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2. Airway microbiota signals anabolic and catabolic remodeling in the transplanted lung

Author

Mouraux, Stéphane, primary, Bernasconi, Eric, additional, Pattaroni, Céline, additional, Koutsokera, Angela, additional, Aubert, John-David, additional, Claustre, Johanna, additional, Pison, Christophe, additional, Royer, Pierre-Joseph, additional, Magnan, Antoine, additional, Kessler, Romain, additional, Benden, Christian, additional, Soccal, Paola M., additional, Marsland, Benjamin J., additional, Nicod, Laurent P., additional, Jougon, J., additional, Velly, J.-F., additional, Rozé, H., additional, Blanchard, E., additional, Dromer, C., additional, Antoine, M., additional, Cappello, M., additional, Ruiz, M., additional, Sokolow, Y., additional, Vanden Eynden, F., additional, Van Nooten, G., additional, Barvais, L., additional, Berré, J., additional, Brimioulle, S., additional, De Backer, D., additional, Créteur, J., additional, Engelman, E., additional, Huybrechts, I., additional, Ickx, B., additional, Preiser, T.J.C., additional, Tuna, T., additional, Van Obberghe, L., additional, Vancutsem, N., additional, Vincent, J.-L., additional, De Vuyst, P., additional, Etienne, I., additional, Féry, F., additional, Jacobs, F., additional, Knoop, C., additional, Vachiéry, J.L., additional, Van den Borne, P., additional, Wellemans, I., additional, Amand, G., additional, Collignon, L., additional, Giroux, M., additional, Angelescu, D., additional, Chavanon, O., additional, Hacini, R., additional, Pirvu, A., additional, Porcu, P., additional, Albaladejo, P., additional, Allègre, C., additional, Bataillard, A., additional, Bedague, D., additional, Briot, E., additional, Casez-Brasseur, M., additional, Colas, D., additional, Dessertaine, G., additional, Durand, M., additional, Francony, G., additional, Hebrard, A., additional, Marino, M.R., additional, Oummahan, B., additional, Protar, D., additional, Rehm, D., additional, Robin, S., additional, Rossi-Blancher, M., additional, Augier, C., additional, Bedouch, P., additional, Boignard, A., additional, Bouvaist, H., additional, Briault, A., additional, Camara, B., additional, Claustre, J., additional, Chanoine, S., additional, Dubuc, M., additional, Quétant, S., additional, Maurizi, J., additional, Pavèse, P., additional, Pison, C., additional, Saint-Raymond, C., additional, Wion, N., additional, Chérion, C., additional, Grima, R., additional, Jegaden, O., additional, Maury, J.-M., additional, Tronc, F., additional, Flamens, C., additional, Paulus, S., additional, Mornex, J.-F., additional, Philit, F., additional, Senechal, A., additional, Glérant, J.-C., additional, Turquier, S., additional, Gamondes, D., additional, Chalabresse, L., additional, Thivolet-Bejui, F., additional, Barnel, C., additional, Dubois, C., additional, Tiberghien, A., additional, Le Pimpec-Barthes, F., additional, Bel, A., additional, Mordant, P., additional, Achouh, P., additional, Boussaud, V., additional, Guillemain, R., additional, Méléard, D., additional, Bricourt, M.O., additional, Cholley, B., additional, Pezella, V., additional, Brioude, G., additional, D'Journo, X.B., additional, Doddoli, C., additional, Thomas, P., additional, Trousse, D., additional, Dizier, S., additional, Leone, M., additional, Papazian, L., additional, Bregeon, F., additional, Basire, A., additional, Coltey, B., additional, Dufeu, N., additional, Dutau, H., additional, Garcia, S., additional, Gaubert, J.Y., additional, Gomez, C., additional, Laroumagne, S., additional, Nieves, A., additional, Picard, L.C., additional, Reynaud-Gaubert, M., additional, Secq, V., additional, Mouton, G., additional, Baron, O., additional, Lacoste, P., additional, Perigaud, C., additional, Roussel, J.C., additional, Danner, I., additional, Haloun, A., additional, Magnan, A., additional, Tissot, A., additional, Lepoivre, T., additional, Treilhaud, M., additional, Botturi-Cavaillès, K., additional, Brouard, S., additional, Danger, R., additional, Loy, J., additional, Morisset, M., additional, Pain, M., additional, Pares, S., additional, Reboulleau, D., additional, Royer, P.