aux hommes (62/252 soit 24,6 %), la difference etant significative (p

National audience; Introduction Depuis le début de l’ère des traitements antirétroviraux hautement actifs, les patients vivant avec le VIH (PVVIH) vieillissent. Les comorbidités liées à l’âge (CLA) deviennent des causes grandissantes de mortalité dans cette population.L’objectif de cette étude était d’évaluer leur impact sur la surmortalité liée au VIH sur 5 ans chez les PVVIH âgés de 60 ans ou plus suivis dans le cadre d’une large cohorte prospective multicentrique française (Dat’AIDS) à l’ère tardive des antirétroviraux hautement actifs (du 01/01/2008 au 31/12/2012).

Background: Etravirine is approved for use in treatment-experienced patients at a dose of 200 mg twice daily. Efavirenz has been associated with greater increases in serum lipids compared with other non-nucleosides in randomized trials of first-line treatment. Methods:In this double-blind, placebo-controlled trial, 157 treatment-naive patients with HIV RNA 5000 copies/mL were randomized 1:1 to either 400 mg of etravirine once daily (n79) or 600 mg of efavirenz once daily (n78) plus two nucleoside analogues (either abacavir/lamivudine, zidovudine/lamivudine or tenofovir/emtricitabine) for 48 weeks. Lipids were measured under fasting conditions at baseline and all visits to Week 48. Clinicaltrials.gov identifier: NCT00903682. Results:Overall, the patients had a median baseline CD4 count of 302 cells/mm(3) (range 74722) and a median HIV RNA of 4.8 log(10) copies/mL (range 3.56.6). Both the non-nucleosides and the nucleoside analogues used caused changes in serum lipids. In the efavirenz arm, patients showed significantly larger increases in high-density lipoprotein (HDL) (0.15 mmol/L, P0.004), low-density lipoprotein (LDL) (0.35 mmol/L, P0.005), total cholesterol (0.61 mmol/L, P0.0001) and triglycerides (0.33 mmol/L, P0.03) at Week 48 compared with the etravirine arm. Across the two arms, patients taking abacavir/lamivudine showed greater increases in total cholesterol (0.47 mmol/L, P0.005) compared with patients taking tenofovir/emtricitabine. There were fewer grade 3/4 elevations in total cholesterol, LDL and triglycerides in the etravirine arm (2 patients, 1 patient and 0 patients, respectively) versus the efavirenz arm (8 patients, 6 patients and 2 patients, respectively). Conclusions:In the SENSE trial, first-line treatment with 400 mg of etravirine once daily plus two nucleoside analogues led to fewer grade 3 or 4 lipid elevations compared with efavirenz plus two nucleoside analogues.

International audience; This paper addresses the speed regulation problem in air traffic management. Because global air traffic volume is continuously increasing, improvement in air traffic control has become a priority. During this decade, European and United States initiatives have been launched to design the future of air traffic management. One of their objectives is to increase air traffic density and optimize flight route plans. This can be achieved through en route deconfliction. Air conflicts have the potential to occur when two or more aircraft are predicted to be below a separation norm in the near future. Such situations affect air traffic controllers' workload; thus, these situations limit controllers' capacity to deal with large numbers of aircraft and induce flight delay. Reducing air traffic controllers' potential workload through speed regulation has been investigated in the En Route Air Traffic Soft Management Ultimate System project. Efficiency of the method has been validated through simulations, including human-in-the-loop experiments, which opens the door to conflict resolution algorithms based on speed regulation. In this paper a formulation for the speed regulation problem is proposed. First, a potential conflict detection and resolution framework is presented. Uncertainty is then introduced in the model, with the aim of reproducing realistic air navigation conditions. A case study of real air traffic instances is described, and results are discussed to assess the potential of the proposed algorithm.

International audience; OBJECTIVES: To compare virological effectiveness in patients who continued on a virologically successful first-line boosted protease inhibitor (PI)-containing combination antiretroviral therapy (cART) regimen or who switched to a PI-free cART including efavirenz, nevirapine or abacavir. METHODS: From the French Hospital Database on HIV, we selected 439 patients with undetectable viral load (VL) on a first-line boosted PI-containing cART regimen who switched to a PI-free combination including efavirenz, nevirapine or abacavir. Each of these patients was matched with three patients who continued to take their first-line cART regimen, on the basis of gender, age, CD4 cell count, VL, date of cART initiation and the duration of VL undetectability. Time to virological failure (VF) was analysed with Kaplan-Meier curves and Cox models. RESULTS: The 12 month probabilities of VF were 3.7% and 5.7% in non-switch and switch patients, respectively, and 3.9%, 7.2% and 9.0% in patients switching to efavirenz-, nevirapine- and abacavir-containing cART, respectively. After adjustment, only patients switching to abacavir-containing cART had a higher risk of VF than non-switch patients (adjusted hazard ratio, 1.99; 95% confidence interval, 1.05-3.79). CONCLUSIONS: Switching from a virologically successful first-line boosted PI-containing cART regimen to a non-nucleoside reverse transcriptase inhibitor-containing cART regimen containing either efavirenz or nevirapine is virologically safe, while switching to abacavir-containing cART should be avoided.

