Circulating amino acid levels can be altered in arterial aneurysms and dissection, but the relationships between them is unclear. The present study investigated the causal relationship between circulating amino acid levels and arterial aneurysms and dissection via bidirectional two-sample Mendelian randomization (MR).

A bidirectional two-sample MR analysis was used. Forward analysis was performed with amino acid levels as the exposure and arterial aneurysms and dissection as outcomes. Reverse analysis was performed with arterial aneurysms and dissection as exposures and circulating amino acid levels as outcomes. MR data were analyzed using five analytical methods: the inverse-variance weighted (IVW), MR‒Egger, weighted median, simple, and weighted methods. IVW was used as the main analytical method, and the other methods were used for supplementary analyses. Heterogeneity was assessed using Cochran's Q test, and horizontal pleiotropy was assessed using intercepts from MR‒Egger regression. The genome-wide association study (GWAS) data for circulating amino acids were obtained from the IEU open GWAS database and the GWAS Catalog database. The GWAS data for arterial aneurysms and dissection were obtained from the Finngen consortium database version R10.

The tyrosine level was negatively correlated with other aneurysms (P = 0.00211, OR: 0.57, 95 % CI: 0.40, 0.82). Aortic dissection decreased the circulating glycine level (P = 0.00168, OR: 0.98, 95 % CI: 0.98, 0.99).

Through bidirectional MR analysis, we found that tyrosine level was negatively correlated with other aneurysms and that aortic dissection reduced circulating glycine. Our findings support a possible interaction between circulating amino acid levels and arterial aneurysms and dissection.

Aortic dissection (AD) is a highly alarming clinical condition of the aorta, with a significant mortality rate. Vascular smooth muscle cell (VSMC) senescence dominantly promotes AD progression. This study planned to clarify the exact functions and mechanisms of protein arginine methyltransferase 1 (PRMT1), E2F7, and Sirtuin 6 (SIRT6) in the VSMC senescence of the AD model. Angiotensin II (Ang II) and β-Aminopropionitrile (BAPN) were used to treat VSMCs or C57BL/6J mice to establish the AD in vitro or in vivo model. Protein expressions were examined by western blot, IHC, and IF staining. Histological change or cell senescence was monitored using H&E or senescence-associated-β-galactosidase (SA-β-gal) staining. Enzyme-Linked Immunosorbent Assay (ELISA) assays were utilized to evaluate senescence-associated secretory phenotype markers' levels. The binding interactions between E2F7 and SIRT6 or PRMT1 and E2F7 were verified by the luciferase reporter, ChIP Co-IP, and GST-pull-down analysis. The ubiquitination levels of E2F7 were assessed using ubiquitination assays. PRMT1, E2F7, and SIRT6 protein levels were decreased in the Ang II-treated VSMCs of the AD model. Moreover, E2F7 repressed cell senescence by transcriptionally regulating SIRT6 in the AD model. PRMT1 silencing promoted cell senescence of VSMCs under Ang II. Further, PRMT1-mediated arginine methylation could maintain the protein stability of E2F7. PRMT1 restrained cell senescence of VSMCs via the E2F7/SIRT6 axis in the AD model. PRMT1 enhanced arginine methylation of E2F7, leading to the upregulation of SIRT6, thereby inhibiting the senescence of VSMCs in the AD model.

Aortic dissection (AD) is a life-threatening condition with a high mortality rate. Oxidative stress and endothelial and vascular smooth muscle cell migration contribute to AD pathogenesis. Herein, we investigated the therapeutic potential of hydrogen (H2), delivered via magnesium diboride nanosheets (MBNs), in a murine model of β-aminopropionitrile-induced AD. This treatment significantly improved survival rate and reduced AD progression, as evidenced by improved aortic wall structure and reduced false lumen formation. Transcriptomic analysis indicated modulation of the RhoA/ROCK pathway, confirmed using Western blotting, immunohistochemistry, and immunofluorescence, which showed significant downregulation of RhoA and ROCK2 after 28 days of treatment (P < 0.05). These findings suggest that hydrogen released from MBNs attenuates AD progression through reactive oxygen species scavenging and RhoA/ROCK pathway inhibition.

BackgroundEndovascular aortic repair has emerged as the preferred treatment modality over open surgery for aortic diseases, primarily because of its association with lower perioperative morbidity and mortality rates. Current diagnostic and treatment guidelines generally advocate for endovascular aortic repair in most cases, with the femoral artery serving as the conventional access route. However, this approach may not be feasible for all patients, particularly those with aortoiliac artery occlusion, necessitating alternative access strategies.Case SummaryThis paper presents a complex case study of a patient with aortoiliac artery occlusion who underwent endovascular aortic repair via the left carotid artery approach for a pseudoaneurysm at the anastomotic site of a descending aortic prosthetic graft. This case underscores the potential value of utilizing the carotid artery as an alternative access route in anatomically challenging situations.ConclusionResearch on transcarotid artery approach endovascular aortic repair is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This case report suggests that endovascular aortic repair via the carotid artery approach may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. While our single case demonstrated successful management with minimal complications, larger studies are needed to fully establish the safety profile and determine if perioperative complications and mortality rates are indeed manageable across diverse patient populations.Clinical ImpactThis study provides valuable insights into the feasibility of the carotid artery as an alternative access route for endovascular aortic repair in patients with aortoiliac artery occlusion. It offers clinicians a potential strategy for cases where the conventional femoral artery route is not feasible. The findings presented herein aim to demonstrate the practicality and relative safety of utilizing the carotid artery for endovascular procedures in anatomically challenging scenarios, contributing to the broader understanding of access alternatives in aortic repair interventions.

