Endovascular repair for acute traumatic transection of the descending thoracic aorta: experience of a single centre with a 12-years follow up

Background: Most blunt aortic injuries occur in the proximal proximal descending aorta causing acute transection of this vessel. Generally, surgical repair of the ruptured segment of aorta is associated with high rates of morbidity and mortality and in this view endovascular treatment seems to be a valid and safer alternative. Aim of this article is to review our experience with endovascular approach for the treatment of acute traumatic rupture of descending thoracic aorta. Methods: From April 2002 to November 2014, 11 patients (9 males and 2 females) were referred to our Department with a diagnosis of acute transection of thoracic aorta. Following preoperative Computed Tomography (CT) evaluation, thoracic endovascular aortic repair (TEVAR) with left subclavian artery coverage was performed. Follow-up consisted clinical and instrumental (CT, Duplex ultrasound) controls at discharge, 1, 3 and 6 months and yearly thereafter. Results: At 12-year follow up, the overall survival for the entire patients cohort was 100 %, no major or minor neurological complications and no episode of left arm claudication occurred. Cardiovascular, respiratory and bleeding complications, in the early period, was represented by minor, non fatal events. No stent graft failure, collapse, leak or distal migration were detected at CT scan during the entire follow up period. Conclusions: According to our experience, despite the small number of patient population, TEVAR procedure with with left subclavian artery coverage, performed in emergency settings, seems to provide excellent long term results. Trials registration: The protocol was registered at a public trials registry, www.clinicaltrials.gov (trial identifier NCT02376998)

Environmental Pollution and Peripheral Artery Disease

Peripheral artery disease (PAD) of the lower limbs represents one of the most important clinical conditions among vascular disease and can negatively impact quality of life of affected patients, representing also an important socioeconomic burden. Several risk factors predispose to PAD and its complications. Nevertheless, the role of pollution in this context has not been fully evaluated and this article explored the most updated information on epidemiology and environmental pollution in order to hypothesize the possible contribution of air pollution in the onset of PAD. Pollution is an important problem for the global community and has harmful effects on human health and cardiovascular system, and, specifically, particulate matter 10 (PM10) was found significantly associated with PAD

Solving the Set Covering Problem with Conflicts on Sets: A new parallel GRASP

In this paper, we analyze a new variant of the well-known NP-hard Set Covering Problem, characterized by pairwise conflicts among subsets of items. Two subsets in conflict can belong to a solution provided that a positive penalty is paid. The problem looks for the optimal collection of subsets representing a cover and minimizing the sum of covering and penalty costs. We introduce two integer linear programming formulations and a quadratic one for the problem and provide a parallel GRASP (Greedy Randomized Adaptive Search Procedure) that, during parallel executions of the same basic procedure, shares information among threads. We tailor such a parallel processing to address the specific problem in an innovative way that allows us to prevent redundant computations in different threads, ultimately saving time. To evaluate the performance of our algorithm, we conduct extensive experiments on a large set of new instances obtained by adapting existing instances for the Set Covering Problem. Computational results show that the proposed approach is extremely effective and efficient providing better results than Gurobi (tackling three alternative mathematical formulations of the problem) in less than 1/6 of the computational time

Use of FTA® classic cards for epigenetic analysis of sperm DNA

FTA® technologies provide the most reliable method for DNA extraction. Although FTA technologies have been widely used for genetic analysis, there is no literature on their use for epigenetic analysis yet. We present for the first time, a simple method for quantitative methylation assessment based on sperm cells stored on Whatman FTA classic cards. Specifically, elution of seminal DNA from FTA classic cards was successfully tested with an elution buffer and an incubation step in a thermocycler. The eluted DNA was bisulfite converted, amplified by PCR, and a region of interest was pyrosequenced

