Preliminary Analysis of the Effects of Ad26.COV2.S Vaccination on CT Findings and High Intensive Care Admission Rates of COVID-19 Patients

On 27 February 2021, the Food and Drug Administration(FDA) authorized the administration of the adenovirus-based Ad26.COV2-S vaccine (J&J-Janssen) for the prevention of COVID-19, a viral pandemic that, to date, has killed more than 5.5 million people. Performed during the early phase of the COVID-19 4th wave, this retrospective observational study aims to report the computerized tomography (CT) findings and intensive care unit admission rates of Ad26.COV2-S-vaccinated vs. unvaccinated COVID-19 patients. From the 1st to the 23rd of December 2021, all confirmed COVID-19 patients that had been subjected to chest non-contrast CT scan analysis were enrolled in the study. These were divided into Ad26.COV2.S-vaccinated (group 1) and unvaccinated patients (group 2). The RSNA severity score was calculated for each patient and correlated to CT findings and type of admission to a healthcare setting after CT-i.e., home care, ordinary hospitalization, sub-intensive care, and intensive care. Descriptive and inference statistical analyses were performed by comparing the data from the two groups. Data from a total of 71 patients were collected: 10 patients in group 1 (4M, 6F, mean age 63.5 years, SD ± 4.2) and 61 patients in group 2 (32M, 29F, mean age 64.7 years, SD ± 3.7). Statistical analysis showed lower values of RSNA severity in group 1 compared to group 2 (mean value 14.1 vs. 15.7, p = 0.009, respectively). Furthermore, vaccinated patients were less frequently admitted to both sub-intensive and high-intensive care units than group 2, with an odds ratio of 0.45 [95%CI (0.01; 3.92)]. Ad26.COV2.S vaccination protects from severe COVID-19 based on CT severity scores. As a result, Ad26.COV2.S-vaccinated COVID-19 patients are more frequently admitted to home in comparison with unvaccinated patients

A multicenter retrospective cohort study evaluating the clinical outcomes of patients with coagulopathy undergoing transcatheter arterial embolization (tae) for acute non-neurovascular bleeding

Background and Objectives: Transcatheter arterial embolization (TAE) is the mainstay of treatment for acute major hemorrhage, even in patients with coagulopathy and spontaneous bleeding. Coagulopathy is associated with worsening bleeding severity and higher mortality and clinical failure rates. Furthermore, some unanswered questions remain, such as the definition of coagulopathy, the indication for TAE or conservative treatment, and the choice of embolic agent. This study aims to assess the efficacy and safety of TAE for spontaneous non-neurovascular acute bleeding in patients with coagulopathy. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients with coagulopathy who had undergone, from January 2018 to May 2023, transcatheter arterial embolization for the management of spontaneous hemorrhages. Results: During the study interval (January 2018–May 2023), 120 patients with coagulopathy underwent TAE for spontaneous non-neurovascular acute bleeding. The abdominal wall was the most common bleeding site (72.5%). The most commonly used embolic agent was polyvinyl alcohol (PVA) particles or microspheres (25.0%), whereas coils and gelatin sponge together accounted for 32.5% of the embolic agents used. Technical success was achieved in all cases, with a 92.5% clinical success rate related to 9 cases of rebleeding. Complications were recorded in 12 (10%) patients. Clinical success was significantly better in the group of patients who underwent correction of the coagulopathy within 24 h of TAE. Conclusions: Transcatheter arterial embolization (TAE) is effective and safe for the management of acute non-neurovascular bleeding in patients with coagulopathy. Correction of coagulopathy should not delay TAE and vice versa, as better clinical outcomes were noted in the subgroup of patients undergoing correction of coagulopathy within 24 h of TAE

Endovascular treatment of visceral artery pseudoaneurysms with ethylene-vinyl alcohol (evoh) copolymer-based non-adhesive liquid embolic agents (naleas)

Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always indicated regardless of their diameters, as their risk of rupture is significantly higher than that of visceral artery aneurysms. The invasiveness of surgery and its associated complications have led to a shift in favor of radiological interventions as the initial treatment of choice. However, there are still some unanswered questions on endovascular treatment of VAPs regarding the optimal endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed. Technical success was achieved in all patients. The clinical success rate was high (92.1% overall), with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients (18.4%) experienced procedure-related complications, related to one case of non-target embolization, four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of procedure-related complications, end-organ infarction, and vascular access-site complications did not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based endovascular embolization. We suggest considering the use of NALEAs, particularly in specific clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels, and embolization targets that are located at a considerable distance from the microcatheter tip and are otherwise difficult to reach

Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature

Introduction: Vacuum-assisted breast biopsy (VABB) has been evaluated as a minimally invasive, safe, and accurate procedure with low complication risks; the most frequent one is the mild/moderate hematoma, which occurs with a low-frequency rate, and the majority of patients who experienced it can be treated successfully with only manual compression and dressing. Although cases of uncontrollable catastrophic bleeding are exceedingly rare, local breast vessel involvement is a concrete risk, even in patients with no bleeding propensity. Case Presentation: In this article, we aimed to describe a 60 years-old woman who, following VABB, experienced a massive hematoma without external bleeding and was successfully treated with embolization. The woman was called back for a cluster of suspicious microcalcifications identified in the left breast’s upper-outer quadrant; however, following histopathological analysis, the few samples collected were negative. She had a silent past medical history, 100% performance status, and no active pharmacotherapy. Approximately 15–30 min after VABB, the patient complained of weakness, pain, and lipothymia. A physical examination revealed a massive hematoma without external bleeding. Clinical data reported PaO 65/40 mmHg and blood chemistry Hb < 10 g/dL. The emergency team was alerted to stabilize the patient, and after that, the breast hemorrhage was controlled by endovascular embolization. Despite this being a rare occurrence, it is important to draw up and follow an appropriate protocol to ensure proper patient management and early treatment. Discussion: This case illustrates the prompt and accurate management of a rare complication following VABB. Due to the very high number of patients undergoing this particular procedure, we aim to point out the concrete risk of vascular injury; other similar cases are described to support our thesis and provide different clinical manifestations of this rare occurrence

Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

OBJECTIVE: To evaluate the effectiveness of endovascular treatment of abdominal aortic aneurysms with hostile neck, comparing the results with those of patients with ideal anatomical conditions. MATERIALS AND METHODS: From January 2005 to December 2013, 300 patients were treated with EVAR at our institution. Patients with a prior Angio-CT scan were included in the study and they were then retrospectively divided into two groups: patients with suitable anatomy that were treated within guidelines of the manufacturers (wIFU: 94 patients, four treated in emergency) and those with unsuitable anatomy that were treated outside of said guidelines (oIFU: 70 patients, 16 treated in emergency). Patients without prior CT study and without follow-up were excluded from the study. RESULTS: Postoperative mortality was 6.3 % in the wIFU group while it was 7.8 % in the oIFU group. There was not a statistically significant difference in the rate of postoperative mortality (p = 0.653). Technical success was 98.6 % in the wIFU group while it was 94.5 % in the oIFU group. All the patients of the wIFU group were treated with a stent-graft with under-renal sealing while in the oIFU group always an over-renal stent-graft was used. No deaths related to the aneurysm were highlighted at follow-up in both groups. There was a statistically significative difference between the two groups regarding intraoperative occlusion of renal arteries (wIFU = 1.1 %; oIFU = 4.7 %; p < 0.05) and in the development of type I endoleak (wIFU = 2.8 %; oIFU = 8.8 %; p < 0.05) CONCLUSION: EVAR in patients with hostile neck is feasible and effective with an acceptable rate of complications

Comparison of clinical results after augmented versus direct surgical repair of acute Achilles tendon rupture

Achilles tendon rupture is frequent and can result in a disabling condition. The ideal method of management remains a matter of debate. We aimed to compare the clinical outcome of patients who underwent surgical repair of Achilles tendon rupture with Silfverskiöld augmentation technique with gastrocnemius fascia flap versus Krackow end-to-end stitching technique

Comparison of clinical results after augmented versus direct surgical repair of acute achilles tendon rupture

Background and aim of the work: Achilles tendon rupture is frequent and can result in a disabling condition. The ideal method of management remains a matter of debate. We aimed to compare the clinical outcome of patients who underwent surgical repair of Achilles tendon rupture with Silfverski\uf6ld augmentation technique with gastrocnemius fascia flap versus Krackow end-to-end stitching technique. Methods: We retrospectively studied all patients that were surgically treated for Achilles tendon rupture at our institution, between January 2000 and December 2015, using either Silfverski\uf6ld or Krackow technique. We excluded all patients deceased or untreaceble, and those refusing the follow up interview. Disability, Quality-of-Life and functional restriction were evaluated using the Achilles-Tendon-total-Rupture-Score (ATRS) and Footand-Ankle-Disability-Index (FADI); means were compared by the Mann-Whitney test and correlations by the Spearman coefficient. Results: A total of 90 patients were included, with a mean age of 45.3\ub112.6 years. The augmented repair group-A included 33 patients and the simple repair group-B 57 patients. Follow-up averaged 8 years (1 to 16). FADI was 103.7\ub11.6 for group-A versus 100.3\ub115.6 for group-B. ATRS was 2.0\ub17.1 and 5.7\ub118.8, respecitvely. Differences were not significant. Age showed a low linear correlation with ATRS (R=0.41) and FADI (R=-0.40), indicating that clinical outcomes minimally tend to worsen in older patients. Conclusions: We didn\u2019t find significative differences in the clinical outcomes between the two groups of patients. Acute uncomplicated Achilles tendon ruptures can be successfully treated with a direct suture technique. Augmentation with a fascial flap should be reserved to chronic or neglected cases with severe tendinosis or tissue defect

CREPE: Mathematical model for crosstalking of endothelial cells and hepatocyte metabolism

The liver shows a close coexistence between endothelial cells and hepatocytes (HepG2). Endothelial cells' main purpose is to protect (HepG2) from blood vessel shear stress, acting as a barrier, but experimental evidence suggests that they could also play a role in regulating (HepG2) glucose metabolism. A well-known singular effect in hepatocyte-endothelial co-cultures is the reduction of glucose consumption respect to (HepG2) in single culture. (HepG2) were shown to reduce their glucose consumption supporting energy needs of endothelial cells. Monti have studied the effects of endothelin-1 (Et-1) on Glucokinase activity in adult rat (HepG2). They observed a reduction in hepatocytes Glucokinase catalytic rate, which is dependent on Et-1 concentration. We developed crosstalking of endothelial cells and hepatocyte metabolism (CREPE) that is a mathematical model of the endothelin-1 mediated crosstalk between HepG2 and endothelial cells (human umbilical vein endothelial cells) in a traditional static co-culture system. CREPE was validated against experimental data, showing good agreement with them

Endoluminal Dilation Technique to Remove Stuck Port-A-Cath: A Case Report

Port-a-cath is a type of central venous catheter (CVC) designed to allow repeated access to the venous system for parenteral delivery of medications, fluids, and nutritional solutions and for sampling venous blood. After years of use or in case of damage, CVC must be removed and eventually replaced: the recovery of the device should normally be easy, with a small surgical incision of the skin and tissues surrounding the device and pulling the catheter. Sometimes, scar tissue can develop around the device, making it resistant to removal even after application of forceful traction. We report a case of stuck port-a-cath that was extracted by using endoluminal dilatation technique