Precision medicine and public health: New challenges for effective and sustainable health

The development of high-throughput omics technologies represents an unmissable opportunity for evidence-based prevention of adverse effects on human health. However, the applicability and access to multi-omics tests are limited. In Italy, this is due to the rapid increase of knowledge and the high levels of skill and economic investment initially necessary. The fields of human genetics and public health have highlighted the relevance of an implementation strategy at a national level in Italy, including integration in sanitary regulations and governance instruments. In this review, the emerging field of public health genomics is discussed, including the polygenic scores approach, epigenetic modulation, nutrigenomics, and microbiomes implications. Moreover, the Italian state of implementation is presented. The omics sciences have important implications for the prevention of both communicable and noncommunicable diseases, especially because they can be used to assess the health status during the whole course of life. An effective population health gain is possible if omics tools are implemented for each person after a preliminary assessment of effectiveness in the medium to long term

Managing anomalous splenic artery aneurysm: a review of the literature and report of two cases

The splenic artery originates from the superior mesenteric artery in approximately 1% of cases,which may explain the extreme rarity of aneurysms involving this anomalous branch, with onlyfive cases reported in the international literature to date. We report our experience of managingtwo patients with aneurysms involving splenic arteries arising from the superior mesentericartery, one treated surgically and the other percutaneously. From a diagnostic point of view, thefirst approach is ultrasound, while computed tomographic (CT) scan and angiography enable abetter definition of the lesion and of the anatomical anomaly; CT angiography is currently themethod of choice for the preoperative workup. Finding these two anomalies in association is sorare that it is impossible to draw any final conclusions as to the best type of treatment. In theauthors' experience, both surgery and percutaneous treatment can prove useful

Trattamento degli aneurismi del tronco celiaco.

Celiac trunk aneurysms, represent about 4%, of all splanchnie aneurysms. They are rare lesions but clinically important because when ruptured are associated with high mortality. We report our experience in the treatment of 3 patients affected by aneurysms involving the celiac trunk, 2 females and1 male, with a median age of 55.3 years (37 - 74). Two were treated surgically and one percutaneously. Based on the Literature data and on personal experience, we suggest that the first diagnostic approach can be echography, while CT scan and angiography improve definition of the lesion and (if they are) of the anatomic anomalies. Concerning treatment, the first choice should be traditional surgery and percutaneous treatment should be reserved to high risk patients

TRAITEMENT DES ANEURISMES DU TRONC C\u152LIAQUE :EXPERIENCE PERSONNELLE ET REVISION DE LA LITTERATURE

INTRODUCTION: Celiac trunk aneurysms represent 4% of all splanchnic artery aneurysms. These lesions are thus extremely rare but yet have a significant clinical importance. Mortality, mainly related to site characteristics, is a significant risk (14%) in the event of rupture. PATIENTS AND METHODS: We put forward our experience in both diagnosis and treatment in three patients, two women and one man (average age 55.3 years, range 35-74), presenting aneurysms involving the celiac trunk. The preoperative diagnosis was established successively with ultrasonography, CT scan and angiography. Two patients were treated via an open surgical approach while endovascular percutaneous treatment was performed for the third patient. RESULTS: Mortality was null at 13 days on average from admission for the surgical patients and 4 days for the patient treated endovascularly. Postoperative complications were modest: pulmonary thickening with pleural effusion for the two surgical patients (spontaneous resolution), while for the third patient treated with an endovascular method, the stent migrated to a splanchnic arterial branch, with no consequence for the spleen. The average follow-up was 19 months (range 14-24). Full exclusion of the aneurysm was maintained at four months for the aneurysm treated percutaneously. A patent celiac was also maintained for the patients treated surgically. CONCLUSIONS: Considering the largely unforeseeable outcome and the high risk of rupture, we suggest that all the patients presenting this type of aneurysmal lesion should be treated. This attitude is widely advocated in the literature. Moreover, we noted null mortality in our small series, with only one percutaneous "re-do" case; resolutive at last control. With the present improvement in stent technology, endovascular treatment should be preferred. Patients should be treated surgically only if a percutaneous procedure would be risky or technically unfeasible due to the size of the aneurysm or its anatomic features

Valutazione dei risultati nel confezionamento di anastomosi per fistola artero-venosa con diversi materiali di sutura

Nei pazienti con insufficienza renale cronica la dialisi extracorporea rappresenta tuttora la terapia di prima scelta mediante l'utilizzo di una fistola artero-venosa (FAV) ottenuta anastomizzando una vena ad una arteria al braccio. La FAV va però incontro nel 20% dei casi ad una occlusione entro i primi 20 giorni; a tale incidenza si aggiunge un altro 10% di occlusione ad 1 anno. Uno dei principali meccanismi fisiopatologici chiamati in causa per spiegare l'occlusione e la stenosi oltre alla non perfetta tecnica chirurgica, è l'elevata presenza di turbolenza di flusso che favorisce il danno endoteliale. A ciò si aggiunge la reazione dell'endotelio della rima anastomotica al corpo estraneo rappresentato dal filo di sutura. Alla contemporanea presenza di questi due fattori è dovuto il fatto che nell' 80% dei casi la stenosi si realizza a livello dell'anastomosi e del primo tratto di vena efferente

GASTROESOPHAGEAL REFLUX BEFORE AND AFTER VERTICAL BANDED GASTROPLASTY

Morbid obesity favours, arnong other factors, the gastroesophageal reflux (G.E.R.) with an increase of the mtraabdominal pressure. According to some Authors, the VBG works as an antireflux mechanism, displacing the gastroesophageal junction to the inside of the abdomen and creating a neo-stomach, much like an extension of the esophagu