Publications by authors named "Nicola Ielapi"

25 Publications

  • Page 1 of 1

Association between Inguinal Hernia and Arterial Disease: A Preliminary Report.

Biology (Basel) 2021 Aug 1;10(8). Epub 2021 Aug 1.

Department of Health Sciences, "Magna Graecia" University, 88100 Catanzaro, Italy.

Background: Inguinal hernia (IH) is a major problem in general surgery and its prevalence is increasing. The presence of hernias has been associated with a wide spectrum of venous diseases, with the involvement of imbalances in collagen and extracellular matrix deposition and metalloproteinases dysfunction. We aimed to evaluate whether the association between IH and vascular diseases is also present with respect to arterial diseases.

Methods: We designed a cross-sectional observational study enrolling consecutive patients undergoing surgical repair of IH. Arterial diseases (AD) considered were carotid stenosis, peripheral artery disease and abdominal aortic aneurysms.

Results: Study population consisted of 70 patients. Mean age was 63.2 ± 4.7 years. Prevalence of AD was 42.9% in the whole cohort. AD patients were older ( = 0.015), and more frequently had hypertension ( = 0.001) and active smoking habits ( = 0.001) than the no-AD group. Albumin-to-creatinine ratio (ACR) was higher in AD than in no-AD patients ( < 0.001). At multivariable analysis, increased ACR (odds ratio, OR: 1.14, < 0.001), old age (OR: 1.25, = 0.001) and a smoking habit (OR: 3.20, = 0.001) were significant correlates for the presence of AD.

Conclusions: Prevalence of AD in patients with IH is non-negligible. Old age, a smoking habit and an abnormal excretion of urine albumin are associated with the presence of AD in these patients. Future studies are needed to gain more insights into the pathogenic mechanisms underlying this association, exploring also the specific role of metalloproteinases.
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http://dx.doi.org/10.3390/biology10080736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8389546PMC
August 2021

Efficacy and Safety of Jotec E-Ventus BX Stent Graft for Iliac Branch Device Procedure: A Retrospective Clinical Study.

Ann Vasc Surg 2021 Aug 23. Epub 2021 Aug 23.

Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University, Catanzaro, Italy. Electronic address:

Background: The endovascular aneurysm repair (EVAR) is a successful treatment for aorto-iliac aneurysms. The success of EVAR is enhanced by the use of devices that maintain the patency of targeted arteries namely the iliac branch device (IBD) With this study we aimed to evaluate the association between the use of Jotec E-ventus during EVAR with IBD and prognosis in patients with aorto-iliac aneurysms.

Methods: This is a retrospective, multicentric study enrolling patients referred to our Vascular Surgery Units from January 2015 to January 2020. All patients underwent EVAR with IBD using Jotec E-ventus as bridging stent. Primary endpoint was the development of types I and III endoleaks. Secondary endpoint was the onset of device occlusion with loss of vascular patency.

Results: We studied 32 patients (mean age 71.7±4.5y). Of these, 25 patients were treated with standard EVAR procedure whereas 7 were treated with isolated IBD due to extension of disease involving iliac bifurcation. Median follow-up lasted 15[IQR11-27] months. During follow-up, incidence rates for endoleaks and occlusion were 3.98(95%CI 0.48-14.41) and 1.99(95%CI 0.05-11.12) per 100 pts/year.

Conclusions: Jotec E-ventus during EVAR is associated with a low rate of severe complications in a small cohort of patients with aorto-iliac aneurysms.
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http://dx.doi.org/10.1016/j.avsg.2021.05.053DOI Listing
August 2021

The Impact of Chronic Kidney Disease on Peripheral Artery Disease and Peripheral Revascularization.

Int J Gen Med 2021 23;14:3749-3759. Epub 2021 Jul 23.

Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy.

Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.
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http://dx.doi.org/10.2147/IJGM.S322417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315808PMC
July 2021

Smoking habit as a risk amplifier in chronic kidney disease patients.

Sci Rep 2021 Jul 20;11(1):14778. Epub 2021 Jul 20.

Renal Unit, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Viale Europa - Campus "Salvatore Venuta", 88100, Catanzaro, Italy.