-J., additional, Fabre, D., additional, Fadel, E., additional, Mercier, O., additional, Mussot, S., additional, Stephan, F., additional, Viard, P., additional, Cerrina, J., additional, Dorfmuller, P., additional, Ghigna, S.M., additional, Hervén, Ph., additional, Le Roy Ladurie, F., additional, Le Pavec, J., additional, Thomas de Montpreville, V., additional, Lamrani, L., additional, Castier, Y., additional, Cerceau, P., additional, Augustin, P., additional, Jean-Baptiste, S., additional, Boudinet, S., additional, Montravers, P., additional, Brugière, O., additional, Dauriat, G., additional, Jébrak, G., additional, Mal, H., additional, Marceau, A., additional, Métivier, A.-C., additional, Thabut, G., additional, Lhuillier, E., additional, Dupin, C., additional, Bunel, V., additional, Falcoz, P., additional, Massard, G., additional, Santelmo, N., additional, Ajob, G., additional, Collange, O., additional, Helms, O., additional, Hentz, J., additional, Roche, A., additional, Bakouboula, B., additional, Degot, T., additional, Dory, A., additional, Hirschi, S., additional, Ohlmann-Caillard, S., additional, Kessler, L., additional, Kessler, R., additional, Schuller, A., additional, Bennedif, K., additional, Vargas, S., additional, Stauder, J., additional, Ali-Azouaou, S., additional, Bonnette, P., additional, Chapelier, A., additional, Puyo, P., additional, Sage, E., additional, Bresson, J., additional, Caille, V., additional, Cerf, C., additional, Devaquet, J., additional, Dumans-Nizard, V., additional, Felten, M.-L., additional, Fischler, M., additional, Si Larbi, A.-G., additional, Leguen, M., additional, Ley, L., additional, Liu, N., additional, Trebbia, G., additional, De Miranda, S., additional, Douvry, B., additional, Gonin, F., additional, Grenet, D., additional, Hamid, A.M., additional, Neveu, H., additional, Parquin, F., additional, Picard, C., additional, Roux, A., additional, Stern, M., additional, Bouillioud, F., additional, Cahen, P., additional, Colombat, M., additional, Dautricourt, C., additional, Delahousse, M., additional, D'Urso, B., additional, Gravisse, J., additional, Guth, A., additional, Hillaire, S., additional, Honderlick, P., additional, Lequintrec, M., additional, Longchampt, E., additional, Mellot, F., additional, Scherrer, A., additional, Temagoult, L., additional, Tricot, L., additional, Vasse, M., additional, Veyrie, C., additional, Zemoura, L., additional, Berjaud, J., additional, Brouchet, L., additional, Dahan, M., additional, Mathe, F.O., additional, Benahoua, H., additional, DaCosta, M., additional, Serres, I., additional, Merlet-Dupuy, V., additional, Grigoli, M., additional, Didier, A., additional, Murris, M., additional, Crognier, L., additional, Fourcade, O., additional, Krueger, T., additional, Ris, H.B., additional, Gonzalez, M., additional, Jolliet, Ph., additional, Marcucci, C., additional, Chollet, M., additional, Gronchi, F., additional, Courbon, C., additional, Berutto, C., additional, Manuel, O., additional, Koutsokera, A., additional, Aubert, J.-D., additional, Nicod, L.P., additional, Mouraux, S., additional, Bernasconi, E., additional, Pattaroni, C., additional, Marsland, B.J., additional, Soccal, P.M., additional, Rochat, T., additional, Lücker, L.M., additional, Hillinger, S., additional, Inci, I., additional, Weder, W., additional, Schuepbach, R., additional, Zalunardo, M., additional, Benden, C., additional, Schuurmans, M.M., additional, Gaspert, A., additional, Holzmann, D., additional, Müller, N., additional, Schmid, C., additional, Vrugt, B., additional, Fritz, A., additional, Maier, D., additional, Deplanche, K., additional, Koubi, D., additional, Ernst, F., additional, Paprotka, T., additional, Schmitt, M., additional, Wahl, B., additional, Boissel, J.-P., additional, Olivera-Botello, G., additional, Trocmé, C., additional, Toussaint, B., additional, Bourgoin-Voillard, S., additional, Sève, M., additional, Benmerad, M., additional, Siroux, V., additional, Slama, R., additional, Auffray, C., additional, Charron, D., additional, Lefaudeux, D., additional, and Pellet, J., additional

