Novel biomarkers in cardiovascular surgery

2021 ◽  
Vol 15 (4) ◽  
pp. 307-318
Author(s):  
Raffaele Serra ◽  
Federica Jiritano ◽  
Umberto M Bracale ◽  
Nicola Ielapi ◽  
Noemi Licastro ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Decision Making ◽  
Surgical Treatment ◽  
High Risk ◽  
Cardiovascular Surgery ◽  
Health Problems ◽  
Point Of View ◽  
Novel Biomarkers ◽  
Arteries And Veins

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.

Abstract P395: High Risk Diabetics Risk of Recurrent Stroke and Cardiovascular Disease Persists Even With Patient Personalized Subspecialty Care

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Hannah Branstetter ◽  
Natalie Buchwald ◽  
Esther Olasoji ◽  
Meghan Humbert ◽  
Rondalyn Dickens ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Nursing Education ◽  
High Risk ◽  
Cardiovascular Event ◽  
Stroke Prevention ◽  
Diabetes Education ◽  
Reperfusion Therapy ◽  
Interquartile Range ◽  
Medication Change

Introduction: Diabetes management is an important aspect of stroke prevention. To our knowledge, studies that focus specifically on the role of multidisciplinary teams for adjusting diabetes medications and diabetes education for stroke and cardiovascular disease prevention to compliment standard stroke prevention and nursing education are lacking. Here we sought to evaluate whether high risk diabetics, hemoglobin A1c (HA1c) > 8%, admitted secondary to stroke would benefit from a multidisciplinary team model that also incorporates endocrinology consultation and diabetes education to personalized nursing education and education and management of the admitting service. Methods: Data was obtained from our Institutional Review Board approved stroke admission database from 2017 to November 2019. Regression analysis was used to identify significant associations between diabetes education (DE) and endocrine consultation (EC) with readmission rates with 30 days, re-admission within 30 days secondary to stroke, cardiovascular event or stroke within a year of the stroke admission, and medication change after controlling for age, sex, NIHSS, HbA1c, low density lipoprotein (LDL), reperfusion therapy for acute stroke. Follow-up HbA1c post hospitalization was available for only 17% of the population, and was not included in the regression models. Results: A total of 202 patients were included, median age 66 (interquartile range 56-75), 43% women, NIHSS median 5 (interquartile range (IQR, 2-9), LDL median 105 (IQR, 69-155), A1c median 9.5 (IQR, 8.5 -11.1), and 24% received reperfusion therapy. EC was associated with higher likelihood of a medication change (odds ratio (OR) 9.43, 95% confidence interval (CI) (3.22-30.69). DE was associated with younger age (OR 0.96, 95% CI 0.92-0.99); higher A1c value (OR 1.47, 95% CI 1.18 - 1.87) and higher likelihood of cardiovascular event within a year of the stroke (OR 3.38, 95% CI 1.23 - 9.70). Conclusion: While the endocrine consultation does lead to medications changes with the intent of improving post discharge glycemic control, cardiovascular events were still more likely, possibly from DM disease severity. Further continuation of follow up of these patients with EC and DE after hospital discharge may be needed.

scholarly journals Aggressive angiomyxoma of the perineal region

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984339 ◽  
Author(s):  
Clémence Raptin ◽  
Jean-Philippe Lucot ◽  
Alfred Bassil ◽  
Edouard Poncelet ◽  
Jean-François Prolongeau ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
High Risk ◽  
Genital Prolapse ◽  
Aggressive Angiomyxoma ◽  
Rare Tumour ◽  
Long Term Follow Up ◽  
Perineal Region

Aggressive angiomyxoma is a rare tumour that frequently involves the perineal region with a high risk of local recurrence. This is a case report of a 24-year-old female patient with a genital prolapse. We performed a surgical treatment. Histological examination found an aggressive angiomyxoma. The tumour recurred 1 year after surgery. Long-term follow-up is necessary.

scholarly journals A Cognitive Development Chart for School-age Children and Adolescents

2019 ◽  
Author(s):  
André R. Simioni ◽  
Daniel S. Pine ◽  
João R. Sato ◽  
Pedro M. Pan ◽  
Rochele Paz Fonseca ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Cognitive Development ◽  
High Risk ◽  
Children And Adolescents ◽  
Mental Health Professionals ◽  
Mental Health Problems ◽  
Health Problems ◽  
Predictive Utility