In patient with arterial hypertension the whole aorta is exposed to increased wall stress due to pressure overload. Different blood pressure (BP) components have been reported as main determinant of aortic remodelling. In particular increased diastolic BP has been associated with aortic dilatation across all its segments with smaller increase in aortic root and ascending aorta related to increased systolic BP and pulse pressure. Optimal BP control is crucial to prevent development of aortic aneurysm and acute aortic disease. Many studies have evaluated the role of different antihypertensive drug classes for prevention of adverse aortic remodelling including beneficial effects of ACEIs, ARBs, dihydropyridinic calcium channel blockers and Beta-blockers. The present review discusses pathophysiological mechanisms, therapeutic interventions and preventive strategies for development of aortic remodeling in patients with arterial hypertension.

PurposeThe purpose of this study is to evaluate the feasibility, efficacy, and safety of transcarotid approach endovascular aortic repair (EVAR) in patients where conventional femoral access is not possible.Materials and MethodsA systematic review of all articles discussing transcarotid approach EVAR published in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were conducted. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsIn accordance with the inclusion criteria, 17 articles discussing transcarotid approach EVAR were retrieved, encompassing 18 patients. Among these patients, 6 patients were related to ascending aortic disease, including 4 cases of pseudoaneurysms, 1 case of penetrating ulcer, and 1 case of dissection. 9 patients had descending aortic disease, comprising 6 aneurysms, 2 penetrating ulcers, and 1 pseudoaneurysm. There were 3 cases of abdominal aortic disease, including 2 aneurysms and 1 endoleak. Among these patients, 10 cases had access through the left common carotid artery, and 8 cases had access through the right common carotid artery. One patient experienced spinal cord ischemia and subsequently died of multi-organ failure caused by acute pancreatitis. Additionally, there was one case of minor embolization in the nonsurgical carotid supply area. No cerebral infarctions were observed in the vascular territory of the ipsilateral carotid artery at the surgical approach site.ConclusionsResearch on transcarotid approach EVAR is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This systematic review suggests that transcarotid approach EVAR may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. These findings indicate that this method is associated with a relatively manageable perioperative complications and mortality rates.

Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively.

Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients.

In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (p < 0.001) and the renal arteries (p < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure.

Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery.

This study investigated the distinguishing characteristics between acute type A aortic dissection (ATAAD) and aortic wall dilatation. Utilizing systematic histopathology criteria from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology consensus statement, the analysis focused on degeneration, atherosclerosis, and inflammation in patients undergoing surgery in a Finnish tertiary care hospital. The study included 156 patients, those undergoing surgery for ATAAD (n = 116) and those with dilatation (n = 40). Despite similar clinical characteristics, histological analysis of the aortic wall indicated a higher overall degeneration in ATAAD compared to dilatation (2.4 ± 0.6 vs. 1.9 ± 0.8, Point score unit (PSU), p < 0.001). Findings included increased intralamellar mucoid extracellular matrix accumulation (69 vs. 32, p = 0.020; extent 2.0 ± 0.3 vs. 1.7 ± 0.5, PSU, p < 0.001; severity 1.8 ± 0.6 vs. 1.5 ± 0.5, PSU, p = 0.005) elastic fiber thinning (68 vs. 9, p = 0.001; extent 1.0 ± 0.9 vs. 0.4 ± 0.8, PSU, p < 0.001; severity 0.8 ± 0.8 vs. 0.4 ± 0.8, PSU, p = 0.001), elastic fiber disorganization (89 vs. 21, p = 0.005; extent 1.2 ± 0.8 vs. 0.9 ± 0.9, PSU, p = 0.029) and laminar medial collapse (64 vs. 6, p < 0.001; type 0.7 ± 0.7 vs. 0.2 ± 0.4, PSU, p < 0.001; extent 0.9 ± 0.9 vs. 0.9 ± 0.9, PSU, p < 0.001) in ATAAD compared to dilatation. Elastic fiber pathology and laminar medial collapse are distinct features of ATAAD compared to aortic dilatation in patients undergoing ascending aorta surgery.

Acute aortic dissection (AD) is a critical condition characterized by high mortality and frequent misdiagnoses, primarily due to symptom overlap with other medical pathologies. This study explores the diagnostic utility of ChatGPT 4.0, an artificial intelligence model developed by OpenAI, in identifying acute AD from patients' presentations and general physical examination findings documented in published case reports. A systematic search was conducted on the PubMed database using the search term "acute aortic dissection," applying filters for articles published within the past year and categorized as case reports. The primary symptoms and physical examination details from each case were inputted into ChatGPT 4.0, which was prompted to generate three differential diagnoses and one main provisional diagnosis based on the case presentation. The search yielded a total of 163 results, from which 10 case reports were randomly selected. The patient demographics across all 10 case reports demonstrated an age range of 29 to 82 years, with equal gender distribution (5 males, 5 females) and hypertension as the most prevalent baseline comorbidity. ChatGPT 4.0 accurately identified acute AD as one of the top three differential diagnoses in all selected cases and identified acute AD as the provisional diagnosis in five of the 10 cases. In conclusion, while ChatGPT 4.0 demonstrates potential in suggesting acute AD as a differential diagnosis based on clinical data, its role should be considered supportive rather than definitive. Based on our findings, it could serve as an early, cost-effective, and quick screening tool, helping physicians adopt a "think aorta" approach.

In patients with aortic dissection (AD) after surgical repair, especially those with hypertension, better management of blood pressure is associated with better health outcomes. The aim of this study is to identify hypertension self-management trajectory patterns and associated factors among Chinese aortic dissection patients after surgical repair to assist in developing tailored behavioural interventions for this population.

178 patients with aortic dissection who underwent surgical repair were followed for 3 months. Data on hypertension self-management, hypertension knowledge, self-efficacy, and social support were collected before discharge and at 1 and 3 months after discharge. Sociodemographic and clinical data were also collected. A latent class growth model and generalized estimating equations were used to explore hypertension self-management trajectory patterns and factors associated with each pattern. The participants' average age was 57.95 (± 11.27) years. Two hypertension self-management trajectory patterns were identified: 'rapid ascent then suppressed growth' (93.4%) and 'continuously slow ascent' (6.6%). For the 'rapid ascent then suppressed growth' pattern, age, educational background, type of health insurance, family monthly income, self-efficacy, and social support were associated with this pattern (P < 0.05).

