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1.
Cell Host Microbe ; 31(10): 1714-1731.e9, 2023 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-37751747

RESUMO

Although gut and lymph node (LN) memory CD4 T cells represent major HIV and simian immunodeficiency virus (SIV) tissue reservoirs, the study of the role of dendritic cells (DCs) in HIV persistence has long been limited to the blood due to difficulties to access lymphoid tissue samples. In this study, we show that LN migratory and resident DC subpopulations harbor distinct phenotypic and transcriptomic profiles. Interestingly, both LN DC subpopulations contain HIV intact provirus and inducible replication-competent HIV despite the expression of the antiviral restriction factor SAMHD1. Notably, LN DC subpopulations isolated from HIV-infected individuals treated for up to 14 years are transcriptionally silent but harbor replication-competent virus that can be induced upon TLR7/8 stimulation. Taken together, these results uncover a potential important contribution of LN DCs to HIV infection in the presence of ART.


Assuntos
Infecções por HIV , Síndrome de Imunodeficiência Adquirida dos Símios , Vírus da Imunodeficiência Símia , Animais , Humanos , Linfócitos T CD4-Positivos , Antirretrovirais/uso terapêutico , Linfonodos , Células Dendríticas
2.
Ann Vasc Surg ; 77: 71-78, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34411672

RESUMO

BACKGROUND: The COVID-19 pandemic has led to widespread postponement and cancelation of elective vascular surgeries in Switzerland. The consequences of these decisions are poorly understood. PATIENTS AND METHODS: In this observational, retrospective, single-center cohort study, we describe the impact of COVID-19 pandemic containment strategies on patients with lower extremity peripheral arterial disease (PAD) referred during the period March 11, to May 11, 2020, compared to the same time frames in 2018 to 2019. Patients admitted for acute limb ischemia (ALI) or chronic PAD and undergoing urgent or elective vascular surgery or primary amputation were included. Patients' characteristics, indications for admission, and surgical features were analyzed. The occurrence of 30 day outcomes was assessed, including length of stay, rates of major adverse cardiovascular events (MACE) and major adverse limb events (MALE), and procedural and hemodynamic success. RESULTS: Overall, 166 patients were included. Fewer subjects per 10 day period were operated in 2020 compared to, 2018 to 2019 (6.7 vs. 10.5, respectively; P < 0.001). The former had higher rates of chronic obstructive pulmonary disease (COPD) (25% vs. 11.1%; P = 0.029), and ASA score (3.13 vs. 2.90; P = 0.015). The percentage of patients with ALI in 2020 was about double that of the same period in 2018 to 2019 (47.5% vs. 24.6%; P = 0.006). Overall, the types of surgery were similar between 2020 and 2018 to 2019, while palliative care and primary amputations occurred only in 2020 (5 out 40 cases). The rate of post-operative MACE was significantly higher in 2020 (10% vs. 2.4%; P = 0.037). CONCLUSIONS: During the first state of emergency for COVID-19 pandemic in 2020, less regular medical follow-up and hindered hospital access could have resulted in more acute and advanced clinical presentations of patients with PAD undergoing surgery. Guidelines are needed to provide appropriate care to this vulnerable population and avoid a large-scale disaster.


Assuntos
COVID-19/epidemiologia , Near Miss/métodos , Doença Arterial Periférica/epidemiologia , Medição de Risco/métodos , SARS-CoV-2 , Idoso , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pandemias , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologia
3.
Front Cardiovasc Med ; 7: 558129, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33173787

RESUMO

Symptomatic peripheral arterial disease management involves medical treatment and interventional procedures. Intermittent claudication and critical limb threatened ischemia (CLTI) should be individually considered with specific outcomes and procedures. When intervention is required, an endovascular approach is usually the first-line option. Plain balloon angioplasty was previously used to dilate clinically significant femoropopliteal lesions with variable results. However, over recent years, the use of self-expanding nitinol stents has enabled treatment of long lesions, yielding significantly improved clinical results. Drug-eluting technology has also exhibited a capacity to limit in-stent restenosis and to drive target revascularization. Nevertheless, calcifications and elastic recoil of the arterial wall remain risk factors for early restenosis and failure. Therefore, vessel preparation using specific devices is required to modify vessel compliance and debulk obstructive calcification. In this short review, we provide an overview of the options for gaining lumen before stenting or dilation using drug-coated balloons.

4.
EJVES Vasc Forum ; 48: 23-26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33078165

RESUMO

INTRODUCTION: When no autologous vein is available for distal bypass in the setting of chronic limb threatening ischaemia (CLTI), new alternatives are required to solve the problems of availability, patency, and resistance to infection. An innovative technique of below the knee bypass for CLTI using a porcine self made stapled pericardial tube graft is reported. REPORT: An 84 year old man, admitted with right CLTI with foot infection due to long occlusion of the femoropopliteal segment, required urgent revascularisation. In the absence of autologous vein and cryopreserved vessels, a 4 mm self made stapled porcine pericardial tube graft 56 cm long was created from two 14 × 8 cm patches, to perform a femorotibioperoneal trunk bypass. On day 10, bypass thrombectomy and balloon angioplasty of the distal anastomosis were needed to treat early occlusion. Oral anticoagulation was then started. Right toe pressure increased from 0 to 70 mmHg, and no infection was reported. Complete wound healing was achieved. At six months, the bypass was still patent. DISCUSSION: The use of porcine self made stapled pericardial tube grafts could offer new options for revascularisation in CLTI. Larger cohort studies with longer follow up are needed to confirm this successful preliminary experience.