ABSTRACTObjectiveTo evaluate the reliability and predictive utility of a time-efficient cognitive development chart that seeks to identify children and adolescents with high-risk for multiple outcomes such as mental health problems, substance use, and educational difficulties.MethodWe analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders (HRC), a longitudinal school-based study conducted from 2010-2011 to 2013-2014. Participants were 2,239 children and adolescents, 6 to 17 years of age, who completed the cognitive assessment at baseline. The task used to track cognitive development was the Two Choice Reaction Time task (<3 minutes of duration, computer-based), which assesses the accuracy and speed of perceptual decision-making. Mental health, substance use, and educational outcomes were assessed by validated standardized methods. Key variables were measured at baseline and 3-year follow-up. The predictive utility was assessed using static (deviations from the age-expected performance at baseline) and dynamic (deviations from the age-expected change in performance over time) indicators.ResultsThe reliability of the task parameter was high (intra-class correlation coefficient = 0.8). Static indicators of cognitive development significantly predicted concurrent mental, intellectual and educational difficulties, as well as incident and persistent educational difficulties and substance use in the 3-year follow-up. Dynamic indicators predicted persistent mental health problems.ConclusionPrimary-care and mental health professionals need a time-efficient tool for tracking deviations from age-expected cognitive development, which predicts multiple unwanted outcomes at the same time. If replicated, future results could support the generation of tools for tracking risk for mental health, substance use, and educational difficulties.

scholarly journals SURGICAL TREATMENT OF ATRIAL FIBRILLATION IN ELDERLY PATIENTS UNDERGOING HIGH RISK CARDIAC SURGERY

2021 ◽  
Author(s):  
Mohsin Uzzaman ◽  
Imthiaz Manoly ◽  
Mohini Panikkar ◽  
Maciej Matuszewski ◽  
Nicolas Nikolaidis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Surgical Treatment ◽  
High Risk ◽  
Elderly Patients ◽  
Control Group ◽  
Surgical Ablation ◽  
Af Ablation

BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

Informed decision making (IDM) for prostate cancer (PCa) screening in a high-risk population.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 112-112 ◽  
Author(s):  
Puneet Dhillon ◽  
Petros Grivas ◽  
Paola Raska ◽  
Devon Hickman ◽  
Paul Elson ◽  
...  
Keyword(s):  
Decision Making ◽  
Family History ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
High Risk Population ◽  
Group Setting ◽  
Incidence And Mortality ◽  
Post Test

112 Background: PCa incidence and mortality in African Americans (AA) is higher than in Caucasians. Health-education programs and culturally appropriate outreach to high-risk groups in accordance with American Cancer Society IDM guidelines can reduce disparities. Data show that it is hard to provide comprehensive unbiased education about screening to patients (pts). This study aims to examine whether IDM guidelines in a large high risk group setting can improve knowledge on PCa and screening decision, and whether such education program is overall beneficial to pts. Methods: Pts were included in one-day outreach event and were given a 15-question pre and post- test focused on standard informative educational PowerPoint and then were offered screening (PSA + DRE). Components of IDM were reviewed during this educational intervention. Demographics and family history was collected and UCSF 10-year mortality index was assessed to help IDM. Pre- and post- test number of correct answers were compared (Wilcoxon signed rank); pts were surveyed on their opinion on the program. The decision regarding screening after the intervention was tracked as well as the % of PCa diagnosed. Pts were tracked via an established navigation system to ensure follow up care. Results: 106 pts were included in the current analysis. Median number of correct answers at pre and post test was 8 and 11 (p < 0.001). Overall, 86% responded that they wanted screening. Of those, 92% were AA and 21% had family history of PCa; 21 pts had PSA only, 60 had PSA + DRE. 13 pts (16%) had abnormal PSA per NCCN guidelines, 5 (8%) had abnormal DRE. 5 PCa were biopsy-diagnosed, 4 had abnormal DRE + PSA; 1 had only abnormal DRE. Overall, 82% pts favored IDM before screening, 18% would prefer screening without IDM. 75% of all pts found the information “very helpful” in decision-making (within a 5-point Likert scale). Conclusions: Our education-based IDM led to significant improvement in knowledge about PCa screening. Most pts preferred education prior to screening. Our approach paired with the use of navigation program is feasible and was positively received by a large high risk group. Project is ongoing with more pts and follow up, and further validation is pending. Clinical trial information: NCT02419846.

