Crossroads between immune responses and physiological regulation: Metabolic control of resistance versus tolerance against disease.

If a threat cannot be avoided, the organism has two defense options: it can try to eliminate the threatening agent or boost physiological mechanisms to tolerate the challenge and its consequences. Both strategies can be (and usually are) used at the same time. Fighting an infection, for instance, requires mounting immune responses to control pathogen burden as well as physiologic adaptations to tolerate stress and damage.

Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia.

Unlabelled: Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia.

Methods: From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/Covidien-ev3 Endovascular Inc.

Stent-assisted detachable coil embolization of wide-necked renal artery aneurysms.

Renal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity.

What the young physician should know about May-Thurner syndrome.

May-Thurner syndrome (MTS) is an anatomically variable condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine with subsequent development of a left deep vein thrombosis (DVT). Although this syndrome is rare, its true prevalence is likely underestimated. Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome.

What the Young Physician Should Know About May-Thurner Syndrome.

May-Thurner syndrome (MTS) is an anatomically variable condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine with subsequent development of a left deep vein thrombosis (DVT). Although this syndrome is rare, its true prevalence is likely underestimated. Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome.

Management of finger gangrene caused by steal syndrome in vascular access for hemodialysis Personal experience and a brief review of the literature.

Introduction: Severe dialysis-associated steal syndrome (DASS) is an uncommon and severe complication after arteriovenous fistula (AVF) creation that can lead to finger gangrene and amputation. As the number of patients on hemodialysis increases in western countries the number of patients at risk for DASS will continue to rise.

Methods: We retrospectively reviewed all patients who underwent a surgical intervention for the management of DASS with finger gangrene from January 2004 to July 2013.

Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment.

The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded.

Mast cells control the expansion and differentiation of IL-10-competent B cells.

The discovery of B cell subsets with regulatory properties, dependent on IL-10 production, has expanded our view on the mechanisms that control inflammation. Regulatory B cells acquire the ability to produce IL-10 in a stepwise process: first, they become IL-10 competent, a poised state in which B cells are sensitive to trigger signals but do not actually express the Il-10 gene; then, when exposed to appropriate stimuli, they start producing IL-10. Even if the existence of IL-10-competent B cells is now well established, it is not yet known how different immune cell types cross talk with B cells and affect IL-10-competent B cell differentiation and expansion.

Use of cocultures for the study of cellular interactions influencing B cell regulatory functions.

Many immunological processes are contextually controlled by complex interactions among different cell types. Several studies have shown that B cells produce the immune regulatory cytokine IL-10 in response to different external stimuli but also to immune-mediated signals. Endogenous signals that derive from the cross talk between B lymphocytes and other cells of the immune system can affect IL-10 production by B cells in both physiological and pathological conditions.

IL-10 production by B cells is differentially regulated by immune-mediated and infectious stimuli and requires p38 activation.

IL-10 is an immune suppressive cytokine with pleiotropic effects on B cell biology. IL-10 production has a pivotal role for the regulatory suppressive functions that B cells exert in many physiological and pathological settings. Several exogenous stimuli and endogenous immune mediators can trigger IL-10-producing B cell maturation.

Endograft connector technique to treat popliteal artery aneurysm in a morbid obese patient.

Surgical repair of popliteal artery aneurysm in morbid obese patients poses additional challenges. We report a morbid obese patient who had a 59 mm right popliteal artery aneurysm which was successfully treated with the endograft connector technique. This technique was used to perform the distal anastomosis of the below-knee femoro-popliteal bypass.

A popliteal artery aneurysm presenting with ab extrinseco popliteal vein occlusion and compartment syndrome: a case report.

Introduction: Aneurysms of popliteal artery are the most frequently reported aneurysm after abdominal aorta. An unusual presentation is compression to adjacent structure.

Case Presentation: A 67 years old caucasian man presenting deep vein thrombosis signs to the right leg including functional impotence was admitted in emergency setting to Vascular Surgery Unit.