Published
2018
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3. Blood CD9+B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Author

Brosseau, Carole, Danger, Richard, Durand, Maxim, Durand, Eugénie, Foureau, Aurore, Lacoste, Philippe, Tissot, Adrien, Roux, Antoine, Reynaud‐Gaubert, Martine, Kessler, Romain, Mussot, Sacha, Dromer, Claire, Brugière, Olivier, Mornex, Jean François, Guillemain, Romain, Claustre, Johanna, Magnan, Antoine, Brouard, Sophie, Jougon, J., Velly, J.‐F., Rozé, H., Blanchard, E., Antoine, M., Cappello, M., Ruiz, M., Sokolow, Y., Vanden Eynden, F, Van Nooten, G., Barvais, L., Berré, J., Brimioulle, S., De Backer, D., Créteur, J., Engelman, E, Huybrechts, I., Ickx, B., Preiser, T.J.C., Tuna, T., Van Obberghe, L., Vancutsem, N., Vincent, J.‐L., De Vuyst, P., Etienne, I., Féry, F., Jacobs, F., Knoop, C., Vachiéry, J.L., Van den Borne, P., Wellemans, I., Amand, G., Collignon, L., Giroux, M., Angelescu, D., Chavanon, O., Hacini, R., Martin, C., Pirvu, A., Porcu, P., Albaladejo, P., Allègre, C., Bataillard, A., Bedague, D., Briot, E., Casez‐Brasseur, M., Colas, D., Dessertaine, G., Francony, G., Hebrard, A., Marino, M.R., Protar, D., Rehm, D., Robin, S, Rossi‐Blancher, M., Augier, C., Bedouch, P., Boignard, A., Bouvaist, H., Briault, A., Camara, B., Chanoine, S., Dubuc, M., Quétant, S., Maurizi, J., Pavèse, P., Pison, C., Saint‐Raymond, C., Wion, N., Chérion, C., Grima, R., Jegaden, O., Maury, J.‐M., Tronc, F., Flamens, C., Paulus, S., Philit, F., Senechal, A., Glérant, J.‐C., Turquier, S., Gamondes, D., Chalabresse, L., Thivolet‐Bejui, F., Barnel, C., Dubois, C., Tiberghien, A., Pimpec‐Barthes, F., Bel, A., Mordant, P., Achouh, P., Boussaud, V., Méléard, D., Bricourt, M.O., Cholley, B., Pezella, V., Brioude, G., D'Journo, X.B., Doddoli, C., Thomas, P., Trousse, D., Dizier, S., Leone, M., Papazian, L., Bregeon, F., Coltey, B., Dufeu, N., Dutau, H., Garcia, S., Gaubert, J.Y., Gomez, C., Laroumagne, S., Mouton, G., Nieves, A., Picard, Ch., Rolain, J.M., Sampol, E., Secq, V., Perigaud, C., Roussel, J.C., Senage, T., Mugniot, A., Danner, I., Haloun, A., Abbes, S., Bry, C., Blanc, F.X., Lepoivre, T., Botturi‐Cavaillès, K., Loy, J., Bernard, M., Godard, E., Royer, P.