Precision medicine and precision nursing. The era of biomarkers and precision health

Precision health, by means of the support of precision medicine and precision nursing, is able to support clinical decision making in order to tailor optimal health-care decisions, around the individual characteristics of patients. The operational arm of precision health is represented by the use of biomarkers that can give useful information about disease susceptibility, exposure, evolution and response to treatment. Omics, imaging and clinical biomarkers are actually studied for their ability to positively impact health-care management. In this article, we try to address the role of biomarkers in the context of modern medicine and nursing with the view of improving patients care

Arteria lusoria dissection with mediastinal hematoma as a complication of a transradial coronary catheterization. Case report and literature review

INTRODUCTION: Aberrant right subclavian artery (ARSA), or arteria lusoria is the most common embro-logic anomaly of the aortic arch. It is generally asymptomatic and incidentally diagnosed during aradiological exam or procedure.PRESENTATION OF CASE: Here, we report a case of ARSA incidentally diagnosed and injured (dissectionwith mediastinal hematoma) during a right transradial coronary angiography in a 83 years old femalepatient. The patient underwent prompt hybrid procedure with the isolation of the right humeral artery from where we positioned a GORE®VIABAHN®9 × 100 mm endoprosthesis. The procedure was successfulwith optimal results at early and long term follow up.DISCUSSION: Sometimes, a dissection of the ARSA may occur, especially for excessive manipulation duringendovascular procedures, and when such complication happens it should be promptly treated as it canbe life-threatening.CONCLUSION: If transradial catheterization during coronary angiography becomes particularly difficult,requires longer time, or the guide wire enters in the descending aorta, particularly attention should bepaid, as dreadful complications such as dissection or lesion may happen and prompt treatment is required

Cardiovascular disease as a biomarker for an increased risk of COVID-19 infection and related poor prognosis

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Infection, infectious agents and vascular disease

Background: Infectious agents may be involved in the pathogenesis of vascular disease and related complications. The aim of this review is to analyze the most relevant information on the common infections related to vascular disease, discussing the main pathophysiological mechanisms. Methods: In the current review, the most important evidences on the issue of infections and vascular disease were searched on Medline, Scopus, and ScienceDirect database. Results: Among infectious agents, herpesviruses, parvovirus B19, hepatitis viruses, human immunodeficiency virus, severe acute respiratory syndrome coronavirus 2, treponema pallidum, mycobacterium tuberculosis, pseudomonas aeruginosa, staphylococcus aureus, and candida albicans seem to particularly related to vascular disease. Conclusion: Infectious agents may affect vessel's homeostasis and functionality, both on the arterial and venous side, by means of several pathophysiological mechanisms such as dysregulation in vasomotor function, thromboembolic complications, initiation and progression of atherosclerosis, alteration of perivascular adipose tissue, recruiting inflammatory cells and molecules

THE ROLE OF HYBRID PROCEDURES IN THE MANAGEMENT OF ILIAC-FEMORAL ARTERIES OCCLUSIVE DISEASE

In the area of iliac-femoral occlusive disease hybrid approach, which consists in endovascular approach at aorta iliac district combined with the simply endarterectomy of the femoral bifurcation, have been considered as an alternative, especially in patients classified to be at a high risk for surgery. The aim of this study is the evaluation of the results in patients treated by hybrid or open surgery in order to establish whether hybrid treatment could be considered a valid first choice alternative. METHODS: This is a retrospective study in order to identify patients treated for iliac femoral atheromasic disease between January 2001 and January 2014. Patients that presented lesions such as TASC C or D have been considered for this study. For the analysis patients will be divided in two main groups: Open Group (OG), which received the open surgery, and Hybrid Group (HG), which received the Hybrid intervention. The HG patients will be divided in two further groups (A e B), whether they presented respectively segmental lesions or continuous lesions from iliac artery to the femoral artery across the groin ligament. Patients with segmental lesions (group A) were treated by femoral open endarterectomy and iliac stenting. In the group B the endarterectomy was extended from the common femoral artery to the iliac artery in a retrograde way and then an iliac uncovered stent was deployed in order to fix the point of interruption of the plaque after retrograde endarterectomy and in the same time to treat the stenosis above this point. RESULTS: Over a frame time of 13 years, 178 limbs in 164 patients treated for iliac femoral atheromasic disease were identified. One hundred limbs were treated by open approach and seventy-eight limbs were treated with hybrid approach. The median follow-up was 5 years (range: 1-13 years) in both groups. Primary patency at 1, 2 and 5 years in HG was respectively 97.5% and 96% vs. 98% and 97% in the OG. Limb salvage rate at 1, 2 and 5 year in the HG was respectively 96.1%, 96.1% and 93.5% vs. 99%, 98% and 98% in the OP. CONCLUSIONS: This study shows that hybrid procedures resulted to be a valid first choice alternative, providing good results in terms of patency and limb salvage rate Furthermore, hybrid procedures were characterized by low 30-day mortality rate and acceptable complications rate considering the significant comorbidities in these patients