Several studies showed the association between non-traditional risk factors [proteinuria and estimated Glomerular Filtration Rate (eGFR)] and cardiovascular (CV) and renal outcomes. Nevertheless, the etiologic role of traditional CV risk factors in referred CKD patients is less defined. Herein, we examined the association between smoking habit and CV events, mortality and CKD progression. We undertook an observational analysis of 1306 stage III-V CKD patients. Smoking habit was modeled as a categorical (never, current or former smokers) and continuous (number of cigarettes/day) variable. Mean eGFR was 35.8 ± 12.5 mL/min/1.73 m. Never, current and former smokers were 61.1%, 10.8% and 28.1%. During a median follow-up of 2.87 years, current and former smokers were at significant risk for CV events (HRs of 1.93 [95% CI, 1.18-3.16] and 1.44 [95% CI, 1.01-2.05]) versus never smokers. Current smokers were at increased mortality risk (HR 2.13 [95% CI, 1.10-4.11]). Interactions were found between former smokers and proteinuria (p = 0.007) and diabetes (p = 0.041) for renal risk, and between current smokers and male gender (p = 0.044) and CKD stage V (p = 0.039) for renal and mortality risk. In referred CKD patients, smoking habit is independently associated with CV events and mortality. It acts as a risk "amplifier" for the association between other risk factors and renal outcomes.
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http://dx.doi.org/10.1038/s41598-021-94270-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292329PMC
July 2021

The use of the Amplatzer Vascular Plug in the prevention of endoleaks during abdominal endovascular aneurysm repair: A systematic literature review on current applications.

Vascular 2021 Jun 14:17085381211025152. Epub 2021 Jun 14.

Department of Medical and Surgical Sciences, 9325University of Catanzaro, Catanzaro, Italy.

Objectives: The Amplatzer Vascular Plug (AVP) is a vascular occlusion device designed to provide optimal embolization in several fields of the endovascular surgery. A full literature review was conducted to analyze AVPs in comparison with coils for the prevention of endoleaks during endovascular abdominal aortic aneurysm repair.

Methods: A systematic review was designed under PRISMA statement guidelines for systematic reviews and meta-analyses. The results were updated with a subsequent electronic search using Medline and Scopus databases up to December 2019.

Results: Eighteen articles making this comparison were found. In 79.7% of the cases, the target vessel was the internal iliac artery; in 1.6%, the common iliac artery; and in 16.7%, the inferior mesenteric artery. Risk of complications (buttock claudication, groin hematoma, endoleaks, and erectile dysfunction) after AVP was low. A cost comparison revealed that the mean cost for coils was around US$2262, while the average cost for the AVP was US$310.

Conclusions: The AVP is an effective and safe device for occluding peripheral vessels, proved to have lower complications rates. Compared with coil embolization, the AVP technique is potentially associated with lower procedural costs.
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http://dx.doi.org/10.1177/17085381211025152DOI Listing
June 2021

Environmental Pollution and Peripheral Artery Disease.

Risk Manag Healthc Policy 2021 27;14:2181-2190. Epub 2021 May 27.

Department of Social Sciences, Vitambiente, Catanzaro, Italy.

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 (PM) was found significantly associated with PAD.
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http://dx.doi.org/10.2147/RMHP.S307150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166356PMC
May 2021

Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.

PLoS One 2021 21;16(5):e0252209. Epub 2021 May 21.

Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.

Background: Acute Kidney Injury (AKI) represents a clinical condition with poor prognosis. The incidence of AKI in hospitalized patients was about 22-57%. Patients undergoing cardiac surgery (CS) are particularly exposed to AKI because of the related oxidative stress, inflammation and ischemia-reperfusion damage. Hence, the risk profile of patients undergoing CS who develop AKI and who are consequently at increased mortality risk deserves further investigation.

Methods: We designed a retrospective study examining consecutive patients undergoing any type of open-heart surgery from January to December 2018. Patients with a history of AKI were excluded. AKI was diagnosed according to KDIGO criteria. Univariate associations between clinical variables and AKI were tested using logistic regression analysis. Variable thresholds maximizing the association with AKI were measured with the Youden index. Multivariable logistic regression analysis was performed to assess predictors of AKI through backward selection. Mortality risk factors were assessed through the Cox proportional hazard model.