Healthcare providers may prioritize hypertension self-management for patients who are younger, have lower educational levels, have resident or employee medical insurance and have a family monthly income between 5001 and 10 000 yuan. Self-efficacy and social support might serve as targets for future intervention to improve hypertension self-management.

ChiCTR2100050542.

Aortic dissection (AD) is a catastrophic life-threatening cardiovascular emergency with a 1-2% per hour mortality rate post-diagnosis, characterized physiologically by the separation of aortic wall layers. AD initially presents as intense pain that can then radiate to the back, arms, neck, or jaw along with neurological deficits like difficulty in speaking, and unilateral weakness in some patients. This spectrum of clinical features associated with AD is often confused with acute myocardial infarction, hence leading to a delay in AD diagnosis. Cardiac and vascular biomarkers are structural proteins and microRNAs circulating in the bloodstream that correlate to tissue damage and their levels become detectable even before symptom onset. Timely diagnosis of AD using biomarkers, in combination with advanced imaging diagnostics, will significantly improve prognosis by allowing earlier vascular interventions. This comprehensive review aims to investigate emerging biomarkers in the diagnosis of AD, as well as provide future directives for creating advanced diagnostic tools and imaging techniques.

An acute aortic dissection (AAD) is a highly lethal condition that demands immediate medical intervention. Survivors often face significant long-term challenges. While immediate survival remains a critical focus in acute care settings, little is known about long-term results, especially with regard to activity levels, post-operative quality of life, and the impact of cultural and ethnic characteristics on recovery. Using data from the Dutch National Aortic Dissection Survivor's Day, this study examines QoL, activity levels, and ethnic diversity among survivors.

All patients (n = 45) participating in a national awareness meeting for AAD survivors at a teaching hospital were included in our study. Participants completed questionnaires assessing QoL, activity levels, and sociodemographic data, including ethnic background. The EQ-5D and IPAQ surveys were employed to measure health-related QoL and physical activity, respectively.

The mean age of the participants was 59.5 years, with 37.8% identifying as women. Ethnically, 88.9% identified as Dutch. The majority reported good health (mean score of 73/100). However, there was a considerable variation in QoL scores. On average, 22.2% of our study population reported moderate or greater problems across all dimensions, compared to 5.5% in the normative sample. Activity levels were mostly low to moderate, and no significant differences in QoL were found based on activity levels. Sleep quality was generally good.

Our study reveals significant limitations in QoL among AAD survivors. This emphasizes the significance of developing a multimodal rehabilitation program focused on addressing current gaps in recovery. Ultimately, this will enhance overall care following AAD. Future research should focus on assessing long-term QoL.

Background/Objectives: An acute aortic dissection (AAD) is a cardiovascular emergency with high mortality rates if left untreated. Survival has increased due to improvements in diagnosis and therapy. However, during their recovery, survivors frequently encounter major social, psychological, and physical challenges. This study aimed to evaluate the recovery experience of AAD survivors in The Netherlands. Insights on sleep quality, physical activity, and quality of life were collected from a unique nationwide cohort of AAD survivors recruited through the national patient support network 'Stichting Aorta Dissectie Nederland'. Methods: This study was conducted among AAD survivors who were recruited through a national association for aortic dissection known as 'Stichting Aorta Dissectie Nederland (SADN)'. The participants (n = 61) completed questionnaires assessing demographic data, physical activity, sleep quality, and health-related QoL. Results: The cohort had a mean age of 60.1 years, and 47.5% of the participants were female. The prevalence of sleep disruptions was high, as 55.7% of the people were categorized as bad sleepers (PSQI > 5). Poor sleep was associated with low physical activity and a higher BMI. The physical activity levels varied, with 47.5% reporting moderate activity levels and 44.3% reporting high activity levels. The QoL scores varied greatly among the participants, with significant impairment across all fields and reduced enthusiasm for daily activities. Poor sleepers reported significantly lower QoL (p < 0.001). Conclusions: Our study highlights significant gaps in post-AAD care, particularly addressing QoL, sleep, and physical activity. By acknowledging the multifaceted nature of recovery, healthcare providers can develop tailored interventions that empower survivors to achieve better quality of life.

Ulinastatin is a protease-inhibiting drug with anti-inflammatory and other pharmacological properties. Little is known regarding its role following acute type A aortic dissection (ATAAD) surgery. We perform a randomized controlled trial to investigate the protective effect of ulinastatin against negative inflammatory response and organ dysfunction in ATAAD surgery (PANDA). The primary outcome of mean daily Sequential Organ Failure Assessment (SOFA) score from baseline to 7 days of surgery is 8.80 (SD, 4.11) in the ulinastatin group and 8.61 (SD, 4.47) in the control group (mean difference between groups was 0.04; 95% confidence interval [CI], -0.24 to 0.33; p = 0.765). Systemic inflammatory response syndrome (SIRS) within 7 days of surgery is lower in the ulinastatin group than in the control group (p < 0.001). Additional ulinastatin to standard treatment is likely to reduce SIRS rates instead of preventing organ dysfunction, highlighting the potential importance of the benefits of anti-inflammatory pharmacotherapeutics. The trial is registered on clinicaltrials.org (NCT04711889).

The objective of this study is to examine the postoperative self-management experiences of patients with aortic dissection (AD) through qualitative interviews, providing a foundation for the standardized management of postoperative home care for these patients.

Semi-structured interviews were conducted with 18 patients with AD postoperatively, in the cardiac surgery department of a tertiary hospital in Fujian Province between March and May 2020. This qualitative study used phenomenological methods and purposive sampling, with data analyzed using Colaizzi's seven-step approach to extract themes.