6.
Ann Thorac Surg ; 96(3): 1062-4, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23992699

RESUMO

Progressive obliteration of the intrahepatic course of a inferior vena cava is an insidious disease that may lead to portal hypertension with progressive liver engorgement and ultimately to liver cirrhosis. Early diagnosis is extremely important so that therapeutic modalities can be offered that can favorably change the natural course of the disease. We present the case of a young woman whose obliterated vena cava could be successfully recanalized by a combined surgical and interventional technique.


Assuntos
Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/cirurgia , Veia Cava Inferior , Trombose Venosa/diagnóstico , Trombose Venosa/cirurgia , Adulto , Ponte Cardiopulmonar/métodos , Terapia Combinada , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Monitorização Intraoperatória/métodos , Flebografia/métodos , Medição de Risco , Índice de Gravidade de Doença , Trombectomia/métodos , Resultado do Tratamento
7.
Ann Thorac Surg ; 90(5): 1507-13, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20971250

RESUMO

BACKGROUND: The PAS-Port system (Cardica, Inc, Redwood City, CA) was used routinely for patients undergoing coronary surgery with at least one venous graft. Graft patency and clinical results were evaluated, respectively, at 6 months and 5 years after surgery. METHODS: A total of 100 patients (82 males, 18 females; mean age 68.9 ± 12 years) underwent coronary bypass surgery with at least one PAS-Port anastomosis (total number of PAS-Port implants: n = 117). At 6 months after surgery all patients were followed up clinically and 86 patients with 101 PAS-Port implants underwent either a multidetector computed tomographic scan or coronary angiography. Actuarial freedom from MACCE (major adverse cardiac and cerebrovascular events) was assessed at 5 years after surgery. RESULTS: Six-month PAS-Port patency was 88%. The inner diameter of the graft at the implant site (measured in 26 patients) did not reveal any pathologic narrowing (mean inner diameter 3.1 ± 0.6 mm). At 5 years, freedom from overall MACCE was 79% ± 5% and freedom from PAS-Port target vessel revascularization was 94% ± 6%. CONCLUSIONS: The routine use of PAS-Port was associated with good vein graft patency at 6 months and a low incidence of MACCE at 5 years after surgery. No evidence of implant-related graft stenosis was detected.


Assuntos
Anastomose Cirúrgica/métodos , Ponte de Artéria Coronária/efeitos adversos , Grau de Desobstrução Vascular , Adulto , Idoso , Ponte de Artéria Coronária/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
8.
J Heart Valve Dis ; 19(6): 789-91, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21214106

RESUMO

The incidence of bacterial endocarditis (BE) during pregnancy is about 0.01%, while maternal and fetal mortality rates due to BE are 22% and 15%, respectively. Fetal survival is <15% until week 25 of gestation, and cesarean delivery is recommended before cardiopulmonary bypass in the third trimester. The case is described of a 24-year-old woman (a known drug addict), gravida 1, para 0, at week 22 of gestation, with an acute mitral valve endocarditis caused by Staphylococcus aureus. Following urgent mitral valve replacement, the strategy for fetal survival involved reducing the hemodilution and scavenging the cardioplegia solution from the right atrium, avoiding deep hypothermia to minimize rewarming, and maintaining a high pump flow rate (>2.5 l/min/m2) with a mean perfusion pressure of 70 mmHg, using pulsatile perfusion. The patient had an uneventful postoperative course, and at 34 weeks' gestation a normal newborn of 1780 g was delivered by cesarean section. No controlled clinical trials using extracorporeal circulation during pregnancy have been conducted, and reports are limited to single cases. A strategy was proposed to manage the present case of uncontrolled maternal BE at an early gestational age, by addressing several factors that would influence the outcome for both mother and baby.


Assuntos
Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca , Valva Mitral/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Complicações Infecciosas na Gravidez/cirurgia , Abuso de Substâncias por Via Intravenosa/complicações , Antibacterianos/uso terapêutico , Cesárea , Endocardite Bacteriana/microbiologia , Feminino , Idade Gestacional , Parada Cardíaca Induzida , Humanos , Nascido Vivo , Valva Mitral/microbiologia , Gravidez , Complicações Cardiovasculares na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Adulto Jovem
9.
Heart Surg Forum ; 10(5): E408-10, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17855208

RESUMO

Nowadays minimally invasive surgery represents an accepted technique to treat heart valve disease. We report a case of surgical correction of multiple valve disease in a 61-year-old woman through a minimally invasive right anterolateral minithoracotomy. The intervention was performed under transesophageal echocardiography and videoscopic guidance. High thoracic epidural anesthesia allowed a rapid weaning from mechanical ventilation and a faster recovery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estenose da Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Anestesia Epidural , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Humanos , Pessoa de Meia-Idade , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/métodos , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
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