Results: We studied 158 patients (mean age 51.2±9.7 years) of which 74.7% were males. Types of procedures performed were: isolated coronary artery bypass (CABG, 50.6%), valve (28.5%), aortic (3.2%) and combined (17.7%) surgery. Overall, incidence of AKI was 34.2%. At multivariable analysis, young age (p = 0.016), low blood glucose levels (p = 0.028), estimated Glomerular Filtration Rate (p = 0.007), pH (p = 0.008), type of intervention (p = 0.031), prolonged extracorporeal circulation (ECC, p = 0.028) and cross-clamp (p = 0.021) times were associated with AKI. The threshold for detecting AKI were 91 and 51 minutes for ECC and cross-clamp times, respectively. At survival analysis, the presence of AKI, prolonged ECC and cross-clamp times, and low blood glucose levels forecasted mortality.

Conclusions: AKI is common among CS patients and associates with shortened life-expectancy. Several pre-operative and intra-operative predictors are associated with AKI and future mortality. Future studies, aiming at improving prognosis in high-risk patients, by a stricter control of these factors, are awaited.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252209PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139497PMC
May 2021

Infection, Infectious Agents and Vascular Disease.

Rev Recent Clin Trials 2021 ;16(3):262-271

Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Surgical and Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy.

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 evidence on the issue of infections and vascular disease is 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.
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http://dx.doi.org/10.2174/1574887116666210325124045DOI Listing
August 2021

Efficacy of a Low-Dose Diosmin Therapy on Improving Symptoms and Quality of Life in Patients with Chronic Venous Disease: Randomized, Double-Blind, Placebo-Controlled Trial.

Nutrients 2021 Mar 19;13(3). Epub 2021 Mar 19.

Department of Health Sciences, University of Catanzaro, 88100 Catanzaro, Italy.

Chronic Venous Disease (CVD) is a common medical condition affecting up to 80% of the general population. Clinical manifestations can range from mild to more severe signs and symptoms that contribute to the impairment of the quality of life (QoL) of affected patients. Among treatment options, venoactive drugs such as diosmin are widely used in the symptomatic treatment in all clinical stages. The aim of this study is to determine the effectiveness of a new formulated diosmin in relieving symptoms and improving QoL in patients suffering from CVD. In this randomized, double-blind, placebo-controlled, multicenter clinical study, CVD patients with a Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system between C2 and C4 were randomized to receive a bioavailable diosmin (as μsmin Plus) 450 mg tablet once daily or a placebo for 8 weeks. Clinical symptoms and QoL were monitored using the measurement of leg circumference, visual analogue scale (VAS) for pain, Global Index Score (GIS) and Venous Clinical Severity Score (VCSS). A total of 72 subjects completed the study. From week 4, leg edema was significantly decreased in the active group ( < 0.001). An improvement in the VAS score was observed in the active group compared to placebo at the end of treatment ( < 0.05). GIS and VCSS scores were significantly improved in the active group at week 8 ( < 0.001). No treatment related-side effects were recorded. The results of this study showed that the administration of low-dose μsmin Plus was safe and effective in relieving symptoms and improving QoL in subjects with CVD.
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http://dx.doi.org/10.3390/nu13030999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003468PMC
March 2021

Novel biomarkers in cardiovascular surgery.

Biomark Med 2021 Mar 16;15(4):307-318. Epub 2021 Feb 16.

Department of Experimental & Clinical Medicine, University of Catanzaro, Italy.

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.
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http://dx.doi.org/10.2217/bmm-2020-0480DOI Listing
March 2021

Aortic Aneurysms, Chronic Kidney Disease and Metalloproteinases.

Biomolecules 2021 01 30;11(2). Epub 2021 Jan 30.

Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, I-88100 Catanzaro, Italy.

