Treatment of Common Femoral Artery Lesions Involving the Superficial and Profunda Femoral Artery Bifurcation: Is the Snow Too Melted to Plow With New Endovascular Devices?

Surgical endarterectomy for common femoral artery bifurcation obstructive atherosclerotic disease repre- sents the "gold standard" therapy, with excellent long-term results and minimal complications. On the other hand, recent advances in endovascular therapy have led to a safer and similar effective results, with a potential reduction in hospital stays, quicker recovery to normal functional status, good short- and long-term clinical outcomes, and consequent lower morbidity and mortality. Percutaneous directional atherectomy and intravascular lithotripsy are game-changer medical devices for the treatment of peripheral arterial disease related to complex and severely calcific atherosclerotic plaque encroaching the common femoral artery bifurcation segment. The application of these devices, technical execution, and clinical experience is reported in two exemplary cases

Long Stent Implantation on the Left Anterior Descending Coronary Artery at a Follow-Up of More Than Five Years

Background: Stent implantation represents the standard of care in coronary intervention. While a short stent implanted on a focal lesion located on the left anterior descending artery (LAD) seems a reasonable alternative to an internal mammary implant, the same for long stents is still debated. Methods: We reported the long-term data of 531 consecutive patients who underwent Percutaneous Coronary Intervention (PCI) with long stents in two highly specialized centres. The main inclusion criteria were the implantation of stents longer than 30 mm on the LAD and a minimum follow-up (FU) of five years. The primary endpoint was mortality, and the secondary endpoints were any myocardial infarction (MI), target vessel and lesion revascularization (TVR and TLR, respectively), and stent thrombosis (ST) observed as definite, probable, or possible. Results: In this selected population with characteristics of complex PCI (99.1%), the long-term follow-up (mean 92.18 ± 35.5 months) estimates of all-cause death, cardiovascular death, and any myocardial infarction were 18.3%, 10.5%, and 9.3%, respectively. Both all-cause and cardiovascular deaths are significantly associated with three-vessel disease (HR 6.8; confidence of interval (CI) 95% 3.844–11.934; p &lt; 0.001, and HR 4.7; CI 95% 2.265–9.835; p &lt; 0.001, respectively). Target lesion (TLR) and target vessel revascularization (TVR) are associated with the presence of three-lesion disease on the LAD (HR 3.4; CI 95% 1.984–5.781; p &lt; 0.001; HR 3.9 CI 95% 2.323–6.442; p &lt; 0.001, respectively). Re-PCI for any cause occurred in 31.5% of patients and shows an increased risk for three-lesion stenting (HR 4.3; CI 95% 2.873–6.376; p &lt; 0.001) and the treatment of bifurcation with two stents (HR 1.6; 95% CI 1.051–2.414; p = 0.028). Stent thrombosis rate at the 5-year FU was 4.4% (1.3% definite; 0.9% probable; 2.1% possible), including a 1.7% rate of very-late thrombosis. The stent length superior to 40 mm was not associated with poor outcomes (all-cause death p = 0.349; cardiovascular death p = 0.855; MI p = 0.691; re-PCI p = 0.234; TLR p = 0.805; TVR p = 0.087; ST p = 0.189). Conclusion: At an FU of longer than five years, patients treated with stents longer than 30 mm in their LAD showed acceptable procedural results but poor outcomes.</p

Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis

The field of inflammatory disease of the heart or "cardio-immunology " is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.Peer reviewe

Long Stent Implantation on the Left Anterior Descending Coronary Artery at a Follow-Up of More Than Five Years

Background: Stent implantation represents the standard of care in coronary intervention. While a short stent implanted on a focal lesion located on the left anterior descending artery (LAD) seems a reasonable alternative to an internal mammary implant, the same for long stents is still debated. Methods: We reported the long-term data of 531 consecutive patients who underwent Percutaneous Coronary Intervention (PCI) with long stents in two highly specialized centres. The main inclusion criteria were the implantation of stents longer than 30 mm on the LAD and a minimum follow-up (FU) of five years. The primary endpoint was mortality, and the secondary endpoints were any myocardial infarction (MI), target vessel and lesion revascularization (TVR and TLR, respectively), and stent thrombosis (ST) observed as definite, probable, or possible. Results: In this selected population with characteristics of complex PCI (99.1%), the long-term follow-up (mean 92.18 ± 35.5 months) estimates of all-cause death, cardiovascular death, and any myocardial infarction were 18.3%, 10.5%, and 9.3%, respectively. Both all-cause and cardiovascular deaths are significantly associated with three-vessel disease (HR 6.8; confidence of interval (CI) 95% 3.844–11.934; p &lt; 0.001, and HR 4.7; CI 95% 2.265–9.835; p &lt; 0.001, respectively). Target lesion (TLR) and target vessel revascularization (TVR) are associated with the presence of three-lesion disease on the LAD (HR 3.4; CI 95% 1.984–5.781; p &lt; 0.001; HR 3.9 CI 95% 2.323–6.442; p &lt; 0.001, respectively). Re-PCI for any cause occurred in 31.5% of patients and shows an increased risk for three-lesion stenting (HR 4.3; CI 95% 2.873–6.376; p &lt; 0.001) and the treatment of bifurcation with two stents (HR 1.6; 95% CI 1.051–2.414; p = 0.028). Stent thrombosis rate at the 5-year FU was 4.4% (1.3% definite; 0.9% probable; 2.1% possible), including a 1.7% rate of very-late thrombosis. The stent length superior to 40 mm was not associated with poor outcomes (all-cause death p = 0.349; cardiovascular death p = 0.855; MI p = 0.691; re-PCI p = 0.234; TLR p = 0.805; TVR p = 0.087; ST p = 0.189). Conclusion: At an FU of longer than five years, patients treated with stents longer than 30 mm in their LAD showed acceptable procedural results but poor outcomes.</p