Post-exposure prophylaxis (PEP) with antiretrovirals is now widely used worldwide after either occupational contact (with blood or another blood-containing fluid), or nonoccupational contact (mainly sexual or injection-drug use). It is assumed to reduce the risk of HIV transmission by at least 80%, although its efficacy has not been completely proven. Several countries have issued guidelines to help the clinician in their decision to offer PEP and to improve its cost–effectiveness. This article reviews the different antiretroviral combinations used, their safety profile, the recommendations and indications of PEP. The initial evaluation of an exposed individual is presented, as well as the follow-up during and after treatment.

Introduction – objectifs Les consequences des ruptures de suivi chez les patients VIH+ sont mal connues. Cette etude a pour objectif de decrire les caracteristiques des patients ayant eu une rupture dans leur suivi et d’analyser les consequences individuelles et collectives de ces ruptures. Materiels et methodes Tous les patients ayant eu au moins 2 recours entre le 1er janvier 2006 et le 30 juin 2013 dans 7 services hospitaliers prenant en charge des patients VIH+ ont ete inclus. Un delai de plus de 15 mois entre deux consultations definissait les patients « temporairement perdus de vue » (TpPDV) qui ont ete compares aux patients avec un suivi regulier (SR). Leurs caracteristiques ont ete etudiees a la date du debut de prise en charge et au 30 juin 2013. Resultats Les TpPDV (N = 824 ; 7,4 %) etaient plus jeunes (mediane 30 versus 33 ans) que les SR (N = 10 292) au diagnostic d’infection, plus souvent usagers de drogue (14 % versus 10 %), et porteurs d’une co-infection VHB ou VHC (24 % versus 20 %). Au 30 juin 2013 les TpPDV etaient plus souvent classes sida (32 % versus 24 %) et avaient moins souvent une charge virale indetectable (52 % versus 85 %) (p Conclusion La population des TpPDV est comparable a celle de la litterature. Les consequences des ruptures sont a la fois individuelles (morbidite) et collectives (% de patients avec charge virale indetectable).

International audience; Objectives The aim of the study was to describe the ageing HIV-infected population (> 50 years old) and their current antiretroviral therapy (ART), comorbidities and coprescriptions in France in 2013 and to compare them to the younger population.Methods A retrospective analysis of a prospectively collected database was performed. The characteristics of patients receiving ART as well as their current ART and their numbers of comorbidities and comedications at the censoring date (1 July 2013) were compared between patients ageing with HIV infection, patients who seroconverted while ageing, and younger patients.Results We compared 10 318 ageing patients [median age 56 years; 25% interquartile range (IQR) 53– 62 years] with 13 302 younger patients (median age 42 years; 25% IQR 36–47 years). The ageing patients were more frequently male than the younger patients (77 vs. 65%). Among the ageing patients, 7025 were diagnosed with HIV infection before 2000 and represented a distinct group, the 'experienced ageing' group, by comparison with the 'recently diagnosed ageing' group. Triple therapy containing a boosted protease inhibitor was used in 28.2% of the patients (vs. 39% and 36% of the younger and " recently diagnosed ageing " groups, respectively); a nonnucleoside reverse transcriptase inhibitor in 27% (vs. 33% and 38%, respectively), an integrase strand transfer inhibitor (INSTI) in 9% (vs. 7% and 9%, respectively), and another regimen (fewer or more than three drugs) in 35.8% (vs. 21% and 16.5%, respectively). " Experienced ageing " patients typically had one or more comorbidities (62.1%) and were receiving at least one comedication (71%). Central nervous system (CNS) agents (prescribed in 44.6% of the " experienced ageing " patients) and antilipidaemics (in 44.2%) were the most frequently prescribed comedications. INSTIs were used in 23% of the population and were used significantly more often in patients with comorbidities and coprescriptions. For all comparisons, P < 0.0001.Conclusions In ageing HIV-infected patients, especially those with a long history of HIV infection, comorbidities and coprescriptions are highly prevalent.