Based on the interviews, four primary themes related to postoperative self-management challenges were identified: limited disease-related knowledge, inadequate disease management behavior, insufficient communication with healthcare providers, and compromised psychological well-being.

Postoperative self-management among patients with AD presents several challenges. Healthcare professionals should provide targeted interventions tailored to the specific condition and individual differences of the patient in self-management. Such interventions are crucial for enhancing the postoperative self-management abilities of patients with AD, promoting rehabilitation, and enhancing the overall quality of life.

There is a wide and ever-increasing range of imaging indications for thoracic computed tomography (CT). Identifying and appropriately triaging cardiovascular findings is often challenging, especially in non-gated or unenhanced studies. The authors provide a pictorial review of clinically relevant abnormalities of the main intrathoracic vessels (aorta, superior vena cava, pulmonary arteries and coronary arteries), for radiologists reporting non-gated enhanced or unenhanced CT of the thorax.

To date, it has been assumed that acute seizures which arise in the context of sudden, spontaneous, atraumatic, acute, arterial dissections (SAAADs) are downstream consequences of the dissections driven by syncope or focal brain lesions (FBLs). As this subject has not been formally investigated, likely due to its rarity, we reviewed published case reports (CRs) to examine the veracity of this assumption.

We included CR describing patients diagnosed with both acute seizures and arterial dissections in order to ascertain the temporal sequence between acute seizures and typical SAAAD symptoms. In addition, we quantified the frequency with which hypotension, bradycardia, and FBLs are associated with acute seizures in such cases.

We found 45 published CRs, six (13.3%) of which involved traumatic arterial dissections and 39 (86.7%) which involved SAAADs. Of the latter, twenty-one (53.8%) described seizures that followed typical SAAAD symptoms (SAFO), and 18 (46.2%) that preceded all such symptoms (SATO). On average, blood pressure and heart rate for both groups exceeded the normal range. Of the CRs that included magnetic resonance imaging (MRI) scans, 8 (100%) SAFO but only 6 (54.5%) SATO patients demonstrated FBLs (p<0.03). A conspicuously large fraction of SATO patients had known epilepsy compared with SAFO patients, (33.3% vs 4.8%; p<0.02). In addition, SATO epilepsy patients' seizure semiologies frequently resembled their breakthrough seizures (BTS). The most common SAAAD associated with acute seizures was aortic dissection (AoD; 17/45; 37.8%). Nine CRs (20%) described patients who died soon after presentation, seven of which were associated with AoDs, including one epilepsy patient. Six of these seven AoDs occurred in patients who suffered from chronic hypertension (CHTN). All five deaths in the SATO group followed first ever seizures (FES) [four AoDs and one coronary artery dissection (CoAD)].

Acute seizures arising in the context of SAAADs are not necessarily associated with hypotension or FBLs, and frequently appear to precede the associated dissections. These results suggest that seizures could act as triggers for SAAADs. In addition, sudden unexpected atraumatic acute arterial dissection-related death after seizure (SUADAS) might be a distinct cause of sudden death in epilepsy patients.

Ferroptosis of vascular smooth muscle cells (VSMCs) is related to the incidence of aortic dissection (AD). Long non-coding RNA (lncRNA) NORAD plays a crucial role in the progression of various diseases. The present study aimed to investigate the effects of NORAD on the ferroptosis of VSMCs and the molecular mechanisms. The expression of NORAD, HUR, and GPX4 was detected using quantitative real-time PCR (qPCR) or western blot. Ferroptosis was evaluated by detecting lactate dehydrogenase (LDH) activity, lipid reactive oxygen species (ROS), malonaldehyde (MDA) content, L-Glutathione (GSH) level, Fe2+ content, and ferroptosis-related protein levels. The molecular mechanism was assessed using RNA pull-down, RNA-binding protein immunoprecipitation (RIP), and luciferase reporter assay. The histology of aortic tissues was assessed using H&E, elastic Verhoeff-Van Gieson (EVG), and Masson staining assays. The data indicated that NORAD was downregulated in patients with AD and AngII-treated VSMCs. Overexpression of NORAD promoted VSMC growth and inhibited the ferroptosis induced by AngII. Mechanistically, NORAD interacted with HUR, which promoted GPX4 mRNA stability and elevated GPX4 levels. Knockdown of GPX4 abrogated the effects of NORAD on cell growth and ferroptosis of AngII-treated VSMCs. Moreover, METTL3 promoted m6A methylation of NORAD in an YTHDF2-dependent manner. In addition, NORAD attenuated AAD symptoms, incidence, histopathology, inflammation, and ferroptosis in AAD mice. In conclusion, METTL3-mediated NORAD inhibited ferroptosis of VSMCs via the HUR/GPX4 axis and decelerated AAD progression, suggesting that NORAD may be an AD therapeutic target.

An acute aortic dissection can be a tremendously fatal vascular condition if not managed promptly. However, the symptom profile of aortic dissections can be ambiguous to numerous conditions which are more common and greater pursued by clinicians before suspicion of dissection is made. The case presented in this study is of a 61-year-old male who arrives to the emergency department for concern of new-onset chest pain which progresses into ventricular fibrillation arrest prior to diagnosis of aortic dissection. This case report profiles the mimicking possibility of aortic dissection to present as acute myocardial injury, and the utility of models use to differentiate the workup between aortic dissections and acute coronary syndromes.

