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Impact of D-dimer on in-hospital mortality following aortic dissection:A systematic review and meta-analysis

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World Journal of Cardiology 2024年第6期16卷 355-362页

作者： Sashwath Srikanth Shabnam Abrishami Lakshmi Subramanian Ashwini Mahadevaiah Ankit Vyas Akhil Jain Sangeetha Nathaniel Subramanian Gnanaguruparan Rupak Desai Department of Medicine ECU Health Medical CenterGreenvilleNC 27834United States Department of Research Independent Outcomes ResearchLos AngelesCA 90036United States Harvard T.H.Chan School of Public Health Harvard UniversityBostonMA 02115United States Department of Vascular Medicine Ochsner Clinic FoundationNew OrleansLA 70121United States Department of Leukemia The University of Texas MD Anderson Cancer CenterHoustonTX 77079United States Department of Cardiology Heart and Vascular ClinicNewarkDE 19713United States Independent Researcher AtlantaGA 30079United States

BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is ***,its predictive value for in-hospital mortality remains uncertain and subject to conflicting *** To conduct a meta-analysis of AD-related in-hospital mortality(ADIM)with elevated DD *** We searched PubMed,Scopus,Embase,and Google Scholar for AD and ADIM literature through May *** was assessed using I2 statistics and effect size(hazard or odds ratio)analysis with random-effects *** size,study type,and patients’mean age were used for subgroup *** significance threshold was P60 *** and larger sample size studies(n>250)demonstrated a heightened likelihood of ADIM associated with elevated DD levels(effect size:2.57,95%CI:1.30-5.08,P<0.01 vs effect size:1.05,95%CI:1.00-1.11,P=0.05,respectively).CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients,highlighting the need for larger,prospective studies to improve risk prediction models.

关键词： D-dimer aortic dissection Mortality Biomarker Systematic review Meta-analysis

Cases Report of Atypical aortic dissection

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Journal of Biosciences and Medicines 2024年第2期12卷 131-137页

作者： Yuan Tang Yong Hu Department of Neurology Xiangzhou District People’s Hospital Xiangyang China Emergency Department The First Affiliated Hospital of Guangxi University of Chinese Medicine Guangxi China

Background: aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persistent, tearing or cutting-like pain in the chest or back. However, there have also been reports of myocardial infarction, heart failure, renal failure, syncope, shock, stroke, paraplegia and other cases. Clinical misdiagnosis is common. Aim: Alert clinicians to aortic dissection with shock and chest tightness as the main clinical presentations. Case Presentation: Report on two cases of aortic dissection with syncope and shock as the main manifestations. Conclusion: aortic dissection is a highly dangerous cardiovascular emergency with a high mortality rate. In clinical practice, awareness of the clinical manifestations of aortic dissection should be increased. Careful inquiry about medical history, attention to atypical clinical presentations of aortic dissection, thorough physical examination, and comprehensive diagnostic evaluation can improve the success rate of diagnosing aortic dissection.

关键词： aortic dissection Syncope Shock Chest Distress

Comparing pharmacotherapy and transcranial magnetic stimulation for the treatment of anxiety and depression after aortic dissection surgery

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World Journal of Clinical Cases 2024年第21期12卷 4476-4482页

作者： Jie-Qiong Su Feng Liang Department of Neurology Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist HospitalXining 810012Qinghai ProvinceChina Department of Vascular Surgery Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist HospitalXining 810012Qinghai ProvinceChina

BACKGROUND aortic coarctation is a potentially fatal condition that is primarily treated *** successful procedures,patients frequently experience postoperative anxiety and depression,which can hinder recovery and worsen *** interventions,such as 5-hydroxytryptamine(5-HT)and norepinephrine reuptake inhibitors,are commonly prescribed;however,their efficacy alone or in combination with non-invasive brain stimulation techniques,such as repetitive transcranial magnetic stimulation(TMS),remains *** To assess the effect of medications and TMS on post-aortic surgery anxiety and *** We analyzed the outcomes of 151 patients with anxiety and depression who were hospitalized for aortic dissection between January 2020 and September *** the random number table method,75 and 76 patients were allocated to the normal control and study groups,*** the patients were treated using routine *** control group was administered anti-anxiety and antidepression drugs,whereas the study group was treated with TMS in addition to these *** patients in both groups showed improvement after two courses of *** Hamilton Anxiety Scale(HAMA)and the Hamilton Depression Scale(HAMD)were used to assess anxiety and depression,*** serum levels of brain-derived neurotrophic factor(BDNF)and 5-HT were determined using enzyme-linked immunosorbent *** Pittsburgh Sleep Quality Index(PSQI)was used to estimate sleep quality,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)was used to assess cognitive *** The HAMD and HAMA scores reduced in 2 groups,with the study group achieving a lower level than control(P<0.05).In the control group,43 patients recovered,17 showed improvement,and 15 were deemed *** the study group,52 recovered,20 improved,and four were *** efficacy rate in study group was 94.74%compared to 80.00%in control(P<0.05