The present research introduces a low cost AoA system used to determine the position in indoor conditions and working in the ISM band at 2.4GHz. A good precision is provided and also a real-time operation offering a position in 60msg. These features are possible due to the application of an angle of incidence estimation algorithm based in a covariance analysis. Precision could be increased by means of spatial diversity technique in the receiver end.

A simple real-time method is presented in order to detect human presence in a changing environment extracting useful information from micro-Doppler signatures. A measurement campaign was performed in order to measure influence of speed, torso and direction of movement. This research line continues open and new approaches are under development at present.

SUMMARYThe aim was to investigate the impact of the main prognostic factors on HIV evolution. A multi-state Markov model was applied in a cohort of 2126 patients to estimate impact of these factors on patients' clinical and immunological evolutions. Clinical progression and immunological deterioration shared most of their prognostic factors: male gender, intravenous drug use, weight loss, low haemoglobin level (3) and HIV viral load (>5 log10copies/ml). Highly active retroviral therapy reduced the risks of clinical progression and immune deterioration whatever patients' CD4 cell count. Risk reductions were 41–60% for protease inhibitor-based and 27–68% for non-nucleoside reverse transcriptase inhibitor-based regimens. Three-year transition probabilities showed that only patients with a CD4 cell count ⩾350 CD4/mm3could in most cases maintain their immunity. This model provides ‘real life’ transition probabilities from one immunological stage to another, allowing decision analyses that could help determine the beneficial therapeutic strategies for HIV-infected patients.

The immunogenicity of vaccines, including vaccine against hepatitis A virus (HAV), is impaired in patients with HIV infection, requiring revised immunization regimens.We evaluated the immunological efficacy and safety of a 3-dose schedule of hepatitis A vaccine in HIV-infected adults. HAV-seronegative HIV-infected adults were randomized to receive either 3 doses of 1440 UI of hepatitis A vaccine (HAVRIX; GlaxoSmithKline, Marly le Roi, France) at weeks 0, 4, and 24 (46 patients) or 2 doses 24 weeks apart (49 patients).At week 28, seroconversion, defined as an anti-HAV antibodyor=20 mIU/mL, occurred in 82.6% and 69.4% of patients in the 3-dose and the 2-dose group, respectively (P = 0.13, intent-to-treat analysis, missing data = nonresponder), and in 88.4% and 72.3% of patients in the 3-dose and the 2-dose group, respectively (P = 0.06, observed analysis). Only 37.9% of patients experienced seroconversion after 1 vaccine dose (intent-to-treat analysis). Anti-HAV antibody geometric mean titers were 323 and 132 mIU/mL in the 3-dose group and 138 and 67 mIU/mL in the 2-dose group, respectively, 28 (P = 0.03) and 72 weeks (P = 0.05) after the first vaccine dose. There were no serious adverse events associated with the vaccine. Multivariate analysis showed no treatment group effect but indicated that absence of tobacco smoking (odds ratio = 2.92, 95% confidence interval: 1.07 to 7.97; P = 0.04) was an independent predictor of response to HAV vaccine.In HIV-infected adults, immunogenicity of hepatitis A vaccine is poor. Three doses of vaccine were safe and increased antibody titers.

PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO COORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR Os desafios de estudar formas levaram matemáticos a criar abstrações, em particular através da geometria diferencial. Porém, formas simples como cubos não se adequam a ferramentas diferenciáveis. Este trabalho é uma tentativa de usar avanços recentes da análise, no caso a teoria das distribuições, para estender quantidades diferenciáveis a objetos singulares. Como as distribuições generalizam as funções e permitem derivações infinitas, substituição das parametrizações de subvariedades clássicas por distribuições poderia naturalmente generalizar as subvariedades suaves. Isso nos leva a definir D-imersões. Esse trabalho demonstra que essa formulação, de fato, generaliza as imersões suaves. Extensões para outras classes de subvariedades são discutidas através de exemplos e casos particulares. The challenge of studying shapes has led mathematicians to create powerful abstract concepts, in particular through Differential Geometry. However, differential tools do not apply to simple shapes like cubes. This work is an attempt to use modern advances of the Analysis, namely Distribution Theory, to extend differential quantities to singular objects. Distributions generalize functions, while allowing infinite differentiation. The substitution of classical immersions, which usually serve as submanifold parameterizations, by distributions might thus naturally generalize smooth immersion. This leads to the concept of D-immersion. This work proves that this formulation actually generalizes smooth immersions. Extensions to non-smooth of immersions are discussed through examples and specific cases.