‐J., Henrio, K., Dartevelle, Ph., Fabre, D., Fadel, E., Mercier, O., Stephan, F., Viard, P., Cerrina, J., Dorfmuller, P., Feuillet, S., Ghigna, M., Hervén, Ph., Le Roy Ladurie, F., Le Pavec, J., Thomas de Montpreville, V., Lamrani, L., Castier, Y., Mordant, P., Cerceau, P., Augustin, P., Jean‐Baptiste, S., Boudinet, S., Montravers, P., Dauriat, G., Jébrak, G., Mal, H., Marceau, A., Métivier, A.‐C., Thabut, G., Lhuillier, E., Dupin, C., Bunel, V., Falcoz, P., Massard, G., Santelmo, N., Ajob, G., Collange, O., Helms, O., Hentz, J., Roche, A., Bakouboula, B., Degot, T., Dory, A., Hirschi, S., Ohlmann‐Caillard, S., Kessler, L., Schuller, A., Bennedif, K., Vargas, S., Bonnette, P., Chapelier, A., Puyo, P., Sage, E., Bresson, J., Caille, V., Cerf, C., Devaquet, J., Dumans‐Nizard, V., Felten, M.L., Fischler, M., Si Larbi, A.G., Leguen, M., Ley, L., Liu, N., Trebbia, G., De Miranda, S., Douvry, B., Gonin, F., Grenet, D., Hamid, A.M., Neveu, H., Parquin, F., Picard, C., Stern, M., Bouillioud, F., Cahen, P., Colombat, M., Dautricourt, C., Delahousse, M., D'Urso, B., Gravisse, J., Guth, A., Hillaire, S., Honderlick, P., Lequintrec, M., Longchampt, E., Mellot, F., Scherrer, A., Temagoult, L., Tricot, L., Vasse, M., Veyrie, C., Zemoura, L., Dahan, M., Murris, M., Benahoua, H., Berjaud, J., Le Borgne Krams, A., Crognier, L., Brouchet, L., Mathe, O., Didier, A., Krueger, T., Ris, H.B., Gonzalez, M., Aubert, J.‐D., Nicod, L.P., Marsland, B.J., Berutto, T.C., Rochat, T., Soccal, P., Jolliet, Ph., Koutsokera, A., Marcucci, C., Manuel, O., Bernasconi, E., Chollet, M., Gronchi, F., Courbon, C., Hillinger, S., Inci, I., Kestenholz, P., Weder, W., Schuepbach, R., Zalunardo, M., Benden, C., Buergi, U., Huber, L.C., Isenring, B., Schuurmans, M.M., Gaspert, A., Holzmann, D., Müller, N., Schmid, C., Vrugt, B., Rechsteiner, T., Fritz, A., Maier, D., Deplanche, K., Koubi, D., Ernst, F., Paprotka, T., Schmitt, M., Wahl, B., Boissel, J.‐P., Olivera‐Botello, G., Trocmé, C., Toussaint, B., Bourgoin‐Voillard, S., Séve, M., Benmerad, M., Siroux, V., Slama, R., Auffray, C., Charron, D., Lefaudeux, D., and Pellet, J.