关键词： aortic dissection Anxiety and depression Simple anti-anxiety and depression medications Repetitive transcranial magnetic stimulation Curative effect

DeBakey Type III aortic dissection Causing Bowel Necrosis: A Case Report

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Journal of Clinical and Nursing Research 2024年第8期8卷 159-162页

作者： Jinhu Kong Jiazheng Li Haiyang Hu Shangyun Pan Hongsheng Liu Clinical Medical College of Jining Medical University Jining 272067Shandong ProvinceChina Department of Cardiac Intensive Medicine Affiliated Hospital of Jining Medical UniversityJining 272000Shandong ProvinceChina

Rationale:aortic dissection is a life-threatening medical emergency associated with high morbidity and *** mesenteric malperfusion increases the surgical risk and mortality in patients with type B aortic *** DeBakey type III B patients involving most of the thoracoabdominal aorta,endovascular treatment to improve true lumen perfusion may have limited *** reperfusion on-time is *** concerns:A 38-year-old man was admitted with sudden severe upper abdominal *** CTA of the entire aorta revealed an aortic dissection with an entry tear in the descending aortic arch involving the celiac trunk,superior mesenteric artery,bilateral common iliac arteries and right external iliac artery,with thrombosis in the superior mesenteric ***:The patient was diagnosed with DeBakey type III aortic dissection with mesenteric artery *** chest CT showed the entry tear location and involvement of major *** confirmed partial blood flow in the superior mesenteric ***:The patient underwent endovascular aortic stent-graft implantation through the left femoral artery,covering the descending aortic arch and sealing the entry ***,the patient received intensive care,including ventilatory support,CRRT,anti-infection therapy,vasoactive drugs and lumbar cistern ***:Two weeks postoperatively,the patient developed massive black stools,indicative of intestinal obstruction and *** laparotomy revealed ischemic necrosis and rupture of the stomach,small intestine,and *** surgical efforts,the patient’s condition deteriorated,leading to death from severe infection,acid-base imbalance and multiple organ failure.

关键词： Abdominal pain aortic dissection Arterial embolism Mesenteric artery

aortic dissection Diagnosis Based on Sequence Information and Deep Learning

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Computers, Materials & Continua 2022年第11期73卷 2757-2771页

作者： Haikuo Peng Yun Tan Hao Tang Ling Tan Xuyu Xiang Yongjun Wang Neal N.Xiong Central South University of Forestry and Technology Changsha410004China The Second Xiangya Hospital of Central South University Changsha410011China Department of Mathematics and Computer Science Northeastern State UniversityTahlequah74464USA

aortic dissection(AD)is one of the most serious diseases with high mortality,and its diagnosis mainly depends on computed tomography(CT)*** existing automatic diagnosis methods of AD are only suitable for AD recognition,which usually require preselection of CT images and cannot be further classified to different *** this work,we constructed a dataset of 105 cases with a total of 49021 slices,including 31043 slices expertlevel annotation and proposed a two-stage AD diagnosis structure based on sequence information and deep *** proposed region of interest(RoI)extraction algorithm based on sequence information(RESI)can realize high-precision for RoI identification in the first *** DenseNet-121 is applied for further ***,the proposed method can judge the type of AD without preselection of CT *** experimental results show that the accuracy of Stanford typing classification of AD is 89.19%,and the accuracy at the slice-level reaches 97.41%,which outperform the state-ofart *** can provide important decision-making information for the determination of further surgical treatment plan for patients.

关键词： aortic dissection deep learning sequence information RoI

aortic dissection with epileptic seizure: A case report

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World Journal of Clinical Cases 2022年第31期10卷 11542-11548页

作者： Bo Zheng Xue-Qiong Huang Zhao Chen Jian Wang Gang-Feng Gu Xiao-Jing Luo Department of Neurology Yaan People’s HospitalYaan 625000Sichuan ProvinceChina Department of Oncology Yaan People’s HospitalYaan 625000Sichuan ProvinceChina

BACKGROUND aortic dissection(AoD)is a life-threatening *** diversified clinical manifestations,especially the atypical ones,make it difficult to *** epileptic seizure is a neurological problem caused by various kinds of diseases,but AoD with epileptic seizure as the first symptom is *** SUMMARY A 53-year-old male patient suffered from loss of consciousness for 1 h and tonicclonic convulsion for 2 *** patient performed persistent hypomania and chest discomfort for 30 min after *** had a history of hypertension without regular antihypertensive drugs,and the results of his bilateral blood pressure varied *** the electroencephalogram showed the existence of epileptic *** thoracic aorta computed tomography angiography showed the appearance of AoD,and it originated at the lower part of the ascending ***,the diagnosis was AoD(DeBakey,type I),acute aortic syndrome,hypertension(Grade 3),and secondary epileptic *** was given symptomatic treatment to relieve symptoms and prevent ***,the medical therapy was effective but he refused our surgical *** The AoD symptoms are *** diagnosing the epileptic seizure etiologically,AoD is important to consider by clinical and imaging examinations.