Abstract P385: My Unlimited Health Potential: Short term Effect of Participation in a Worksite Lifestyle Intervention Program on Significant Weight Loss and Eligibility Criteria for Bariatric Surgery Among High Risk Individuals

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Lara L Roberson ◽  
Ehimen Aneni ◽  
Sameer Shaharyar ◽  
Ebenezer Oni ◽  
Maribeth Rouseff ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Body Weight ◽  
High Risk ◽  
Disease Risk ◽  
Morbidly Obese ◽  
Metabolic Risk ◽  
Short Term

Background: Current recommendations support bariatric surgery among the morbidly obese as an option to mitigate future risk of cardiovascular disease, diabetes and hypertension. To date, there is little evidence on the effect of extensive lifestyle interventions among those high-risk individuals in reducing the need for such procedures. Methods: The purpose of the present study was to examine the efficacy of an intensive lifestyle workplace intervention on significant body weight and cardiovascular disease risk factors across the spectrum of obesity. Changes in BMI were measured from baseline to 12 week follow up, along with corresponding improvements in cardio-metabolic risk. In addition, the decrease in participants meeting criteria for bariatric surgery over the study period was examined. Bariatric surgery criteria were defined as BMI≥40 or BMI between 35 and 40 and at least one of the following co-morbidities: diabetes, hypertension, or high cholesterol. Results: The study population consisted of 169 individuals (49±10 years, 77% female) with BMI≥27 at baseline and complete data at follow-up. A total of 65 (39%) participants lost at least 5% of both their initial BMI and body weight. Additionally, 32% dropped an entire BMI category. Of note, 38%(18 of 48) who were classified as BMI>40 were in BMI 35-39 at follow-up, respectively 37%(13 of 55) of individuals in the BMI category 35-39 successfully moved to the BMI category 30-34 at 3 months follow-up. Sixty-three participants (37% of total) initially met criteria for bariatric surgery. At 12 weeks follow-up 35% (22 of 63) of these candidates no longer qualified. Conclusions: Worksites can be effective for achieving clinically important reductions in body weight and diminish the potential need for procedures among a small proportion of morbidly obese individuals. Further follow-up is needed to ascertain whether weight loss can be sustained long-term, and if the short term gains will translate to significant improvements in cardio-metabolic risk profile.

Sinusitus with Subdural Empyema

2019 ◽  
pp. 267-273
Author(s):  
Christina Sayama
Keyword(s):  
Infectious Disease ◽  
Decision Making ◽  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Broad Spectrum ◽  
Clinical Care ◽  
Subdural Empyema ◽  
Neurologic Examination ◽  
Infectious Disease Specialists

Subdural empyema is considered a neurosurgical emergency and, if found on neuroimaging, should prompt craniotomy for evacuation followed by broad spectrum antibiotics. In the setting of a patient with severe parenchymal swelling, a craniectomy may be indicated, as well as other modalities to lower intracranial pressure. Clinical care and decision making occurs with a multidisciplinary team of pediatric intensivists, infectious disease specialists, otolaryngologists, and neurosurgeons. Detection of recurrent subdural empyema is critical to prevent further morbidity and mortality, and surveillance of fever, neurologic examination, and follow-up imaging is critical. Timely surgical treatment of these infections can lead to good clinical outcomes.

scholarly journals Intraductal Papillary Mucinous Neoplasm of the Pancreas: Need for a Tailored Approach to a Rare Entity

Folia Medica ◽  
2021 ◽  
Vol 63 (6) ◽  
pp. 970-976
Author(s):  
Marina Konaktchieva ◽  
Dimitar Penchev ◽  
Georgi Popivanov ◽  
Lilia Vladova ◽  
Roberto Cirocchi ◽  
...  
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Risk Stratification ◽  
Pancreatic Duct ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Indications For Surgery ◽  
Mucinous Neoplasm ◽  
Tailored Approach ◽  
Duct Cancer

Intraductal papillary mucinous neoplasm (IPMN)&nbsp;of the pancreas is a relatively new entity that has gained increased attention because of its unique features &ndash; presence of different subtypes with different malignant potential, biological behavior, and prognosis, higher rates of recurrences and concomitant or metachronous pancreatic duct cancer. It is rare with an incidence of 4 to 5 cases per 100&nbsp;000. The relative lack of experience significantly hampers decision making for surgery (pancreatic head resection, distal pancreatectomy or enucleation) or follow-up. Herein we present two cases managed by diametrically different tactic according to the risk stratification &ndash; distal pancreatectomy with splenectomy and observation, respectively. An up-to-date literature review on the key points in diagnostics, indications for surgery, the extent of surgery, follow-up, and prognosis is provided. The tailored approach based on risk stratification is the cornerstone of management. Absolute indications for surgery are the lesions with high-risk stigmata, whereas the worrisome features should be evaluated by endoscopic ultrasound and fine-needle aspiration. Main duct and mixed type are usually referred to surgery, whereas the management of a branch type is more conservative due to the lower rate of invasive cancer. Strict postoperative follow-up is mandatory even in negative resection margins due to a high risk for recurrences and metachronous lesions. Despite the guidelines, the intraductal papillary mucinous neoplasm remains a major challenge for clinicians and surgeons in the balance the risk/benefit of observation versus resection. Risk stratification plays a key role in decision-making. Future trials need to determine the optimal period of surveillance and the most reliable predictive factors for concomitant pancreatic duct cancer.

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