Abstract

Bronchiolitis obliterans syndrome is the main limitation for long‐term survival after lung transplantation. Some specific B cell populations are associated with long‐term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow‐up. CD24hiCD38hitransitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hiCD38hitransitional B cells specifically secrete IL‐10 and express CD9. Thus, patients with a total CD9+B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL‐10‐secreting CD24hiCD38hitransitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9‐expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long‐term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome–free survival. In lung transplant patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow‐up, IL‐10–secreting CD24hiCD38hi transitional B cells expressing CD9 are associated with better allograft outcome, suggesting CD9‐expressing B cells as a new predictive biomarker of bronchiolitis obliterans syndrome–free survival.

Published
2019
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5. T Cells Promote Bronchial Epithelial Cell Secretion of Matrix Metalloproteinase‐9 via a C‐C Chemokine Receptor Type 2 Pathway: Implications for Chronic Lung Allograft Dysfunction

Author

Pain, M., Royer, P.‐J., Loy, J., Girardeau, A., Tissot, A., Lacoste, P., Roux, A., Reynaud‐Gaubert, M., Kessler, R., Mussot, S., Dromer, C., Brugière, O., Mornex, J.‐F., Guillemain, R., Dahan, M., Knoop, C., Botturi, K., Pison, C., Danger, R., Brouard, S., Magnan, A., Jougon, J., Velly, J.‐F., Rozé, H., Blanchard, E., Antoine, M., Cappello, M., Souilamas, R., Ruiz, M., Sokolow, Y., Vanden Eynden, F., Van Nooten, G., Barvais, L., Berré, J., Brimioulle, S., De Backer, D., Créteur, J., Engelman, E., Huybrechts, I., Ickx, B., Preiser, T.J.C., Tuna, T., Van Obberghe, L., Vancutsem, N., Vincent, J.‐L., De Vuyst, P., Etienne, I., Féry, F., Jacobs, F., Vachiéry, J.L., Van den Borne, P., Wellemans, I., Amand, G., Collignon, L., Giroux, M., Arnaud‐Crozat, E., Bach, V., Brichon, P.‐Y., Chaffanjon, P., Chavanon, O., de Lambert, A., Fleury, J.P., Guigard, S., Hireche, K., Pirvu, A., Porcu, P., Hacini, R., Albaladejo, P., Allègre, C., Bataillard, A., Bedague, D., Briot, E., Casez‐Brasseur, M., Colas, D., Dessertaine, G., Durand, M., Francony, G., Hebrard, A., Marino, M.R., Oummahan, B., Protar, D., Rehm, D., Robin, S., Rossi‐Blancher, M., Bedouch, P., Boignard, A., Bouvaist, H., Briault, A., Camara, B., Chanoine, S., Dubuc, M., Lantuéjoul, S., Quétant, S., Maurizi, J., Pavèse, P., Saint‐Raymond, C., Wion, N., Chérion, C., Grima, R., Jegaden, O., Maury, J.‐M., Tronc, F., Flamens, C., Paulus, S., Philit, F., Senechal, A., Glérant, J.‐C., Turquier, S., Gamondes, D., Chalabresse, L., Thivolet‐Bejui, F., Barnel, C., Dubois, C., Tiberghien, A., Le Pimpec‐Barthes, F., Bel, A., Mordant, P., Achouh, P., Boussaud, V., Méléard, D., Bricourt, M.O., Cholley, B., Pezella, V., Adda, M., Badier, M., Bregeon, F., Coltey, B., D'Journo, X.B., Dizier, S., Doddoli, C., Dufeu, N., Dutau, H., Forel, J.M., Gaubert, J.Y., Gomez, C., Leone, M., Nieves, A., Orsini, B., Papazian, L., Picard, C., Roch, A., Rolain, J.M., Sampol, E., Secq, V., Thomas, P., Trousse, D., Yahyaoui, M., Baron, O., Perigaud, C., Roussel, J.C., Danner, I., Haloun, A., Lepoivre, T., Treilhaud, M., Botturi‐Cavaillès, K., Morisset, M., Pares, S., Reboulleau, D., Dartevelle, P., Fabre, D., Fadel, E., Mercier, O., Stephan, F., Viard, P., Cerrina, J., Dorfmuller, P., Feuillet, S., Ghigna, M., Hervén, P., Le Roy Ladurie, F., Le Pavec, J., Thomas de Montpreville, V., Lamrani, L., Castier, Y., Cerceau, P., Francis, F., Lesèche, G., Allou, N., Augustin, P., Boudinet, S., Desmard, M., Dufour, G., Montravers, P., Dauriat, G., Jébrak, G., Mal, H., Marceau, A., Métivier, A.‐C., Thabut, G., Ait Ilalne, B., Falcoz, P., Massard, G., Santelmo, N., Ajob, G., Collange, O., Helms, O., Hentz, J., Roche, A., Bakouboula, B., Degot, T., Dory, A., Hirschi, S., Ohlmann‐Caillard, S., Kessler, L., Schuller, A., Bennedif, K., Vargas, S., Bonnette, P., Chapelier, A., Puyo, P., Sage, E., Bresson, J., Caille, V., Cerf, C., Devaquet, J., Dumans‐Nizard, V., Felten, M.L., Fischler, M., Si Larbi, A.G., Leguen, M., Ley, L., Liu, N., Trebbia, G., De Miranda, S., Douvry, B., Gonin, F., Grenet, D., Hamid, A.M., Neveu, H., Parquin, F., Picard, C., Stern, M., Bouillioud, F., Cahen, P., Colombat, M., Dautricourt, C., Delahousse, M., D'Urso, B., Gravisse, J., Guth, A., Hillaire, S., Honderlick, P., Lequintrec, M., Longchampt, E., Mellot, F., Scherrer, A., Temagoult, L., Tricot, L., Vasse, M., Veyrie, C., Zemoura, L., Berjaud, J., Brouchet, L., Le Balle, F, Mathe, O., Benahoua, H., Didier, A., Goin, A.L., Murris, M., Crognier, L., and Fourcade, O.