Metalloproteinases (MPs) are proteolytic enzymes involved in extracellular matrix deposition, regulation of cellular signals of inflammation, proliferation, and apoptosis. Metalloproteinases are classified into three families: Matrix-MPs (MMPs), A-Disintegrin-and-Metalloprotease (ADAMs), and the A-Disintegrin-and-Metalloproteinase-with-Thrombospondin-1-like-Domains (ADAMTS). Previous studies showed that MPs are involved in the development of aortic aneurysms (AA) and, concomitantly, in the onset of chronic kidney disease (CKD). CKD has been, per se, associated with an increased risk for AA. The aim of this review is to examine the pathways that may associate MPs with CKD and AA. Several MMPs, such as MMP-2, -8, -9, and TIMP-1 have been shown to damage the AA wall and to have a toxic effect on renal tubular cells, leading to fibrosis. Similarly, ADAM10 and 17 have been shown to degrade collagen in the AA wall and to worsen kidney function via pro-inflammatory stimuli, the impairment of the Renin-Angiotensin-Aldosterone System, and the degradation of structural proteins. Moreover, MMP-2 and -9 inhibitors reduced aneurysm growth and albuminuria in experimental and human studies. It would be important, in the future, to expand research on MPs from both a prognostic, namely, to refine risk stratification in CKD patients, and a predictive perspective, likely to improve prognosis in response to targeted treatments.
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http://dx.doi.org/10.3390/biom11020194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912263PMC
January 2021

Precision Medicine and Precision Nursing: The Era of Biomarkers and Precision Health.

Int J Gen Med 2020 31;13:1705-1711. Epub 2020 Dec 31.

Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.

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.
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http://dx.doi.org/10.2147/IJGM.S285262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781105PMC
December 2020

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

Rev Recent Clin Trials 2021 ;16(2):173-179

Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy.

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 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.

Conclusion: 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.
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http://dx.doi.org/10.2174/1574887115999201027145406DOI Listing
January 2021

The Role of Prognostic and Predictive Biomarkers for Assessing Cardiovascular Risk in Chronic Kidney Disease Patients.

Biomed Res Int 2020 8;2020:2314128. Epub 2020 Oct 8.

Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University of Catanzaro, Catanzaro, Italy.

Chronic kidney disease (CKD) is currently defined as the presence of proteinuria and/or an eGFR < 60 mL/min/1.73m on the basis of the renal diagnosis. The global dimension of CKD is relevant, since its prevalence and incidence have doubled in the past three decades worldwide. A major complication that occurs in CKD patients is the development of cardiovascular (CV) disease, being the incidence rate of fatal/nonfatal CV events similar to the rate of ESKD in CKD. Moreover, CKD is a multifactorial disease where multiple mechanisms contribute to the individual prognosis. The correct development of novel biomarkers of CV risk may help clinicians to ameliorate the management of CKD patients. Biomarkers of CV risk in CKD patients are classifiable as prognostic, which help to improve CV risk prediction regardless of treatment, and predictive, which allow the selection of individuals who are likely to respond to a specific treatment. Several prognostic (cystatin C, cardiac troponins, markers of inflammation, and fibrosis) and predictive (genes, metalloproteinases, and complex classifiers) biomarkers have been developed. Despite previous biomarkers providing information on the pathophysiological mechanisms of CV risk in CKD beyond proteinuria and eGFR, only a minority have been adopted in clinical use. This mainly depends on heterogeneous results and lack of validation of biomarkers. The purpose of this review is to present an update on the already assessed biomarkers of CV risk in CKD and examine the strategies for a correct development of biomarkers in clinical practice. Development of both predictive and prognostic biomarkers is an important task for nephrologists. Predictive biomarkers are useful for designing novel clinical trials (enrichment design) and for better understanding of the variability in response to the current available treatments for CV risk. Prognostic biomarkers could help to improve risk stratification and anticipate diagnosis of CV disease, such as heart failure and coronary heart disease.
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http://dx.doi.org/10.1155/2020/2314128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568793PMC
May 2021

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

Int J Surg Case Rep 2020 23;75:426-428. Epub 2020 Sep 23.

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.

Introduction: Aberrant right subclavian artery (ARSA), or arteria lusoria is the most common embrologic anomaly of the aortic arch. It is generally asymptomatic and incidentally diagnosed during a radiological exam or procedure.

Presentation Of Case: Here, we report a case of ARSA incidentally diagnosed and injured (dissection with mediastinal hematoma) during a right transradial coronary angiography in a 83 years old female patient. 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 successful with optimal results at early and long term follow up.

Discussion: Sometimes, a dissection of the ARSA may occur, especially for excessive manipulation during endovascular procedures, and when such complication happens it should be promptly treated as it can be 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 be paid, as dreadful complications such as dissection or lesion may happen and prompt treatment is required.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522376PMC
September 2020

The Shaggy Aorta Syndrome: An Updated Review.