Novel biomarkers in cardiovascular surgery

Cardiovascular disease includes health problems related to the heart, arteries and veins and is a significant healthcare problem worldwide. Cardiovascular disease may be acute or chronic and relapses are frequent. Biomarkers involved in this field may help clinicians and surgeons in diagnosis and adequate decision making. Relevant articles searched in the following databases Medline, Scopus, ScienceDirect, were retrieved and analysed. Several biomarkers have been identified and we analyzed those of most importance from a clinical and surgical point of view. Biomarkers can better identify high-risk individuals, facilitate follow-up process, provide information regarding prognosis and better tailor the most appropriate surgical treatment

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Biomarkers for Cardiovascular Surgery Procedures: A Literature Review

Background: Neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been studied so far as prognostic factors of cardiovascular diseases. Their role interplayed with endothelial inflammation, has emerged as optimal predictors for major cardiovascular disease events and as prognostic factors for post-procedural outcomes. Methods: A review of the current literature was undertaken to investigate the relationship between NLR and PLR with percutaneous, cardiac surgery, and vascular surgery procedures. Results: Our findings show that perioperative NLR and PLR levels are significantly correlated with patient morbidity and mortality rates. Conclusions: These biomarkers have several attractive characteristics, as they are inexpensive and quickly available, and they can contribute to the early identification of patients at high risk for periprocedural adverse events

PredyCLU: A prediction system for chronic leg ulcers based on fuzzy logic; part II-Exploring the arterial side

Peripheral arterial disease (PAD) and its most severe form, critical limb ischaemia (CLI), are very common clinical conditions related to atherosclerosis and represent the major causes of morbidity, mortality, disability, and reduced quality of life (QoL), especially for the onset of ischaemic chronic leg ulcers (ICLUs) and the subsequent need of amputation in affected patients. Early identification of patients at risk of developing ICLUs may represent the best form of prevention and appropriate management. In this study, we used a Prediction System for Chronic Leg Ulcers (PredyCLU) based on fuzzy logic applied to patients with PAD. The patient population consisted of 80 patients with PAD, of which 40 patients (30 males [75%] and 10 females [25%]; mean age 66.18 years; median age 67.50 years) had ICLUs and represented the case group. Forty patients (100%) (27 males [67.50%] and 13 females [32.50%]; mean age 66.43 years; median age 66.50 years) did not have ICLUs and represented the control group. In patients of the case group, the higher was the risk calculated with the PredyCLU the more severe were the clinical manifestations recorded. In this study, the PredyCLU algorithm was retrospectively applied on a multicentre population of 80 patients with PAD. The PredyCLU algorithm provided a reliable risk score for the risk of ICLUs in patients with PAD

The Shaggy Aorta Syndrome: an updated review

Shaggy aorta (SA) depicts the severe aortic surface degeneration, extremely friable and likely to cause spontaneous peripheral and visceral embolization or during catheterization, aortic manipulation, surgery or minimally invasive procedures. This study aims to provide the most accurate and up-to-date information on this disease