International audience; OBJECTIVE: To describe the characteristics of hepatitis B (HBV) infection in HIV-infected patients and the impact of anti-HBV treatments. PATIENTS AND METHODS: All the patients with past or present chronic HBV infection seen in October 2005 in 17 French hospitals were included. Data were retrospectively collected from their first visit in a time-dependent manner, through a detailed standardized questionnaire. RESULTS: Among 477 HBV-infected patients, 261 (55%) were co-infected with HIV. The HBV-HIV co-infected patients underwent fewer serological, virological and histological evaluations. Initial positive HBe antigenemia (HBe Ag) was more frequent in these patients (57.9 versus 28.6%; P < 10), as was cirrhosis on the initial liver biopsy (17.9 versus 7.6%; P = 0.05). Throughout the mean 5-year follow-up, HBe Ag loss was less frequent (P = 0.04), as was HBe seroconversion (incidence rate 2.6 versus 10/100 patient-years; P < 10). HBe Ag loss was associated with fibrosis improvement (METAVIR score -0.5 +/- 0.4 versus +0.2 +/- 0.6 if persistent positive HBe Ag, P = 0.01). In co-infected patients on tenofovir, adefovir or interferon, HBe seroconversions were seen in patients on combined HBV treatment, the use of which is increasing (58% in 2005). Nevertheless, no significant difference in virological, immunological or biochemical evolution was observed between these different treatments. CONCLUSIONS: In HBV-HIV co-infected patients, the assessment of HBV infection still needs to be improved, the HBV wild-type remains predominant, and HBe Ag loss is rare and associated with a better histological evolution. There is insufficient evidence of the superiority of combined HBV treatment, and this still needs be demonstrated in long term studies.

Summary. The objective of the present study was to determine mortality because of end-stage liver disease (ESLD) in a nationwide population of HIV-infected patients, 7 years following the introduction of highly active antiretroviral therapy (HAART). All departments of internal medicine and infectious diseases from the GERMIVIC Study Group prospectively recorded all deaths in HIV-infected patients during 2003. Fifty-nine departments, following a total of 20 940 HIV-infected patients, participated in the study. Results were compared with those of previous surveys conducted using similar methodology in 1995, 1997 and 2001. Among 215 deaths observed during 2003, 101 (46.9%) were related to AIDS, 27 (12.6%) to ESLD and 87 (40.5%) to other causes. Mortality because of ESLD represented 23.7% of non-AIDS-related deaths. Patients dying from ESLD had chronic hepatitis because of hepatitis C virus (HCV) in 92.6% of cases and moderate (30–60 g) or high (>60 g) alcohol consumption (43.5% and 26.0%, respectively). In this population, deaths because of ESLD were 1.5% in 1995, 6.6% in 1997, 14.3% in 2001 and 12.6% in 2003. The prevalence of hepatocellular carcinoma as a cause of death remained high in 2003 but stable when compared with 2001 (25%vs 14.8%). Treatment of hepatitis C in patients who died from ESLD was more frequent in 2003 (44.4%) than in 2001 (26.3%). Seven years after the introduction of HAART, ESLD associated with HCV infections is a leading cause of mortality in HIV-infected patients, which did not increase between the years 2001 and 2003.

High rates of virologic failure have been reported in antiretroviral-naive patients receiving triple-nucleoside reverse transcriptase inhibitor (NRTI) combinations containing tenofovir disoproxil fumarate (TDF) with lamivudine (3TC) and didanosine or 3TC and abacavir (ABC). A regimen of once-daily zidovudine (ZDV), 3TC, ABC, and TDF showed an acceptable virologic success rate, however.This was a pilot prospective cohort study. Treatment-naive subjects were offered a fixed-dose combination of ZDV/3TC (300 mg/150 mg) twice daily and 300 mg of TDF once daily.Fifty-one patients were enrolled between April 2002 and March 2005. At baseline, the median CD4 count was 230 cells/microL (range: 23-425 cells/microL), 20 (39%) of 51 subjects had CD4 counts of200 cells/microL, the median HIV-1 viral load was 4.89 log (3.14 to5.87 log), and 24 (47%) of 51 subjects had a viral load5 log. The median follow-up was 12 months (range: 1 week to 38 months). On-treatment analysis showed a median HIV RNA load decrease of -1.7 log after 1 to 2 weeks of treatment and -2.41 log after 1 month, and 34 (89%) of 38 subjects had a viral load50 copies/mL at month 6, 21 (78%) of 27 at month 12, and 13 (81%) of 16 after 18 months (intent-to-treat results were 34 [72%] of 47 subjects, 21 [56%] of 36 subjects, and 13 [50%] of 25 subjects at months 6, 12, and 18, respectively). The median CD4 count increase at month 18 was 142 cells/microL. Nine (17.6%) of 51 treatment interruptions for adverse effects were seen. Six viral failures occurred, including 2 with K65R mutations (alone or associated with Y115F and M184V).The combination of ZDV/3TC + TDF in treatment-naive HIV-infected subjects induces a rapid and sustained HIV-1 RNA decrease and is associated with a good immunologic response. No severe adverse events occurred. This triple-NRTI combination needs to be evaluated further.