ER stress is a crucial factor in the progression of vascular cell diseases. Notably, octanoic acid (OA; C8:0) and decanoic acid (DA; C10:0), prominent components of medium-chain fatty acids (MCFAs), may provide potential health benefits. However, their effects on vascular smooth muscle cells (VSMCs) remain unknown. Given the link between ER stress and vascular cell pathological conditions, the primary goal of this research is to investigate the protective effects of OA and DA against ER stress induction in rat aortic smooth muscle cells (RASMCs). To achieve this objective, RASMCs were pretreated with OA and DA at concentrations of 250 and 500 μM for 24 h. Subsequently, the cells were exposed to 1 μg/mL of tunicamycin, an ER stress inducer, for an additional 24 h. Apoptosis was assessed using DAPI staining, while DCFH2-DA probe was used to measure ROS levels. Furthermore, the gene expression of ER stress markers, such as CHOP, GRP78, ATF4, and eIF2α, as well as contractile markers like αSMA and MYH11, was assessed using real-time reverse transcription polymerase chain reaction. Moreover, the αSMA protein level was measured using immunocytochemistry techniques. The study revealed that OA and DA significantly mitigated cell death caused by tunicamycin, decreased ROS production, and inhibited the gene expression of ER stress markers (CHOP, GRP78, and eIF2α). Notably, OA and DA also inhibited the expression of contractile genes (α-SMA and MYH11) and reduced the number of α-SMA-positive cells in tunicamycin-treated RASMCs. These findings indicate that OA and DA offer protection against ER stress-stimulated cell death and ROS generation in VSMCs, thereby supporting their potential therapeutic applications for safeguarding these cells.

This case article takes you on a journey starting with a paediatric patient presenting with sudden-onset lower limb paralysis and paraesthesia. Differential diagnoses, investigations and management are discussed as the case progresses, ultimately leading to the underlying cause.

Background/Objectives: Aortic dissection (AD) and aortic intramural hematoma (IMH) are fatal diseases with similar clinical characteristics. Immediate computed tomography (CT) with a contrast medium is required to confirm the presence of AD or IMH. This retrospective study aimed to use CT images to differentiate AD and IMH from normal aorta (NA) using a deep learning algorithm. Methods: A 6-year retrospective study of non-contrast chest CT images was conducted at a university hospital in Seoul, Republic of Korea, from January 2016 to July 2021. The position of the aorta was analyzed in each CT image and categorized as NA, AD, or IMH. The images were divided into training, validation, and test sets in an 8:1:1 ratio. A deep learning model that can differentiate between AD and IMH from NA using non-contrast CT images alone, called YOLO (You Only Look Once) v4, was developed. The YOLOv4 model was used to analyze 8881 non-contrast CT images from 121 patients. Results: The YOLOv4 model can distinguish AD, IMH, and NA from each other simultaneously with a probability of over 92% using non-contrast CT images. Conclusions: This model can help distinguish AD and IMH from NA when applying a contrast agent is challenging.

Iatrogenic type A aortic dissection (IAAD) is a rare but life-threatening complication of percutaneous coronary intervention (PCI), often presenting significant therapeutic challenges. A looped guidewire between the right subclavian artery and brachiocephalic artery during coronary angiography (CAG) via right radial artery access can complicate catheter manipulation. This report discusses the case of a 58-year-old hypertensive female patient who developed aortic dissection during PCI, specifically due to wire manipulation at the brachiocephalic loop. The dissection extended retrogradely into the ascending aorta. Despite the severity, the patient remained hemodynamically stable and free from myocardial ischemia. Given her stability, conservative management focusing on blood pressure control was chosen. Serial CT imaging confirmed stabilization of the dissection. The patient underwent successful PCI via the femoral approach at a later date and was discharged the following day. This case underscores the potential for conservative management in select IAAD cases, emphasizing individualized treatment strategies.

Acute aortic dissection (AAD) is a life-threatening condition that necessitates rapid medical intervention. In Japan, helicopter emergency medical services (HEMS) are deployed using either keyword-based early requests or standard requests from ground emergency medical services (GEMS). This study evaluates the impact of these request methods on patient outcomes.

We conducted a retrospective cohort study using data from the Japanese Society for Aeromedical Services registry from April 2015 to March 2020. A total of 342 AAD patients transported by HEMS were analyzed, excluding those with out-of-hospital cardiac arrest. Patients were categorized based on whether HEMS was requested using a keyword method or after initial GEMS contact. We compared the groups on time intervals, prehospital interventions, and outcomes including Cerebral Performance Category.

The time from GEMS awareness to HEMS contact was significantly shorter in the keyword methods group compared with the control group (median 27 vs. 33 minutes, respectively; P < .001). No significant difference was observed in the time from contact to departure from the scene. Patient characteristics, vital signs at HEMS staff contact, and medical interventions provided by HEMS staff showed no statistically significant differences. Changes in vital signs from HEMS staff contact to hospital arrival included a significant decrease in the respiratory rate and systolic blood pressure. Patients in the keyword methods group had a significantly higher proportion of favorable outcomes in terms of Cerebral Performance Category compared with the control group (77.2% vs. 66.5%, P = .03). However, logistic analysis did not show significant differences (odds ratio = 1.007; 95% confidence interval, 0.987-1.016; P = .814).

Keyword methods for early HEMS requests may appear to reduce time to specialty care and suggest improvement of outcomes for patients with AAD.

Aortic dissection (AD) is a life-threatening cardiovascular emergency that is often misdiagnosed as other chest pain conditions. Physiologically, AD may cause abnormalities in peripheral blood flow, which can be detected using pulse oximetry waveforms.

This study aimed to assess the feasibility of identifying AD based on pulse oximetry waveforms and to highlight the key waveform features that play a crucial role in this diagnostic method.

This prospective study employed high-risk chest pain cohorts from two emergency departments. The initial cohort was enriched with AD patients (n = 258, 47% AD) for model development, while the second cohort consisted of chest pain patients awaiting angiography (n = 71, 25% AD) and was used for external validation. Pulse oximetry waveforms from the four extremities were collected for each patient. After data preprocessing, a recognition model based on the random forest algorithm was trained using patients' gender, age, and waveform difference features extracted from the pulse oximetry waveforms. The performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA). The importance of features was also assessed using Shapley Value and Gini importance.

