Chronic aortic aneurysms are permanent and localized dilations of the aorta that remain asymptomatic for long periods of time but continue to increase in diameter before they eventually rupture. Left untreated, the patients’ prognosis is dismal, since the internal bleeding of the rupture brings about sudden death. Although successful treatment cures the disease, the risky procedures can result in paraplegia from spinal cord ischaemia or even death, particularly for aneurysms extending from the thoracic to the abdominal aorta and thus involving many segmental arteries to the spinal cord, i.e. thoracoabdominal aortic aneurysms of Crawford type II. Although various strategies have achieved a remarkable decrease in the incidence of paraplegia, it is still no less than 10 to 20%. However, it has been found that the deliberate occlusion of the segmental arteries to the paraspinous collateral network finally supplying the spinal cord does not increase rates of permanent paraplegia. A therapeutic option, ‘minimally invasive segmental artery coil embolization’ has been devised which proceeds in a ‘staged’ way to occlude groups of arteries under highly controlled conditions after which time must be allowed for arteriogenesis to build a robust collateral blood supply. PAPA-ARTiS is a phase II trial to demonstrate that a staged treatment approach can reduce paraplegia and mortality dramatically. It can be expected to have both a dramatic impact on the individual patient's quality of life if saved from a wheelchair, and also upon financial systems through savings in; 1) lower costs in EU health care; 2) lower pay-outs in disability insurance (est. at 500k in Year 1), and; 3) loss of economic output from unemployment. Approx. 2500 patients a year in Europe undergo these high risk operations with a cumulative paraplegia rate of over 15%; therefore >100M per year in costs can be avoided and significantly more considering the expected elimination of type II endoleaks.

Heart transplantation is the gold standard treatment for advanced heart failure, a major cause of premature death. The critical organ shortage however limits this therapeutic approach with a ratio of two recipient candidates for one allograft nowadays. The allocation of a growing number of marginal grafts increases the risk of primary graft failure and early death after transplant. All the most, conventional static cold storage allows for only 4 hours of ischemia. This time limitation induces a geographic restriction between donor and recipient. Ex vivo heart perfusion (EVHP) has been applied to expand the duration of organ preservation. This method provides continuous perfusion of the donor heart using oxygenated blood at 34°C. However no clearance of deleterious molecules for the heart (e.g. pro-inflammatory cytokines, oxygen radicals) is provided by commercially available machines for EVHP. Prolonged EVHP is therefore limited to a maximum duration of 10 hours. There is therefore a need for a portable blood filter connected to EVHP platform. Since there is no commercially available approach to achieve our clinical need, we aim at developing an optimal blood filtration device to ensure the homeostasis of the perfusate during prolonged EVHP. Our study aims to apply microfluidic technology for blood filtration during EVHP. We trust this approach would rapidly increase the chance for heart transplantation: 1) By increasing the duration for organ preservation, we could remove geographic restrictions for organ allocation; 2) By applying cardiovascular imaging using contrast agents, we could diagnose coronary artery disease in cardiac allografts from high-risk donors (age>55 years, cardiovascular risk factors); 3) By improving the quality of organ preservation, we could apply pharmacological intervention for organ repair and rehabilitation of marginal grafts before transplantation.

Forms of varying severity of COVID-19 have been described in pregnant women, but in addition to the direct effects of the virus on the woman or the newborn, the pandemic context itself, as has been shown in contexts other than that of COVID-19, is likely to act as a psychological risk factor. Very recently, work published by Chinese, Italian and Canadian teams has indeed shown an increase in anxiety and depressive disorders in women during pregnancy. To date and to our knowledge, there is no data that allow us to know the impact that this context may have had on the mental health of pregnant women in France and there are no studies on the impact of this pandemic context on the prevalence of psychological disorders in the postpartum period, even though this period corresponds to a time of particular psychological vulnerability when the risk of maternal suicide is at its highest. The PsyCOVIDUM project is a repeated cross-sectional epidemiological study whose main objective is to estimate the evolution of the prevalence of women in the immediate postpartum period presenting depressive symptoms at 4 defined times in relation to the COVID-19 pandemic. This research will be carried out in the population of 3 maternity units in the Paris region carrying out a post-partum screening for perinatal depression based on the Edinburgh Postnatal Depression Depression Scale (EPDS) self-questionnaire. Secondary objectives include studying factors associated with the risk of developing depressive symptoms in the context of the COVID-19 pandemic. The 4 measurement times are 1) epidemic peak, 2) deconfinement phase, 3) at 2 months from deconfinement and 4) out of the pandemic context (1 year from peak) in order to constitute a control group of women not exposed to the pandemic context during pregnancy. Based on the prevalences of depressive disorders defined by an EPDS score > 10 reported in the literature, we were able to estimate the number of women to be included in the analysis at 545 women for each of the 4 phases in order to estimate the prevalence with a precision of +/- 3%, and to highlight a difference in prevalence of 7.5% with a power of 85% at 5% alpha risk. In total, for the 4 phases, 2180 women will therefore be included. Women will be included during hospitalisation in the post-natal suite or retrospectively for women who gave birth before the start of the study. The three participating maternity units are part of the same University Hospital Federation (FHU PREMA) and were chosen because of different population profiles, thus improving the representativeness of the sample. Individual data will be extracted from computer and paper records by automated processes for a number of variables and by clinical research assistants (TEC) for the others. Statistical analysis will be conducted within the UMR1153 EPOPé. This study, the only one to date capable of estimating the impact of the COVID-19 pandemic context on the risk of depressive disorders in the perinatal period, will provide a solid basis for constructing an appropriate response in the event of a second wave of COVID-19 or other epidemic episodes. Prevalence results for women who gave birth during phase 1 (available from July 2020) will provide information on the extent of the impact and the resources to be mobilized, in addition to the usual means. This study will also make it possible to identify the factors linked to the pandemic context (viral circulation, containment measures, restriction of access to hospital services for accompanying persons, length of hospital stay) most associated with the risk of depression, to offer antenatal psychological support to women most at risk and to adapt post-partum screening measures.