While there is little controversy on the profitability of momentum strategies, their implementation is afflicted with many difficulties. Most important, chasing momentum can generate high turnover. Though there are already several attempts to make momentum strategies less expensive with respect to transaction costs, we go a step further in the simplification of momentum strategies. By restricting our sample to Switzerland's largest blue-chip stocks and choosing only one winner and one loser stock, we find average returns to our momentum arbitrage portfolios of up to 44% p.a. depending on the formation and holding periods. While unconditional risk models are at odds with momentum profits, stock market predictability and time-varying expected returns explain a large part of the momentum payoffs, including the post-holding period behavior of the winner and loser stocks (overreaction and subsequent price correction). We also report interesting patterns of a number of stock characteristics over the (pre-)formation and (post-)holding periods.

OSTEOPOROSIS AND OSTEOPENIA: The use of multiple antiretroviral therapies has transformed the prognosis of HIV infection. However, the potential disadvantages of these treatments have rapidly appeared: lipodystrophy, cardiovascular complications and, more recently bone affections with osteonecrosis, followed by other weakening osteopathies (osteoporosis and osteopenia). Osteoporosis is a reduction in bone mineral density (BMD) leading to a high risk of fracture. It is measured by dual energy x-ray absorptiometry and is defined by a T-score-2.5 standard deviations from the mean value of a young adult. Osteopenia corresponds to low bone density with, avec -1T-score-2.5. REGARDING THE AVAILABILITY OF RETROVIRAL AGENTS: During HIV infections, an osteopathy (most often osteopenia) is observed in a quarter to more than half of patients who have never received antiretroviral agents, and in up to three quarters in those in whom treatment in ongoing. The transversal nature of the majority of the studies, the heterogeneity of the treatments, the inclusion of both male and female patients in some studies, and the differences in the results observed do not permit one to draw any conclusions as to the possible responsibility of antiretroviral agents. An association between an osteopathy and a lipodystrophy is inconstant. Lastly, the substitution of a class of a antiretroviral agents by another does not lead to any significant modification in BMD. THE MECHANISM OF OCCURRENCE OF AN OSTEOPATHY: Has not been clearly established. The modifications in serum concentrations of biochemical markers of bone formation and resorption observed in HIV-infected patients and their evolution under antiretroviral treatment, suggest a viral origin, mediated by pro-inflammatory cytokines. The rare in vitro studies, or on animal models, are contradictory, with the results of clinical trials regarding the inherent role of antiretroviral drugs. However, it is probable that the classical risk factors for osteoporosis are often implied.

The effects of new treatments need to be assessed: in the case of multiple sclerosis it is possible to measure those effects by studying the evolutions of temporal lesions in time series of MRIs. But it is a laborious task to manually analyze such sets of images. This article proposes a new method to statistically analyze a series of T2-weighted MRIs of a patient with multiple sclerosis lesions taking both temporal and spatial coherence into account. The main idea of the method is to fit a temporal parametric model of intensity evolution on each voxel of the series; these estimations give different parameter values in the case of normal and pathological areas. A statistical inference stage makes it possible to determine significant sets of connected voxels corresponding to pathological evolving areas. The significancy is estimated using permutation tests. Promising results show the feasibility of our approach. On our data sets the evolving lesions were detected and their temporal behavior could be quantified.