The model demonstrated strong performance in identifying AD in both the training and external validation sets. In the training set, the model achieved an area under the ROC curve of 0.979 (95% CI: 0.961-0.990), sensitivity of 0.918 (95% CI: 0.873-0.955), specificity of 0.949 (95% CI: 0.912-0.985), and accuracy of 0.933 (95% CI: 0.904-0.959). In the external validation set, the model attained an area under the ROC curve of 0.855 (95% CI: 0.720-0.965), sensitivity of 0.889 (95% CI: 0.722-1.000), specificity of 0.698 (95% CI: 0.566-0.812), and accuracy of 0.794 (95% CI: 0.672-0.878). Decision curve analysis (DCA) further showed that the model provided a substantial net benefit for identifying AD. The median mean and median variance of the four limbs' signals were the most influential features in the recognition model.

This study demonstrated the feasibility and strong performance of identifying AD based on peripheral pulse oximetry waveforms in high-risk chest pain populations in the emergency setting. The findings also provided valuable insights for future human fluid dynamics simulations to elucidate the impact of AD on blood flow in greater detail.

Aortic dissection (AD) is a medical emergency that occurs as a result of a compromise in the structural integrity of the aorta. If left untreated, AD can have severe consequences such as organ dysfunction or even death. Malperfusion syndrome is a major complication of aortic dissection with mesenteric malperfusion syndrome being a rare but devastating form that can lead to mesenteric ischemia and is associated with poor prognosis despite timely management. Here we report a case of a 31-year-old woman who was diagnosed with mesenteric ischemia secondary to incidental findings of aortic dissection whilst being investigated for ischemic hepatitis. She underwent emergency surgery to repair the aortic dissection but faced challenges due to unusual arterial vasculature. Despite best efforts, the patient's condition deteriorated, leading to severe brain injury. Management of aortic dissection complicated by mesenteric malperfusion remains a clinical challenge with high mortality rates and despite this, there is currently no definitive national guideline for the best management approach.

In the segmentation of aortic dissection, there are issues such as low contrast between the aortic dissection and surrounding organs and vessels, significant differences in dissection morphology, and high background noise. To address these issues, this paper proposed a reinforcement learning-based method for type B aortic dissection localization. With the assistance of a two-stage segmentation model, the deep reinforcement learning was utilized to perform the first-stage aortic dissection localization task, ensuring the integrity of the localization target. In the second stage, the coarse segmentation results from the first stage were used as input to obtain refined segmentation results. To improve the recall rate of the first-stage segmentation results and include the segmentation target more completely in the localization results, this paper designed a reinforcement learning reward function based on the direction of recall changes. Additionally, the localization window was separated from the field of view window to reduce the occurrence of segmentation target loss. Unet, TransUnet, SwinUnet, and MT-Unet were selected as benchmark segmentation models. Through experiments, it was verified that the majority of the metrics in the two-stage segmentation process of this paper performed better than the benchmark results. Specifically, the Dice index improved by 1.34%, 0.89%, 27.66%, and 7.37% for each respective model. In conclusion, by incorporating the type B aortic dissection localization method proposed in this paper into the segmentation process, the overall segmentation accuracy is improved compared to the benchmark models. The improvement is particularly significant for models with poorer segmentation performance.

Aortic dissection, a serious medical condition characterized by a tear in the aorta's inner layer leading to the establishment of a false channel within the vessel wall, in this report, we present a very rare case of asymptomatic substantial aortic dissection spanning from the ascending aorta to the abdominal aorta.

A 36-year-old male with fever and cough was found to have clinical features suggestive of Marfan syndrome. Examination revealed bilateral fine crackles and a diastolic heart murmur. Imaging showed bilateral infiltrates, hyperinflation, and aortic dissection. Echocardiography confirmed severe aortic valve regurgitation and Stanford type A dissection. Despite recommended surgery, the patient opted for medical therapy due to financial constraints, showing stable cardiac anomalies after 6 months.

Aortic dissection, a critical cardiovascular emergency, affects mainly the elderly, exacerbated by hypertension, atherosclerosis, and connective tissue disorders. Early detection via CT and biomarkers is crucial. Type A dissections typically require surgical repair, while endovascular repair is used for complex Type B cases, reducing long-term mortality. The TEM system aids in categorization, guiding treatment. Conditions like Marfan syndrome significantly contribute to aortic wall degeneration, requiring close monitoring and intervention.

The coalescence of aortic dissections with Marfan syndrome underscores the need for tailored monitoring in high-risk populations and highlights the silent complexities of cardiovascular pathologies, urging refined diagnostics and therapeutic approaches.

Acute lung injury (ALI) is a serious adverse event in the management of acute type A aortic dissection (ATAAD). Using a large-scale cohort, we applied artificial intelligence-driven approach to stratify patients with different outcomes and treatment responses. A total of 2,499 patients from China 5A study database (2016-2022) from 10 cardiovascular centers were divided into 70% for derivation cohort and 30% for validation cohort, in which extreme gradient boosting algorithm was used to develop ALI risk model. Logistic regression was used to assess the risk under anti-inflammatory strategies in different risk probability. Eight top features of importance (leukocyte, platelet, hemoglobin, base excess, age, creatinine, glucose, and left ventricular end-diastolic dimension) were used to develop and validate an ALI risk model, with adequate discrimination ability regarding area under the receiver operating characteristic curve of 0.844 and 0.799 in the derivation and validation cohort, respectively. By the individualized treatment effect prediction, ulinastatin use was significantly associated with significantly lower risk of developing ALI (odds ratio [OR] 0.623 [95% CI 0.456, 0.851]; P = 0.003) in patients with a predicted ALI risk of 32.5-73.0%, rather than in pooled patients with a risk of <32.5 and >73.0% (OR 0.929 [0.682, 1.267], P = 0.642) (Pinteraction = 0.075). An artificial intelligence-driven risk stratification of ALI following ATAAD surgery were developed and validated, and subgroup analysis showed the heterogeneity of anti-inflammatory pharmacotherapy, which suggested individualized anti-inflammatory strategies in different risk probability of ALI.