Ann Vasc Surg 2021 Jan 13;70:528-541. Epub 2020 Aug 13.

Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy.

Background: 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.

Methods: Potentially eligible studies to be included were identified by searching the following databases: CENTRAL Library, ClinicalTrials.gov, MEDLINE, and CINAHL, using a combination of subject headings and text words to identify relevant studies: (Shaggy aorta) OR (aortic embolization) OR (aortic embolism) OR (aortic thrombus) OR (aortic plaque). From a total of 29,111 abstracts, and after applying inclusion and exclusion criteria, we considered 60 studies for inclusion in this review.

Results: Appropriate measurement and assessment of the aortic wall are pivotal in the modern era, in particular when percutaneous procedures are performed, as SA has been identified as an independent risk factor for spinal cord injury, mesenteric embolization, and cerebral infarction after endovascular aortic repair. Furthermore, SA increases the rate of cerebral complications during transcatheter aortic valve implantation.

Conclusions: In conclusion, prompt diagnosis of SA syndrome and appropriate guidelines on the management of these conditions may help physicians to better assess the patient risk and to minimize the dreadful-related complications.
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http://dx.doi.org/10.1016/j.avsg.2020.08.009DOI Listing
January 2021

Vascular Nursing and Vascular Surgery.

Ann Vasc Surg 2020 Oct 29;68:522-526. Epub 2020 May 29.

Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy. Electronic address:

Background: Patients requiring vascular surgery have turned in older subjects with several comorbidities with frailty problems and increased vulnerability. Treating this kind of patients has become an important challenge both for vascular surgeons and for dedicated nurses, as these patients are more susceptible to postoperative complications and during discharge. The aim of this review is to analyze the role of vascular nurse in vascular surgery activities.

Methods: For this study, Medline, ScienceDirect, and Scopus databases were searched. The following keywords were used: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient.

Results: From the search strategy, the following areas were identified as relevant and analyzed in detail: vascular disease related to vascular surgery, the definition of vascular nursing, the role of vascular nursing in implementing clinical pathways in vascular surgery procedures, nursing postoperative care in vascular surgery, frailty assessment in vascular patient, nursing in phlebology and wound care, and the management of vascular access.

Conclusions: Vascular nursing is a discipline that is able to provide comprehensive and optimal care, better postoperative outcomes, and coordinated, standardized, and cost-effective clinical pathways for patients managed in the area of vascular surgery.
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http://dx.doi.org/10.1016/j.avsg.2020.05.038DOI Listing
October 2020

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

Biomark Med 2020 06 19;14(9):713-716. Epub 2020 May 19.

Interuniversity Center of Phlebolymphology (CIFL), International Research & Educational Program in Clinical & Experimental Biotechnology at the Department of Medical & Surgical Sciences University Magna Graecia of Catanzaro, Viale Europa, Catanzaro 88100, Italy.

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http://dx.doi.org/10.2217/bmm-2020-0201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236792PMC
June 2020

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

Int Wound J 2020 Aug 13;17(4):987-991. Epub 2020 Apr 13.

Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology", Catanzaro, Italy.

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.
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http://dx.doi.org/10.1111/iwj.13360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948557PMC
August 2020

Expression of MMP-2, MMP-9, and NGAL in Tissue and Serum of Patients with Vascular Aneurysms and Their Modulation by Statin Treatment: A Pilot Study.

Biomolecules 2020 02 26;10(3). Epub 2020 Feb 26.

Department of Health Sciences, University of Catanzaro, and Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini Hospital, 88100 Catanzaro, Italy.

Background: Matrix metalloproteinases (MMPs) are involved in vascular wall degradation, and drugs able to modulate MMP activity can be used to prevent or treat aneurysmal disease. In this study, we evaluated the effects of statins on MMP-2, MMP-9, and neutrophil gelatinase-associated lipocalin (NGAL) in both plasma and tissue in patients with aneurysmal disease.

Methods: We performed a prospective, single-blind, multicenter, control group clinical drug trial on 184 patients of both sexes >18 years old with a diagnosis of arterial aneurysmal disease. Enrolled patients were divided into two groups: Group I under statin treatment and Group II not taking statins. In addition, 122 patients without aneurysmal disease and under statin treatment were enrolled as a control group (Group III). The expression of MMPs and NGAL in plasma was evaluated using ELISA, while their expression in endothelial tissues was evaluated using Western blot.