International audience; The study of temporal series of medical images can be helpful for physicians to perform pertinent diagnoses and to help them in the follow-up of a patient: in some diseases, lesions, tumors or anatomical structures vary over time in size, position, composition, etc., either because of a natural pathological process or under the effect of a drug or a therapy. It is a laborious and subjective task to visually and manually analyze such images. Thus the objective of this work was to automatically detect regions with apparent local volume variation with a vector field operator applied to the local displacement field obtained after a non-rigid registration between two successive temporal images. On the other hand, quantitative measurements, such as the volume variation of lesions or segmentation of evolving lesions, are important. By studying the information of apparent shrinking areas in the direct and reverse displacement fields between images, we are able to segment evolving lesions. Then we propose a method to segment lesions in a whole temporal series of images. In this article we apply this approach to automatically detect and segment multiple sclerosis lesions that evolve in time series of MRI scans of the brain. At this stage, we have only applied the approach to a few experimental cases to demonstrate its potential. A clinical validation remains to be done, which will require important additional work.

Clinicians need to study the effects of new treatments: it is sometimes possible to detect and quantify those effects by looking at evolutions in the medical images of a patient over time especially in the case of multiple sclerosis (MS) where lesions are related to clinical signs [1]. Some methods allow to compare two images to know where there are differences, typically between the last and the previous exam 2,3. However a retrospective analysis might be done on the whole set of images to find the moments when evolutions occur [4]. We propose to use the analogy between an activation in functional imaging (for instance PET, SPECT and fMRI) [5] and a signal change due to an evolving multiple sclerosis lesion. Voxels corresponding to evolving pathological areas are named ELV (Evolving Lesion Voxels) in this abstract.

Preventing hepatitis B by vaccination is essential in HIV-infected patients (higher progression rate of HBV infection to chronicity, lower rate of serum HBe Ag loss). However, it has been shown a decreased anti-HBs response in these individuals after a standard vaccination (3 doses of 20 micrograms). Thus, we tested the hypothesis that doubling the number of hepatitis B vaccine injections might increase anti-HBs response rate. HIV-infected patients with CD4 > 200/microliter, who were on stable antiretroviral treatment, as well as seronegative for HBV markers, and who have never been vaccinated against HBV, were given 3 intramuscular injections of Genhevac B 20 micrograms at 1 month intervals. Initial non responders were given 3 additional monthly injections. Anti-HBs titer was followed. We also evaluated the effects on HIV-1 viral load. Twenty patients with a median CD4 cell count of 470/microliter were enrolled. The response rate after three 20 micrograms injections was 55% (11/20), lower in individuals with CD4 between 200 and 500/microliter (4/12 = 33.3%), compared to patients with CD4 above 500/microliter (7/8 = 87.5%, P = 0.02). Among 9 initial non-responders, only 2 did not respond to 3 additional doses; thus, the overall response rate was 90% (18/20). Geometric mean titers of anti-HBs were 133 IU/l and 77.5 IU/l, after 3 and 6 Genhevac doses, respectively (P = 0.38). One year later, only 10/17 (58.8%) patients had protective anti-HBs. Five patients experienced a significant viral load increase, transient in 3 cases. These preliminary results suggest that doubling the number of hepatitis B vaccinations in HIV-infected patients might significantly improve anti-HBs response rate; however, close monitoring of anti-HBs is necessary because of its short-lived persistence. The effects on HIV-1 viral load are limited.

Isolated renal Aspergillus abscess is a very rare complication of HIV infection. It usually occurs in patients with severe immune deficiency. The case of a 29-year-old HIV-infected homosexual male, a nonintravenous drug abuser, who developed a right renal Aspergillus abscess despite normalization of the CD4+ cell count after highly active antiretroviral treatment is described. When antimicrobial treatment failed (amphotericin B followed by itraconazole), he was cured by right nephrectomy and remains in good health 3 months later with no recurrence. In cases of Aspergillus renal abscess in HIV-infected patients, surgery is the treatment of choice, especially in the current era of highly active antiretroviral therapy.