Abstract

Chronic lung allograft dysfunction (CLAD) is the major limitation of long‐term survival after lung transplantation. CLADmanifests as bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS). Alloimmune reactions and epithelial‐to‐mesenchymal transition have been suggested in BOS. However, little is known regarding the role of allogenicity in epithelial cell differentiation. Primary human bronchial epithelial cells (BECs) were treated with activated T cells in the presence or absence of transforming growth factor (TGF)‐β. The expression of epithelial and mesenchymal markers was investigated. The secretion of inflammatory cytokines and matrix metalloproteinase (MMP)‐9 was measured in culture supernatants and in plasma from lung transplant recipients (LTRs): 49 stable, 29 with BOS,and 16 with RAS. We demonstrated that C‐C motif chemokine 2 secreted by T cells supports TGF‐β–induced MMP‐9 production by BECsafter binding to C‐C chemokine receptor type 2. Longitudinal investigation in LTRsrevealed a rise in plasma MMP‐9 before CLADonset. Multivariate analysis showed that plasma MMP‐9 was independently associated with BOS(odds ratio [OR] =6.19, p = 0.002) or RAS(OR= 3.9, p = 0.024) and predicted the occurrence of CLAD12 months before the functional diagnosis. Thus, immune cells support airway remodeling through the production of MMP‐9. Plasma MMP‐9 is a potential predictive biomarker of CLAD. The authors investigate the production of matrix metalloproteinase‐9 by primary bronchial epithelial cells after interaction with activated T cells and show that plasma matrix metalloproteinase‐9 can serve as a predictor of chronic lung allograft dysfunction 12 months before clinical diagnosis.

Published
2017
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6. Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report.

Author

Oulehri W, Cristinar M, Ajob G, Marguerite S, Heger B, Cebula H, Kindo M, and Mertes PM

Subjects
Adult, Anticoagulants therapeutic use, Humans, Ischemic Stroke diagnostic imaging, Ischemic Stroke etiology, Male, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest physiopathology, Shock, Cardiogenic diagnosis, Shock, Cardiogenic physiopathology, Treatment Outcome, Decompressive Craniectomy, Heart-Assist Devices, Ischemic Stroke surgery, Out-of-Hospital Cardiac Arrest therapy, Prosthesis Implantation adverse effects, Prosthesis Implantation instrumentation, Shock, Cardiogenic therapy, Ventricular Function, Left
Abstract

Background: Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy., Case Presentation: A 39-year-old man presented with cardiogenic shock following an out-of-hospital cardiac arrest. After a period of stabilization, the patient was referred for LVAD placement. Upon recovery from anesthesia, he presented with acute neurological deficits suggestive of IS. A brain computed tomography confirmed the diagnosis, and an emergency decompressive hemicraniectomy (DHC) was performed. Anticoagulation was managed empirically. The patient's neurological status progressively improved and he was referred for heart transplantation at five months from DHC. One month later, cranioplasty was performed., Conclusions: This report suggests an anticoagulation management approach in combination with decompressive craniectomy after IS in a patient with LVAD placement was successful. An optimized anticoagulation management and collaborative team-based practice may contribute to successful outcomes in complex cases.

Published
2020
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7. Left ventricular assist device-associated infections: incidence and risk factors.