Results: The ELISA test revealed greater plasma levels ( < 0.01) of MMPs and NGAL in Groups I and II vs. Group III. Western blot analysis showed higher expression ( < 0.01) of MMPs and NGAL in Group II vs. Group I, and this increase was significantly higher ( < 0.01) in patients treated with low potency statins compared to high potency ones.

Conclusions: MMPs and NGAL seem to play a major role in the development of aneurysms, and their modulation by statins suggests that these drugs could be used to prevent arterial aneurysmal disease.
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http://dx.doi.org/10.3390/biom10030359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175213PMC
February 2020

The Association of Matrix Metalloproteinases with Chronic Kidney Disease and Peripheral Vascular Disease: A Light at the End of the Tunnel?

Biomolecules 2020 01 17;10(1). Epub 2020 Jan 17.

Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University, 88100 Catanzaro, Italy.

Chronic Kidney Disease (CKD) represents a risk factor for fatal and nonfatal cardiovascular (CV) events, including peripheral vascular disease (PVD). This occurs because CKD encompasses several factors that lead to poor prognoses, mainly due to a reduction of the estimated glomerular filtration rate (eGFR), the presence of proteinuria, and the uremic inflammatory milieu. The matrix metalloproteinases (MMPs) are a group of zinc-containing endopeptidases implicated in extracellular matrix (ECM) remodeling, a systemic process in tissue homeostasis. MMPs play an important role in cell differentiation, angiogenesis, inflammation, and vascular damage. Our aim was to review the published evidence regarding the association between MMPs, PVD, and CKD to find possible common pathophysiological mechanisms. MMPs favor ECM deposition through the glomeruli, and start the shedding of cellular junctions and epithelial-mesenchymal transition in the renal tubules. MMP-2 and -9 have also been associated with the presence of systemic vascular damage, since they exert a pro-inflammatory and proatherosclerotic actions. An imbalance of MMPs was found in the context of PVD, where MMPs are predictors of poor prognoses in patients who underwent lower extremity revascularization. MMP circulating levels are increased in both conditions, i.e., that of CKD and PVD. A possible pathogenic link between these conditions is represented by the enhanced production of transforming growth factor-β that worsens vascular calcifications and atherosclerosis and the development of proteinuria in patients with increased levels of MMPs. Proteinuria has been recognized as a marker of systemic vascular damage, and this may explain in part the increase in CV risk that is manifest in patients with CKD and PVD. In conclusion, MMPs can be considered a useful tool by which to stratify CV risk in patients with CKD and PVD. Further studies are needed to investigate the causal-relationships between MMPs, CKD, and PVD, and to optimize their prognostic and predictive (in response to treatments) roles.
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http://dx.doi.org/10.3390/biom10010154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022805PMC
January 2020

The Role of Biofilm in Central Venous Catheter Related Bloodstream Infections: Evidence-based Nursing and Review of the Literature.

Rev Recent Clin Trials 2020 ;15(1):22-27

Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Background: Biofilm is a fundamental component in the pathogenesis of infections related to the use of the central venous catheter (CVC,) which can represent an important health issue in everyday practice of nursing and medical staff.

Objective: The objective of the following review is to analyze the components of biofilm and their role in catheter-related infection determinism in an evidencebased nursing perspective in such a way as to give health professionals useful suggestions in the prevention and management of these complications.

Methods: The following databases were consulted for the bibliographic search: Medline, Scopus, Science Direct. Biofilm can be the cause of CVC extraction and can lead to serious haematogenic infectious complications that can increase the morbidity and mortality of affected patients.

Results: Updated pathophysiologic knowledge of biofilm formation and appropriate diagnostic methodology are pivotal in understanding and detecting CVC-related infections. Lock therapy appears to be a useful, preventive, and therapeutic aid in the management of CVCrelated infections. New therapies attempting to stop bacterial adhesion on the materials used could represent new frontiers for the prevention of CVC-related infections.