Aortic dissection (AD) remains a difficult diagnosis in the emergency setting. Despite its rare occurrence, it is a life-threatening pathology that, if missed, is typically fatal. Previous studies have documented minimal improvement in timely and accurate diagnoses despite the advancement of computed tomography. Previous literature has highlighted aortic dissections as a major cause of serious misdiagnosis-related harm. The aim of this article is to review the available literature on AD, discussing the diversity in presentations and the prevalence of historical and exam features to better aid in the diagnosis of AD. AD remains a difficult diagnosis, even with the widespread prevalence of computed tomography angiography usage. No single feature of the history or physical examination is enough to raise suspicion. The diagnosis should be strongly considered in any patient with chest pain that is severe and unexplained by other findings or testing. Those who do not present with acute pain are often complicated by neurologic deficits, hypotension, or syncope. These patients suffer from a change in mental status limiting their ability to participate in the history and physical examination and have a higher rate of complications and mortality. An educated understanding of the atypical presentations of aortic dissection helps the clinician to realistically rank it on the differential diagnosis, culminating in judicious use of definitive imaging.

Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring timely surgical intervention. Despite successful surgery, postoperative outcomes are frequently suboptimal due to the high frequency of cardiovascular risk factors. This study examines baseline cardiovascular risk factors in a population of ATAAD patients in the Netherlands. Additionally, this study outlines the protocol for a randomized controlled trial, designed to improve postoperative management.Baseline data were collected from patients with ATAAD. Data were gained through the Stichting Aorta Dissectie Nederland, a Dutch association for aortic dissection patients. The data included information on cardiovascular risk factors and health-related quality of life. A survey was further conducted, to gain more insights into the ATAAD postoperative care experiences of cardiac and vascular surgeons.Among the 50 ATAAD patients in our study, we found significant cardiovascular risk factors, including smoking (36.7%), obesity (34.2%), and hypertension (51.3%). In the surgeon survey (N = 48), 84% of respondents highlighted the significance of lifestyle changes for patients, underscoring the need for individualized risk management. These findings underscore the need for tailored postoperative management programs aimed at improving patient outcomes.The results of our study highlight that ATAAD patients require comprehensive postoperative care management strategies. The ultimate goal is to enhance long-term patient outcomes and improve health-related quality of life. To address this need, the TRAIN (Targeted caRdiovAscular rIsk reductioN) Health Awareness platform seeks to implement personalized eHealth-based lifestyle interventions.

Acute aortic dissection is a cardiovascular emergency that should be recognised on presentation in the Emergency Department (ED) because clinical outcome is time-dependent. In suspected cases of acute aortic dissection, immediate imaging with chest computed tomography scan followed by transthoracic echocardiography (TTE) is essential to confirm diagnosis. Immediate medical management is aimed at controlling the heart rate (60-80 beats/min), systolic blood pressure (100-120 mmHg) and pain. Patients with Type A acute aortic dissection should immediately be referred to the cardiothoracic surgeons for emergency aortic surgery while those with Type B acute aortic dissection should be referred to the vascular surgeons for surgical/endovascular interventions if indicated.

Bevacizumab (Bev) is a humanized monoclonal antibody that targets vascular endothelial growth factor A and is primarily used for the treatment of various solid tumors. Aortic dissection (AD) is a severe vascular disease caused by the tearing of the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of different layers of the aortic wall. However, the pathogenesis is not fully understood. Some studies have suggested that Bev treatment is associated with the occurrence of AD.

A 67-year-old Chinese male was diagnosed with rectal cancer accompanied by liver and lung metastasis. Three days after starting combined chemotherapy with Bev, the patient developed persistent abdominal pain. Abdominal CT scan revealed celiac trunk AD in the abdominal aorta.

The patient was diagnosed with rectal cancer accompanied by liver and lung metastases. Abdominal CT tomography revealed a celiac trunk AD.

Somatostatin combined with valsartan was used to control blood pressure. The patient was subsequently referred for vascular surgery and underwent an abdominal aortic angiography. Conservative treatment was continued.

Three months after the initiation of treatment, follow-up abdominal CT scans showed stability in the condition of celiac trunk AD, with no abdominal pain or hypertension. There were no signs of worsening dissection, aneurysm formation, or inadequate perfusion of end organs.

There may be a connection between Bev and elevated blood pressure as well as celiac trunk AD.

Aortic dissection (AD) is a life-threatening condition with a high mortality rate and without effective pharmacological therapies. Our previous study illustrated that leukocyte immunoglobulin-like receptor B4 (LILRB4) knockdown promoted the contractile phenotypic switch and apoptosis of AD cells. This study aimed to further investigate the role of LILRB4 in animal models of AD and elucidate its underlying molecular mechanisms. Animal models of AD were established using 0.1% beta-aminopropionitrile and angiotensin II and an in vitro model was developed using platelet-derived growth factor BB (PDGF-BB). The effects of LILRB4 knockdown on histopathological changes, pyroptosis, phenotype transition, extracellular matrix (ECM), and Janus kinase 2 (JAK2)/signal transducers and activators of transcription 3 (STAT3) pathways were assessed using a series of in vivo and in vitro assays. The effects of the JAK2 inhibitor AG490 on AD cell function, phenotypic transition, and ECM were explored. LILRB4 was highly expressed in AD and its knockdown increased survival rate, reduced AD incidence, and alleviated histopathological changes in the AD mouse model. Furthermore, LILRB4 knockdown promoted contractile phenotype switch, stabilized the ECM, and inhibited pyroptosis. Mechanistically, LILRB4 knockdown inhibited the JAK2/STAT3 signaling pathway. JAK2 inhibitor AG490 inhibited cell viability and migration, enhanced apoptosis, induced G0/G1 cell cycle arrest, and suppressed S-phase progression in PDGF-BB-stimulated human aortic smooth muscle cells. LILRB4 knockdown suppresses AD development by inhibiting pyroptosis and the JAK2/STAT3 signaling pathway.