Alternative schedules more immunogenic than the standard hepatitis B vaccine regimen are needed in patients with human immunodeficiency virus 1 (HIV-1) infection.To compare the safety and immunogenicity of 4 intramuscular double-dose and 4 intradermal low-dose regimens vs the standard hepatitis B vaccine regimen.An open-label, multicenter, 1:1:1 parallel-group, randomized trial conducted between June 28, 2007, and October 23, 2008 (date of last patient visit, July 3, 2009) at 33 centers in France with patients enrolled in French National Agency for Research on AIDS and Viral Hepatitis trials in adults with HIV-1 infection who were hepatitis B virus (HBV) seronegative and having CD4 cell counts of more than 200 cells/μL.Patients were randomly assigned to receive 3 intramuscular injections of the standard dose (20 μg) of recombinant HBV vaccine at weeks 0, 4, and 24 (IM20 × 3 group, n = 145); 4 intramuscular double doses (40 μg [2 injections of 20 μg]) of recombinant HBV vaccine at weeks 0, 4, 8, and 24 (IM40 × 4 group, n = 148); or 4 intradermal injections of low doses (4 μg [1/5 of 20 μg]) of recombinant HBV vaccine at weeks 0, 4, 8, and 24 (ID4 × 4 group, n = 144).Percentage of responders at week 28, defined as patients with hepatitis B surface antibody (anti-HBs) of at least 10 mIU/mL in patients who received at least 1 dose of vaccine. Patients with missing anti-HBs titer measurement at the final follow-up visit at week 28 were considered as nonresponders in the primary (efficacy) analysis.A total of 437 patients were randomized to the 3 study groups, of whom 11 did not receive any vaccine. Of these, 396 had available anti-HBs titers at week 28. The percentage of responders at week 28 was 65% (95% confidence interval [CI], 56%-72%) in the IM20 × 3 group (n = 91), 82% (95% CI, 77%-88%) in the IM40 × 4 group (n = 119) (P.001 vs IM20 × 3 group), and 77% (95% CI, 69%-84%) in the ID4 × 4 group (n = 108) (P = .02 vs IM20 × 3 group). No safety signal and no effect on CD4 cell count or viral load were observed.In adults with HIV-1, both the 4 intramuscular double-dose regimen and the 4 intradermal low-dose regimen improved serological response compared with the standard HBV vaccine regimen.clinicaltrials.gov Identifier: NCT00480792.

La population seropositive VIH (VIH +) est particulierement susceptible a certaines infections pouvant beneficier d’une protection vaccinale. L’objectif de cette etude observationnelle prospective a ete d’evaluer la couverture vaccinale des patients VIH+ suivis en Alsace, vis-a-vis des vaccins obligatoires ou recommandes, afin de definir des strategies d’amelioration de la prise en charge. Patients et methodes 331 patients vus en consultation dans les centres hospitaliers d’Alsace entre le 20/08 et le 15/09/2007 ont ete inclus. Resultats Les prevalences de vaccination etaient de 21,4 % pour la grippe, 3,3 % pour le pneumocoque, 10,3 % pour l’hepatite A, 36,3 % pour l’hepatite B et 56,2 % pour le tetanos. Par rapport a la population generale, la couverture vaccinale etait moins bonne pour le tetanos, similaire pour la grippe et meilleure pour l’hepatite B. Toutefois, si l’on considere les recommandations chez les sujets VIH +, la couverture vaccinale restait insuffisante, quel que soit le vaccin considere. Paradoxalement, au sein de cette cohorte, les patients les plus a risque d’infection par le virus de la grippe, le pneumocoque et les hepatites virales etaient les moins bien vaccinees vis-a-vis de ces infections. Les motifs de non vaccination etaient principalement la non proposition du vaccin, le deficit immunitaire du patient (CD4 3 ) et plus rarement, le refus de celui-ci. Conclusion Il apparait necessaire de sensibiliser les prescripteurs et les malades a l’interet de la vaccination qui doit etre integree dans le suivi standard des patients. La repetition de cette etude permettra d’apprecier l’impact de ces actions de sensibilisation sur la protection vaccinale de nos patients VIH +.

We describe six cases of progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection; 2 of them are confirmed by histological examination. Diagnostic and therapeutic options are then discussed.

B eta-la&m antibiotics are sometimes responsible for severe neutropenia in treated patients. The mechanisms of this potentially serious side effect seem heterogeneous, since the beta-la&am-induced neutropenias have been reported to be related either to an immune-mediated process affecting peripheral leukocytes [l-3] or to direct toxicity of the drugs to bonemarrow precursors. In particular, recent in vitro data showed a correlation between the inhibitory capacity of beta-lactam antibiotics on granulocyte precursors and the doses inducing neutropenia in vivo [4]. We present a case report that emphasizes a higher degree of complexity of the mechanism underlying a betalactam (ceftriaxone)-induced granulopenia. This complexity can be related to two different events: one is humoral (a serum factor), the other is cellular and located at the level of the bone-marrow granulocyte precursors. Both of these drug-driven related events were reversible.