Social capital in chronic disease: an ethnographic study

Chronically ill conditions are particularly difficult to manage because of their impact both on the social and on the corporal sphere to such an extent as to involve a series of problems that negatively alter the quality of life of affected patients. Chronicity has also a considerable ef-fect on social capital. In the current literature, it is known that social capital may contribute to a range of advantages to people health. Chronic Venous Disease (CVD) includes several pathologi-cal alterations of the venous system of the lower limbs that cause a wide range of symptoms and signs. The aim of this study is to explore, with a qualitative approach, the dynamics of social cap-ital within people's experience of CVD and describe the roles of family and friends and the health care system. The method used is based on face-to-face semistructured interviews was performed, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Six-teen patients were included: 11 women and 5 men. The results obtained are completely in line with the current literature, which shows a certain difficulty in terms of daily activities, pain management; work-related difficulties; non-coverage of healthcare costs for medications and drugs prescribed. In the context of social capital, the bonding social capital of the patients inter-viewed was more positively perceived in the role of CVD management than by the patients' fami-lies. Another interesting result concerns the total absence of knowledge of patient associations with CVD. Thus, alongside the biographical destruction that CVD entails, there is evidence of the scarce relevance and presence of health policies capable of improving the quality of life of these people not only from a social and medical point of view but also from an economic point of vie

Ruptured Left Subclavian Artery Aneurysm in a 41-Year-Old Woman with Neurofibromatosis Type 1

Abstract Introduction Intrinsic lesions of the arterial wall are important manifestations of Neurofibromatosis type 1. Report A 41-year-old woman with Neurofibromatosis type 1, suffering sudden onset of upper back as well as left shoulder and upper chest pain is addressed to our hospital. The contrast-enhanced thoracic computed tomogram demonstrated a huge hematoma due to ruptured left subclavian artery aneurysm treated with endovascular therapy. Discussion A ruptured left subclavian artery is an uncommon but life threatening manifestation in Neurofibromatosis type 1

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

Aortic banding and endovascular aneurysm repair in a case of juxtarenal aortic aneurysm with unsuitable infrarenal neck

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DeepEOR: automated perioperative volumetric assessment of variable grade gliomas using deep learning

PURPOSE Volumetric assessments, such as extent of resection (EOR) or residual tumor volume, are essential criterions in glioma resection surgery. Our goal is to develop and validate segmentation machine learning models for pre- and postoperative magnetic resonance imaging scans, allowing us to assess the percentagewise tumor reduction after intracranial surgery for gliomas. METHODS For the development of the preoperative segmentation model (U-Net), MRI scans of 1053 patients from the Multimodal Brain Tumor Segmentation Challenge (BraTS) 2021 as well as from patients who underwent surgery at the University Hospital in Zurich were used. Subsequently, the model was evaluated on a holdout set containing 285 images from the same sources. The postoperative model was developed using 72 scans and validated on 45 scans obtained from the BraTS 2015 and Zurich dataset. Performance is evaluated using Dice Similarity score, Jaccard coefficient and Hausdorff 95%. RESULTS We were able to achieve an overall mean Dice Similarity Score of 0.59 and 0.29 on the pre- and postoperative holdout sets, respectively. Our algorithm managed to determine correct EOR in 44.1%. CONCLUSION Although our models are not suitable for clinical use at this point, the possible applications are vast, going from automated lesion detection to disease progression evaluation. Precise determination of EOR is a challenging task, but we managed to show that deep learning can provide fast and objective estimates

Using Pathway Signatures as Means of Identifying Similarities among Microarray Experiments

Widespread use of microarrays has generated large amounts of data, the interrogation of the public microarray repositories, identifying similarities between microarray experiments is now one of the major challenges. Approaches using defined group of genes, such as pathways and cellular networks (pathway analysis), have been proposed to improve the interpretation of microarray experiments. We propose a novel method to compare microarray experiments at the pathway level, this method consists of two steps: first, generate pathway signatures, a set of descriptors recapitulating the biologically meaningful pathways related to some clinical/biological variable of interest, second, use these signatures to interrogate microarray databases. We demonstrate that our approach provides more reliable results than with gene-based approaches. While gene-based approaches tend to suffer from bias generated by the analytical procedures employed, our pathway based method successfully groups together similar samples, independently of the experimental design. The results presented are potentially of great interest to improve the ability to query and compare experiments in public repositories of microarray data. As a matter of fact, this method can be used to retrieve data from public microarray databases and perform comparisons at the pathway level