A wire-loop technique for implantation of an iliac branched device in a patient with previous surgery for a ruptured abdominal aortic aneurysm.

We described a modified technique for implanting a bridging stent-graft into an iliac branched device. A 79-year-old male who had received aortobiiliac synthetic graft surgery for a ruptured abdominal aortic aneurysm six months earlier was admitted to our unit for treatment of a left common iliac aneurysm involving the origin of the hypogastric artery. A standard technique was unsuccessful at implanting the bridging stent-graft, and therefore a wire-loop guidewire over the graft bifurcation was used to stabilize the contralateral sheaths and to complete the implantation.

Late, giant brachial artery aneurysm following hemodialysis fistula ligation in a renal transplant patient: case report and literature review.

Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula ligation after renal transplantation is uncommon. Herein, we describe the case of a 64-year-old man who developed a giant symptomatic BAA 21 years after ligation of the fistula. He was submitted to surgical excision of the aneurysm followed by interposition prosthetic graft.

Regulatory B cells: evidence, developmental origin and population diversity.

The adaptive immune system has developed several highly effective mechanisms in order to avoid excessive or unwanted reactions and promote resolution of immune activation. An emerging, significant body of evidence indicates that B cells can actively modulate immune responses by mechanisms that do not directly involve the production of antibodies. B cells appear to have the capacity to both induce and suppress immune effector mechanisms and they exert these functions both by contact-dependent interactions and through the secretion of cytokines.

Carotid artery stenting with contralateral carotid occlusion in a rare aortic arch configuration.

We present the case of a 47-year-old man admitted to our department with an episode of aphasia. Duplex scan showed an occluded right internal carotid artery and severe left internal carotid artery stenosis. Contrast-enhanced computer tomography demonstrated a common trunk for both common carotid arteries anterior to the trachea and aberrant right subclavian artery posterior to the esophagus.

Retroaortic left renal vein and inflammatory abdominal aortic aneurysm.

The aim of this study was to report successful surgical management of an inflammatory abdominal aortic aneurysm associated with a retroaortic left renal vein. The patient, a 78-year-old man, presented with diffuse abdominal pain, fever, and constipation. Contrast-enhanced computed tomography showed soft tissue surrounding the aneurysm and a left renal vein behind the aorta.

TRAF2 and p38 are involved in B cells CD40-mediated APE/Ref-1 nuclear translocation: a novel pathway in B cell activation.

The interaction between CD40 and its ligand CD40L plays a key role in the regulation of B cell proliferation, activation, isotype switching and the humoral memory response. APE/Ref-1 plays a key role in transcriptional responses during CD40-mediated B cell activation. It is demonstrated that CD40 signaling is mediated principally through TRAF adapter proteins.

CD40 stimulation induces Pax5/BSAP and EBF activation through a APE/Ref-1-dependent redox mechanism.

CD40 is a member of the growing tumor necrosis factor receptor family that has been shown to play important roles in T cell-mediated B lymphocyte activation. Ligation of B cell CD40 by CD154, mainly expressed on activated T cells, stimulates B cell proliferation, differentiation, isotype switching, up-regulation of surface molecules contributing to antigen presentation, development of the germinal center, and the humoral memory response. In this study we demonstrate that the redox factor APE/Ref-1 acts as a key signaling intermediate in response to CD40-mediated B cell activation.

H(2)O(2) induces translocation of APE/Ref-1 to mitochondria in the Raji B-cell line.

Reactive oxygen species (ROS) are generated as by-products of respiration and are used as signal transducing intermediates in out-in signaling pathways. ROS are also generated during inflammatory responses and it has been shown that hydrogen peroxide may trigger activation of B-lymphocytes, similar to cross-linking of surface immunoglobulins. On the other hand, both exogenous and endogenous generated ROS are a major source of nuclear and mitochondrial DNA (mtDNA) damage.