Author

Rahal A, Ruch Y, Meyer N, Perrier S, Minh TH, Schneider C, Lavigne T, Marguerite S, Ajob G, Cristinar M, Epailly E, Mazzucotelli JP, and Kindo M

Abstract

Background: Left ventricular assist device (LVAD)-associated infections are major complications that can lead to critical outcomes. The aims of this study were to assess the incidence of and to determine the risk factors for LVAD-associated infections., Methods: We included all consecutive patients undergoing LVAD implantation between January 1, 2010, and January 1, 2019, in a single institution. Infection-related data were retrospectively collected by review of patient's medical files. LVAD-associated infections were classified into three categories: percutaneous driveline infections, pocket infections and pump and/or cannula infections., Results: We enrolled 72 patients. Twenty-one (29.2%) patients presented a total of 32 LVAD-associated infections. Eight (38.1%) patients had more than one infection. Five (62.5%) pocket infections and one (50.0%) pump and/or cannula infection were preceded by a driveline infection. The median delay between the operation and LVAD-associated infection was 6.5 (1.4-12.4) months. The probability of having a LVAD-associated infection at one year after receiving an implant was 26.6% (95% CI: 17.5-40.5%). Percutaneous driveline infections represented 68.7% of all LVAD-associated infections. Staphylococcus aureus and coagulase-negative staphylococci were the predominant bacteria in LVAD-associated infections (53.1% and 15.6%, respectively). Hospital length of stay (sdHR =1.22 per 10 days; P=0.001) and postoperative hemodialysis (sdHR =0.17; P=0.004) were statistically associated with infection. Colonization with multidrug-resistant bacteria was more frequent in patients with LVAD-associated infections than in others patients (42.9% vs . 15.7%; P=0.013)., Conclusions: LVAD-associated infections remain an important complication and are mostly represented by percutaneous driveline infections. Gram-positive cocci are the main pathogens isolated in microbiological samples. Patients with LVAD-associated infections are more frequently colonized with multidrug-resistant bacteria., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.03.26). The authors have no conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)

Published
2020
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8. Minimally invasive surgery for left ventricular assist device implantation is safe and associated with a decreased risk of right ventricular failure.

Author

Carmona A, Hoang Minh T, Perrier S, Schneider C, Marguerite S, Ajob G, Mircea C, Mertes PM, Ramlugun D, Atlan J, Von Hunolstein JJ, Epailly E, Mazzucotelli JP, and Kindo M

Abstract

Background: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is associated with significant mortality and morbidity. The objective of this study was to determine pre- and postoperative risk factors associated with the occurrence of RVF after LVAD implantation., Methods: This retrospective study included 68 patients who received LVADs between 2010 and 2018 either for bridge to transplant (40 patients, 58.8%) or bridge to destination therapy (28 patients, 41.2%). RVF after LVAD implantation was defined according to the INTERMACS classification. The primary endpoint was the occurrence of RVF. The secondary endpoints were hospital mortality and morbidity and long-term survival., Results: The majority of patients (61.8%) had an INTERMACS profile 1 (36.8%) or 2 (25.0%). The LVAD was implanted either by sternotomy (37 patients, 54.4%) or thoracotomy (31 patients, 45.6%). RVF after LVAD implantation was observed in 32 patients (47.1%). In univariate analysis, an elevated serum glutamic oxaloacetic transaminase (SGOT) (P=0.028) and a high preoperative vasoactive inotropic score (VIS) (P=0.028) were significantly associated with an increased risk of RVF, whereas the implantation of LVAD through a thoracotomy approach was associated with a significant reduction in this risk (P=0.006). The multivariate analysis demonstrated that only the thoracotomy approach was significantly associated with decreased risk of RVF (odds ratio =0.33, 95% confidence interval: 0.17-0.96; P=0.042). Hospital mortality was 53.1% and 5.6% in the RVF and control groups, respectively (P<0.0001). The incidence of stroke and postoperative acute renal failure were significantly increased in the RVF group compared with the control group. The survival after LVAD implantation was 33.5%±9.0% and 85.4%±6.0% at 1 year in the RVF and control groups, respectively (P<0.0001)., Conclusions: LVAD implantation by thoracotomy significantly reduced the risk of postoperative RVF. This surgical approach should, therefore, be favored., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.02.32). The authors have no conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)

Published
2020
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9. In Trauma Patients, the Occurrence of Early-Onset Nosocomial Infections is Associated With Increased Plasma Concentrations of Chromogranin A.