Site layout planning has been widely investigated in the literature as a means of minimising transportation costs, improving safety etc. The majority of the research conducted focuses on developing adequate formulations capable of producing optimum results. However, there is a lack of consensus on a particular format to implement for the problem, particularly in regards to the assumptions and constraints to be adopted. Distance between facilities, which is an important measure in site layout planning, has been modelled in several ways, all in the hope of producing reasonable approximations to the path followed by workers, machinery etc. between facilities. This paper aims to compare the performance of several models of the site layout problem. The objective function considered in this study is the transportation cost of material movement between facilities. A main mixed integer programming model is proposed to represent the site layout problem and a comparison is carried out against a relaxed variant, where travel distances are approximated. Further, a constraint generation algorithm is presented in a bid to improve the computational performance of the main model.

Activities undertaken on a construction site are often accompanied with high levels of noise. Addressing the issue of noise pollution in construction is gaining significance with the growing awareness about the social and environmental components of sustainable construction and the increasing numbers of projects being undertaken in congested urban areas. The documented methods for reducing noise pollution in construction include controlling (1) the noise produced at the source; (2) noise levels reaching a receptor; (3) noise propagated along the transmission path. Methods addressing the latter points use the fact that attenuation of noise increases as the transmission path gets longer. Thus the efficiency of such methods can be improved considerably through optimising the arrangement of temporary facilities on construction sites, with respect to a receptor, making use of noise attenuation due to distancing noisy facilities away from noise-sensitive receivers. The building under construction can also be used as a barrier to the noise transmission path, where obstruction of particular facilities from a given receiver can help in producing lower levels of sound as measured at the receptor. The available literature on site layout planning is extensive but limited to only achieving traditional construction project objectives (travel and material handling cost, safety, etc.). This paper presents a mixed integer non-linear programming (MINLP) model that optimises the location of temporary facilities on site in order to minimise the sound levels measured at a pre-defined receptor. The present model is expressed in three stages: (1) defining the noise objective function; (2) implementing model constraints; and (3) application of COUENNE to solve the MINLP for a case study.

This article presents a tutorial/discussion of three commonly-used IEEE 802.11 wireless network security standards: WEP, WPA and WPA2. A detailed analysis of the RC4 algorithm supporting WEP is presented, including its vulnerabilities. The WPA and WPA2 encryption protocols’ most relevant aspects and technical characteristics are reviewed for a comparative analysis of the three standards in terms of the security they provide. Special attention has been paid to WEP encryption by using an educational simulation tool written in C++ Builder for facilitating the understanding of this protocol at academic level. Two practical cases of wireless security configurations using Cisco networking equipment are also presented: configuring and enabling WPA-Personal and WPA2-Personal (these being security options used by TKIP and AES, respectively).

Background There are few data regarding HCV treatment initiation among HIV/HCV coinfected patients. The objective of this study was to analyze the changing patterns of HCV coinfection and HCV treatment initiation over time in a large French cohort of HIV/HCV coinfected patients at the beginning of DAA’s era and to analyze factors associated with treatment initiation. Methods All HIV/HCV coinfected patients enrolled during 2000–2012 were analyzed. HCV status was defined per calendar year as naïve, spontaneous cure, sustained virological response (SVR), failure or reinfection. HCV treatment initiation rate was determined per year. Trends over time were analyzed using Chi-2 test for trend and linear regression analysis. The effect of covariates on treatment initiation over time was analyzed using generalized estimating equations. Results Among 34,308 HIV-infected patients enrolled between 2000 and 2012, 5,562 were HCV coinfected. HCV prevalence declined from 38.4 to 15.1 %. HCV treatment initiation rate fluctuated from 5.6 to 7.4 %/year from 2000 to 2007, dropped to 5.6 % in 2011 and increased to 8.5 % in 2012 due to the use of first-generation DAAs (29.1 % of initiations in 2012). Cumulative HCV treatment initiation rate increased from 14.8 % in 2000 to 54.7 % in 2012. HCV cure rate increased from 12.4 to 45.2 %. Older age, male gender, male homosexuality, high CD4, undetectable HIV-RNA, CDC stage A-B, and severe fibrosis/cirrhosis were associated with a higher treatment initiation rate. The role of HCV genotype 1, CDC stage, fibrosis and recent HCV infection on treatment initiation rate changed over time. Conclusion A high rate of HCV treatment initiation was observed at the beginning of DAAs era in HIV/HCV coinfected patients. Given the very high efficacy of new DAA-based regimens and if treatment initiation keeps increasing, HCV prevalence among HIV patients will drastically decrease during the forthcoming years. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1681-1) contains supplementary material, which is available to authorized users.