关键词： aortic dissection Epileptic seizure Hypertension Diagnosis Surgical treatment Case report

aortic dissection Research in China:Analysis of Studies Funded by the National Natural Science Foundation of China

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Current Medical Science 2023年第1期43卷 206-212页

作者： Zhang YUE Da-shuai WANG Sheng LE Jia-hong XIA Ping YE Xiao-fan HUANG Department of Cardiovascular Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Department of Cardiovascular Surgery The First Affiliated Hospital of Zhengzhou UniversityZhengzhou450052China Department of Cardiology The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430014China

Objective The National Natural Science Foundation of China(NSFC)has made great progress in promoting the development of aortic dissection research in recent *** study aimed to examine the development and research status of aortic dissection research in China so as to provide references for future *** The NSFC projects data from 2008 to 2019 were collected from the Internet-based Science Information System and other websites utilized as search *** publications and citations were retrieved by Google Scholar,and the impact factors were checked by the InCite Journal Citation Reports *** investigator’s degree and department were identified from the institutional faculty *** A total of 250 grant funds totaling 124.3 million Yuan and resulting in 747 publications were *** funds in economically developed and densely populated areas were more than those in underdeveloped and sparsely populated *** was no significant difference in the amount of funding per grant between different departments’***,the funding output ratios of the grants for cardiologists were higher than those for basic science *** amount of funding for clinical researchers and basic scientific researchers in aortic dissection was also *** researchers were better in terms of the funding output *** These results suggest that the medical and scientific research level of aortic dissection in China has been greatly ***,there are still some problems that urgently need to be solved,such as the unreasonable regional allocation of medical and scientific research resources,and the slow transition from basic science to clinical practice.

关键词： National Natural Science Foundation of China aortic dissection grant funding funding output ratio

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery:A case report

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World Journal of Clinical Cases 2022年第27期10卷 9897-9903页

作者： Kyungeun Ha Albert Youngwoo Jang Yong Hoon Shin Joonpyo Lee Jeongduk Seo Seok In Lee Woong Chol Kang Soon Yong Suh Division of Cardiology Department of Internal MedicineYonsei University College of Medicine50 Yonsei-roSeodaemun-guSeoulSouth Korea Division of Cardiology Department of Internal MedicineGil Medical CenterGachon University College of MedicineIncheonSouth Korea Department of Thoracic and Cardiovascular Surgery Gil Medical CenterGachon University College of MedicineIncheonIncheonSouth Korea

BACKGROUND Aberrant right subclavian artery(ARSA)is the most common congenital anomaly of the aortic *** patients having such anomalies receive transradial intervention(TRI),aortic dissection(AD)may ***,we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient,that was later salvaged by percutaneous *** SUMMARY A 73-year-old man presented to our hospital with intermittent chest *** computed tomography(CT)angiography revealed significant stenosis in the left anterior descending *** coronary angiography was performed via the right radial artery without ***,we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention,while the guidewire tended to go down the descending *** patient suddenly complained of chest and back *** CT aortography revealed type B AD propagating to the left renal artery(RA)with preserved renal ***,after 2 d,the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly ***-up CT indicated further progression of dissection to the right external iliac artery(EIA)and left RA with limited *** performed percutaneous angioplasty of the right EIA and left RA without ***-up CT aortography at 8 mo showed optimal *** A caution is required during right TRI in ARSA to avoid *** angioplasty can be a treatment option.

关键词： Aberrant subclavian artery Coronary angiography aortic dissection Aortography Percutaneous transluminal angioplasty Case report

Successful treatment of aortic dissection with pulmonary embolism:A case report

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World Journal of Clinical Cases 2022年第16期10卷 5394-5399页

作者： Xu-Guang Chen Sheng-Yi Shi Yun-Yan Ye Huan Wang Wen-Fei Yao Lan Hu Department of Emergency Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong UniversityShanghai 201800China

BACKGROUND aortic dissection(AD)and pulmonary embolism(PE)are both life-threatening *** of their conflicting treatments,treatment becomes difficult when they occur together,and there is no standard treatment *** SUMMARY A 67-year-old man fell down the stairs due to syncope and was brought to our hospital as a confused and irritable patient who was uncooperative during the physical *** examination of the head,chest and abdomen by computed tomography revealed a subdural hemorrhage,multiple rib fractures,a hemopneumothorax and a renal *** was admitted to the Emergency Intensive Care Unit and given a combination of oxygen therapy,external rib fixation,analgesia and enteral *** patient regained consciousness after 2 wk but complained of abdominal pain and dyspnea with an arterial partial pressure of oxygen of 8.66 *** tomography angiograms confirmed that he had both AD and *** subsequently performed only nonsurgical treatment,including nasal high-flow oxygen therapy,nonsteroidal analgesia,amlodipine for blood pressure control,beta-blockers for heart rate *** weeks after admission,the patient improved and was discharged from the *** Patients with AD should be alerted to the possibility of a combined PE,the development of which may be associated with aortic *** patients with type B AD combined with low-risk PE,a nonsurgical,nonanticoagulant treatment regimen may be feasible.

关键词： aortic dissection Pulmonary embolism Treatment Case report