Bioformulação de Beauveria bassiana (ATCC MYA-4886) e Trichoderma lignorum (ATCC-8751) como biocontrolador de Atta cephalotes

I. The Leaf cutting Ant is associated with losses in the agricultural sector, for the most part in the cultivation of citrus fruit sector, due to its activity defoliator. Control of the species has been handmade, chemical and biologically, the latter with environmental benefits and low risk to human health. This research had as objective develop a formulation biological for the control of the Leaf cutting Ant (Atta cephalotes) using a mixture of spores of two fungi filamentous (Beauveria bassiana and Trichoderma lignorum). M. He was the isolation of Beauveria bassiana (ATCC MYA-4886) and Trichoderma lignorum (ATCC 8751), through cultivation YPDA and was conducted identifying fungal imprint and biochemical tests. Developing five formulations with ratios of 1:1, 6:4, 4:6, 3:7, 2:8 of Beauveria bassiana and Trichoderma lignorum respectively, they underwent the test of viability in nutrient agar, pathogenicity by immersion test and proof of purity; the tests were performed in triplicate. R. The formulations presented viability to 24 h 95% 2, 100% of the formulations were pure after 10 days, formulations 6.4, 1:1, 2:8 infected all of the individuals in 6 days, formulations 4:6 and 3:7-8 days of exposure. C. Formulations 6.4, 1:1, 2:8 of Beauveria bassiana and Trichoderma lignorium, present infectious activity on the Leaf cutting Ant (Atta cephalotes) in laboratory.I. La hormiga arriera está asociada a pérdidas en el sector agrícola, debido a su actividad defoliadora. El control de la especie se ha venido realizado artesanal, química y biológicamente, esta última con beneficios ambientales y de bajo riesgo para la salud humana. El objetivo de esta investigación fue desarrollar una formulación biológica para el control de la hormiga arriera (Atta cephalotes) utilizando una mezcla de esporas de dos hongos filamentosos (Beauveria bassiana y Trichoderma lignorum). M. Se desarrollaron 5 formulaciones empleando las relaciones: 1:1,6:4,4:6,3:7,2:8, de cepas de B. bassiana (ATCC MYA-4886) y T. lignorum (ATCC 8751), realizándoles prueba de viabilidad, patogenicidad y pureza. La colonización de las esporas en tejidos, se evaluó mediante la exposición de ratas Wistar a la formulación y sus componentes, realizando diagnóstico veterinario (disección) y cultivo microbiológico. R. Las formulaciones presentaron viabilidad a 24 h del 95+2 %, el 100% de las formulaciones no se contaminaron después de 10 días, las formulaciones 6.4, 1:1, 2:8 infectaron la totalidad de los individuos en 6 días, las formulaciones 4:6 y 3:7 a los 8 días, no se observó colonización de las cepas en la formulación, ni en tejidos de los biomodelos. C. Las formulaciones 6.4, 1:1, 2:8 de Beauveria bassiana y Trichoderma lignorum, poseen mayor actividad infecciosa sobre la hormiga arriera (Atta cephalotes).&nbsp;I. O formigueiro está associado a perdas no setor agrícola, devido à sua atividade desfolhadora. O controle das espécies tem sido realizado artesanalmente, quimicamente e biologicamente, este último com benefícios ambientais e baixo risco para a saúde humana. O objetivo desta pesquisa foi desenvolver uma formulação biológica para o controle de formigas (Atta cephalotes) usando uma mistura de esporos de dois fungos filamentosos (Beauveria bassiana e Trichoderma lignorum). M. 5 As formulações foram desenvolvidas usando a relação: 1: 1,6: 4,4: 6,3: 7,2: 8 estirpes de B. bassiana (ATCC MAA-4886) e T. lignorum (ATCC 8751), realizándoles Teste de viabilidade, patogenicidade e pureza. A colonização dos esporos nos tecidos foi avaliada pela exposição de ratos Wistar à formulação e seus componentes, realizando diagnóstico veterinário (dissecção) e cultura microbiológica. R. As formulações mostraram viabilidade em 24 h de 95 + 2%, 100% das formulações não foram contaminadas após 10 dias, as formulações 6,4, 1: 1, 2: 8 infectaram todos os indivíduos em 6 dias, as formulações 4: 6 e 3: 7 aos 8 dias, nenhuma colonização das cepas foi observada na formulação, nem nos tecidos dos biomodelos. C. As formulações 6.4, 1: 1, 2: 8 de Beauveria bassiana e Trichoderma lignorum, apresentam maior atividade infecciosa sobre os antirretera (Atta cephalotes)