Advancing Global Equity in Cardiac Care as Cardiac Implantable Electronic Device Reuse Comes of Age

A nation’s health and economic development are inextricably and synergistically connected. Stark differences exist between wealthy and developing nations in the use of cardiac implantable electronic devices (CIEDs). Cardiovascular disease is now the leading cause of death in low- and middle-income countries (LMIC), with a significant burden from rhythm-related diseases. As science, technology, education, and regulatory frameworks have improved, CIED recycling for exportation and reuse in LMIC has become possible and primed for widespread adoption. In our manuscript, we outline the science and regulatory pathways regarding CIED reuse. We propose a pathway to advance this technology that includes creating a task force to establish standards for CIED reuse, leveraging professional organizations in areas of need to foster the professional skills for CIED reuse, collaborating with regulatory agencies to create more efficient regulatory expectations and bring the concept to scale, and establishing a global CIED reuse registry for quality assurance and future science

Characteristics of lymphocyte subsets in HIV-infected, long-term nonprogressor, and healthy Asian children through 12 years of age

Background: There are limited data on the immune profiles of HIV-positive children compared with healthy controls, and no such data for Asian children. Objectives: To immunophenotype HIV-positive Asian children, including long-term nonprogressors (LTNPs), compared with age-matched healthy controls. Methods: We used flow cytometry to analyze 13 lymphocyte and monocyte subsets from 222 untreated, HIV-positive children with 15% to 24% CD4(+) T cells and no AIDS-related illnesses and 142 healthy children (controls). Data were compared among age categories. Profiles from LTNPs (n = 50), defined as children >= 8 years old with CD4(+) T-cell counts >= 350 cells/mm(3), were compared with data from age-matched non-LTNPs (n = 17) and controls (n = 53). Results: Compared with controls, HIV-positive children had lower values (cell count per mm(3) and percent distribution) for T-H cells and higher values for cytotoxic T cells, with reductions in populations of naive T-H and cytotoxic T cells, B cells, and natural killer (NK) cells. HIV-positive children had high values for activated T-H and cytotoxic T cells. Compared with non-LTNPs, LTNPs had higher values of T-H and cytotoxic T cells, naive and memory T-cell subsets, and B and NK cells. Surprisingly, counts of activated T-H and cytotoxic T cells were also higher among LTNPs. LNTPs were more frequently male. Conclusion: Untreated, HIV-infected Asian children have immune profiles that differ from those of controls, characterized by low values for T-H cells, naive T cells, B cells, and NK cells but high values for cytotoxic, activated T-H, and cytotoxic T cells. The higher values for activated T cells observed in LTNPs require confirmation in longitudinal studies. (J Allergy Clin Immunol 2010;126:1294-301.