Author

Schneider F, Marban C, Ajob G, Helle S, Guillot M, Launoy A, Maestraggi Q, Scavello F, Rohr O, and Metz-Boutigue MH

Subjects
Adult, Age of Onset, Female, Humans, Male, Microscopy, Fluorescence, Middle Aged, Peptide Fragments blood, THP-1 Cells, Chromogranin A blood, Cross Infection blood, Wounds and Injuries blood
Abstract

In previously healthy persons suffering from acute illnesses, nosocomial infections (NIs) are frequent. Their prevalence suggests the existence of as yet unknown conditions that may promote care-related infection. This study assessed whether the measurement of plasma chromogranin A, a stress-related protein involved in innate defense, is related to NI risk, and whether any chromogranin A-derived fragment included in vasostatin-I displays immunosuppressive activities related to AP-1 or NF-kappa B downregulation. At the clinical level, trauma patients and healthy controls were recruited to be eligible. Clinical histories were recorded, and standard biological tests (including plasma chromogranin A) were performed. For 9 randomly chosen patients and 16 controls, the time-dependent concentrations of chromogranin A (CGA) were assessed twice a day over 66 h. The data show that trauma patients present a higher value of CGA concentration during 66 h in comparison with healthy controls. In addition, patients maintaining this significant increase in CGA readily develop NIs. We therefore studied the effects of chromogranin A-derived peptides on monocytes, focusing on transcription factors that play a central role in inflammation. In vitro assay demonstrated that a chromogranin A-derived fragment (CGA47-70) displays a significant inhibition of NF-kappa B and AP-1 transcriptional activities in these cells. In conclusion, the occurrence of NI in trauma patients is associated with significantly increased plasma CGA concentrations. Downregulation of the two transcription factors by CGA47-70 might induce early acquired immune defect after a serious medical stress.

Published
2018
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10. Impact of prosthesis-patient mismatch on early haemodynamic status after aortic valve replacement.

Author

Kindo M, Minh TH, Perrier S, Petit-Eisenmann H, Bentz J, Cristinar M, Ajob G, Collange O, and Mazzucotelli JP

Subjects
Aged, Aortic Valve Stenosis blood, Coronary Artery Bypass, Female, Hemodynamics physiology, Humans, Male, Middle Aged, Natriuretic Peptide, Brain blood, Prospective Studies, Time Factors, Treatment Outcome, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Prosthesis Fitting
Abstract

Objectives: Prosthesis-patient mismatch (PPM) has been reported to impact early haemodynamic status and early mortality after prosthetic aortic valve replacement (AVR) in patients with aortic stenosis (AS). The aim of this study was to assess the impact of PMM on early haemodynamic status after AVR using vasoactive-inotropic dependency index (VDI), postoperative pressures and end-organ perfusion., Methods: A total of 183 patients with AS were included in this prospective cohort study, and underwent elective AVR with or without combined coronary artery bypass graft surgery. PPM was defined as a projected indexed effective orifice area of ≤0.85 cm 2 /m 2 , and was present in 27.9% of the patients. The primary end-point was the VDI [VDI = vasoactive-inotropic score/mean arterial pressure] measured upon admission to the intensive care unit (POD0) and on the morning of the first postoperative day (POD1). The secondary end-points were the following: mean left atrial pressure, mean central venous pressure, fluid balance, brain natriuretic peptide, troponin I, glomerular filtration rate and lactate levels on POD0 and POD1., Results: No significant differences in VDI were observed between the no PPM and PPM groups on POD0 (0.08 ± 0.48 vs 0.05 ± 0.13, respectively, P = 0.622) or on POD1 (0.09 ± 0.40 vs 0.06 ± 0.13, respectively; P = 0.583). The mean arterial pressure, mean left atrial pressure, central venous pressure, troponin I, glomerular filtration rate and lactate levels did not differ between the two groups on POD0 and POD1, as well as fluid balance and brain natriuretic peptide on POD1., Conclusions: PPM is not associated with early haemodynamic status impairment and end-organ perfusion after AVR., Clinical Trial Number: ClinicalTrials.gov number, NCT00699673., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Published
2017
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