Conclusion: The correct evidence-based nursing methods, based on the use of guidelines, provides the opportunity to minimize the risks of infection through the implementation of a series of preventive measures both during the CVC positioning phase and in the subsequent phase, for example, during device management which is performed by medical and nursing staff.
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http://dx.doi.org/10.2174/1574887114666191018144739DOI Listing
March 2021

Novel biomarkers for cardiovascular risk.

Biomark Med 2018 09 21;12(9):1015-1024. Epub 2018 Aug 21.

Interuniversity Center of Phlebolymphology (CIFL). International Research & Educational Program in Clinical & Experimental Biotechnology' at the Department of Surgical & Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy.

Cardiovascular disease refers to different diseases involving the heart and/or the arteries and/or the veins. Cardiovascular disease, overall considered, is a notable source of morbidity and mortality worldwide. Therefore, several research studies are dedicated to explore, by means of biomarkers, the possiblity to calculate the cardiovascular risk both for the onset and for the complications of the related clinical manifestations such as coronary artery disease, carotid artery stenosis, peripheral artery disease, arterial aneurysm, chronic venous disease and venous thromboembolism. This review discusses the most updated information in the area of the novel biomarkers related to omics, imaging techniques and clinical data, that may help physicians in order to improve the knowledge and the management of the cardiovascular risk.
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http://dx.doi.org/10.2217/bmm-2018-0056DOI Listing
September 2018

Haemorrhage from varicose veins and varicose ulceration: A systematic review.

Int Wound J 2018 Oct 28;15(5):829-833. Epub 2018 May 28.

Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Varicose veins (VVs) and varicose ulceration (VU) are usually considered non-life-threatening conditions, but in some cases they can lead to major complications such as fatal bleeding. The aim of this systematic review is to evidence the most updated information on bleeding from VV and VU. As evidence acquisition, we planned to include all the studies dealing with "Haemorrhage/Bleeding" and "VVs/VU". We excluded all the studies, which did not properly fit our research question, and with insufficient data. As evidence synthesis, of the 172 records found, after removing of duplicates, and after records excluded in title and abstract, 85 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 68 articles because of the following reasons: (1) not responding properly to our research questions; (2) insufficient data; the final set included 17 articles. From literature searching, we identify the following main issues to be discussed in the review: epidemiology and predisposing factors, pathophysiology and forensic aspects, first aid. It has been estimated that deaths for bleeding due to peripheral venous problems account up to 0.01% of autopsy cases. From a pathological point of view, venous bleeding may arise from either acute or chronic perforation of an enlarged vein segment through the weakened skin. From a forensic point of view, in cases of fatal haemorrhage the death scene can even simulate non-natural events, due to crime or suicide. In most cases, incorrect first aid led to fatal complications. Further investigation on epidemiology and prevention measures are needed.
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http://dx.doi.org/10.1111/iwj.12934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949652PMC
October 2018

Skin tears and risk factors assessment: a systematic review on evidence-based medicine.

Int Wound J 2018 Feb 17;15(1):38-42. Epub 2017 Oct 17.

Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Skin tears represent a common condition of traumatic wounds, which may be encountered in some categories of individuals at the extremes of age, such as infants and the elderly. Despite the high prevalence and cost of these lesions, there has been little investigation into the risk factors that lead to this condition. The aim of this review was to systematically evaluate the main risk factors involved in development of skin tears. We planned to include all the studies dealing with risk factors related to skin tears. Only publications in English were considered. We excluded all the studies that did not properly fit our research question and those with insufficient data. Of the 166 records found, 24 matched our inclusion criteria. After reading the full-text articles, we decided to exclude seven articles because of the following reasons: (1) not responding properly to our research questions and (2) insufficient data; the final set included 17 articles. From a literature search, we found the following main issues related to risk factors, which have been described in detail in this section: age-related skin changes, dehydration, malnutrition, sensory changes, mobility impairment, pharmacological therapies and mechanical factors related to skin care practices. Our findings clearly show that in frail populations (especially infant and elderly), the stratification risk, as a primary prevention strategy, is an effective tool in avoiding the development of chronic wounds. The development and the implementation of prevention strategies based on appropriate knowledge of the risk factors involved and the adoption of correct techniques during skin care practices could reduce or even avoid the onset of skin tears.
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http://dx.doi.org/10.1111/iwj.12815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950130PMC
February 2018
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