Molecular signatures of atherosclerotic plaques: An up-dated panel of protein related markers.

Atherosclerosis remains the leading cause of ischemic syndromes such as myocardial infarction or brain stroke, mainly promoted by plaque rupture and subsequent arterial blockade. Identification of vulnerable or high-risk plaques constitutes a major challenge, being necessary to identify patients at risk of occlusive events in order to provide them with appropriate therapies. Clinical imaging tools have allowed the identification of certain structural indicators of prone-rupture plaques, including a necrotic lipidic core, intimal and adventitial inflammation, extracellular matrix dysregulation, and smooth muscle cell depletion and micro-calcification. Additionally, alternative approaches focused on identifying molecular biomarkers of atherosclerosis have also been applied. Among them, proteomics has provided numerous protein markers currently investigated in clinical practice. In this regard, it is quite uncertain that a single molecule can describe plaque rupture, due to the complexity of the process itself. Therefore, it should be more accurate to consider a set of markers to define plaques at risk. Herein, we propose a selection of 76 proteins, from classical inflammatory to recently related markers, all of them identified in at least two proteomic studies analyzing unstable atherosclerotic plaques. Such panel could be used as a prognostic signature of plaque instability.

Documento de consenso sobre el tratamiento de las infecciones en el pie del diabético / Consensus document on the treatment of diabetic foot infections

La infección del pie diabético, sobre todo si se asocia a isquemia, es la causa más frecuente de amputación de la extremidad inferior en la población general, de ingreso hospitalario y de disminución de la calidad de vida en los diabéticos. El 15% de los diabéticos van a sufrir a lo largo de su vida una infección del pie, con una incidencia anual del 1-4%, precedida en más del 80% de los casos de una úlcera en el pie. Son infecciones complejas en cuyo pronóstico influyen muchos factores, dependientes de la úlcera (localización, extensión, cronicidad, amputación previa, grado de isquemia) y del paciente (edad, insuficiencia renal, tiempo de evolución de la diabetes, comorbilidad asociada), lo que hay que tener en cuenta a la hora de plantear su tratamiento. Las infecciones deben clasificarse en función de su gravedad (leves, moderadas-leves, moderadas-graves y graves). Su tratamiento es complejo y debe ser multidisciplinar; debe incluir desbridamiento, descarga, antibioticoterapia adecuada, revascularización y cura de la úlcera.En este documento de consenso, fruto de la colaboración de la Sociedad Española de Angiología y Cirugía Vascular (SEACV), Sociedad Española de Medicina Interna (SEMI), Sociedad Española de Quimioterapia (SEQ), Asociación Española de Cirujanos (AEC), Sociedad Española de Medicina de Urgencias y Emergencias (INFURG-SEMES) y Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), se desarrollan las pautas, basadas en la mejor evidencia disponible, de las infecciones de pie diabético, encaminadas a obtener la mayor eficacia clínica(AU)

Diabetic foot infection, particularly if it is associated to ischaemia, is the most common cause of lower limb amputation, in the general population, of hospital admissions, and a decrease in the quality of life in diabetics. Of all diabetics, 15% of them are going to suffer from a foot infection during their life, with an annual incidence of 1-4%, preceded by a foot ulcer in more than 80% of cases. They are complex infections and the prognosis is influenced by many factors, depending on the ulcer (location, extension, whether chronic or not, previous amputation, ischaemia grade), and the patient (age, renal impairment, time of onset of diabetes, associated comorbidity). All these must be taken into account when establishing its treatment. The infections must be classified according to their severity (mild, moderate-mild, moderate-severe, and severe). Their treatment is complex and must be multidisciplinary and must include debridement, discharge, adequate antibiotic therapy, revascularisation, and treatment of the ulcer. In this consensus document, produced in collaboration with the Spanish Angiology and Vascular Surgery Society (SEACV), the Spanish Society of Internal Medicine (SEMI), the Spanish Chemotherapy Society (SEQ), the Spanish Surgeons Association (AEC), the Spanish Society of Urgent Medicine and Emergencies (INFURG-SEMES) and the Spanish Society of Intensive and Critical Medicine and Coronary Care (SEMICYUC), the guidelines are developed based on the best available evidence on diabetic foot infections, aimed at achieving greater clinical efficacy(AU)

Acute pseudoaneurysm of the femoral artery after repeated trauma in full-contact karate practice.

Traumatic pseudoaneurysms of the deep femoral artery are only encountered infrequently in sports medical literature. We present the case of a male who, after practising full-contact karate, experienced pain and oedema in the right thigh. The ultrasound results and the arteriography showed the presence of a pseudoaneurysm in a branch of the deep femoral artery. Traumatic pseudoaneurysms of the deep femoral artery are normally secondary to endovascular interventions or to mycotic infections in injecting drug users. The majority appear asymptomatically as a pulsatile mass, although on occasions clinical signs of compression (pain, neurological or venous symptoms) may occur or, if the aneurysm bursts, hypovolemic shock.