Since the endovascular repair for aortic dissection by stent graft still has limitations of the application scope and complications, our group has been developing and evaluating a new stenting function by replacing it with a large self-expandable bare metal stent. In this study, we use finite element analysis to evaluate the remodeling outcomes of the dissected aorta by this new stent. An ideal aortic dissection model was also designed using numerical simulations based on previous animal and in vitro experiments, and then a 32mm bare metal stent was deployed at the location of the lesion. The radial force was measured by both experimental and computational methods to evaluate the mechanical performance of the bare metal stent. Results showed that two tears were successfully closed by the stent; the ratio of the lumen area between the false and true lumens was successfully decreased by more than 50% after the deployment; the diameter of the vessel did not change significantly after treatment; the stent was in good apposition with the inner wall of the aorta, but there were still small gaps and stress concentrations. The positive outcomes indicate the feasibility of this treatment and predict its long-term usage with associated fewer risks compared to the stent graft. Such analyses may provide valuable information for the design of the stent to optimize the remodeling of the true lumen and advance clinical use in the future.

Aortic dissections (ADs) are serious conditions of the main artery of the human body, where a tear in the inner layer of the aortic wall leads to the formation of a new blood flow channel, named false lumen. ADs affecting the aorta distally to the left subclavian artery are classified as a Stanford type B aortic dissection (type B AD). This is linked to substantial morbidity and mortality, however, the course of the disease for the individual case is often unpredictable. Computed tomography angiography (CTA) is the gold standard for the diagnosis of type B AD. To advance the tools available for the analysis of CTA scans, we provide a CTA collection of 40 type B AD cases from clinical routine with corresponding expert segmentations of the true and false lumina. Segmented CTA scans might aid clinicians in decision making, especially if it is possible to fully automate the process. Therefore, the data collection is meant to be used to develop, train and test algorithms.

Chest radiography (CR) has been used as a screening tool for lung cancer and the use of low-dose computed tomography (LDCT) is not recommended in Japan. We need to reconsider whether CR really contributes to the early detection of lung cancer. In addition, we have not well discussed about other major thoracic disease detection by CR and LDCT compared with lung cancer despite of its high frequency. We review the usefulness of CR and LDCT as veridical screening tools for lung cancer and other thoracic diseases. In the case of lung cancer, many studies showed that LDCT has capability of early detection and improving outcomes compared with CR. Recent large randomized trial also supports former results. In the case of chronic obstructive pulmonary disease (COPD), LDCT contributes to early detection and leads to the implementation of smoking cessation treatments. In the case of pulmonary infections, LDCT can reveal tiny inflammatory changes that are not observed on CR, though many of these cases improve spontaneously. Therefore, LDCT screening for pulmonary infections may be less useful. CR screening is more suitable for the detection of pulmonary infections. In the case of cardiovascular disease (CVD), CR may be a better screening tool for detecting cardiomegaly, whereas LDCT may be a more useful tool for detecting vascular changes. Therefore, the current status of thoracic disease screening is that LDCT may be a better screening tool for detecting lung cancer, COPD, and vascular changes. CR may be a suitable screening tool for pulmonary infections and cardiomegaly.

Reports of primary cardiovascular disease in goats are rare and most commonly include ventricular septal defect, valvular endocarditis, traumatic pericarditis, ionophore poisoning and nutritional cardiomyopathies. We now report the pathological findings in a 67 kg, 6-year-old, adult female Boer goat that presented with neurological signs (ie, head pressing, unsteadiness and paddling) and hyperthermia 2 days prior to death. Lack of therapeutic response to meloxicam and penicillin‒streptomycin and poor prognosis led to euthanasia of the animal. At necropsy, the main findings included severe aortic dissection with luminal thrombosis and stenosis, and pulmonary congestion and oedema. Histological examination of the aorta revealed severe chronic granulomatous and fibrosing dissecting aortitis with mineralization. Bacterial culture of the affected aortic segment resulted in isolation of a profuse growth of Pasteurella multocida and a moderate growth of Staphylococcus spp. Histopathological findings in the central nervous system were consistent with neurolisteriosis.

The aim of this research was to compile a self-management assessment scale for patients with aortic dissection (AD). The questionnaire is useful in making the patient aware of the need for post-operative care in order to contribute to improving the outcome and quality of life.

The initial version of the "postoperative self-management assessment scale for patients with aortic dissection" was developed using the Delphi expert consultation method based on qualitative research results, consultation of self-management-related literature, reference to the existing self-management scale, and self-efficacy theory, combined with the disease characteristics of AD. By using the convenience sampling method, a total of 201 patients with AD who had undergone surgery were selected as the research participants. The initial version of the scale was used for follow-up investigation, and the scale entries were evaluated and exploratory factor analysis carried out to form the formal version of the "postoperative self-management assessment scale for patients with aortic dissection." A total of 214 patients with AD after surgery were selected as the research participants. The formal version of the scale was used for follow-up investigation, and its reliability and validity were evaluated.

The formal version of the scale had 6 dimensions and 35 entries. The Cronbach's α coefficient for the total scale was 0.908, the split-half reliability was 0.790, and the test-retest reliability after 2 weeks was 0.471. The content validity index of the total scale was 0.963. Exploratory factor analysis yielded six common factors, and the cumulative contribution rate of variance was 66.303%. Confirmatory factor analysis showed that except for the incremental fit index, Tucker-Lewis index, and comparative fit index >0.85, slightly lower than 0.90, χ 2/df <3, root mean square of approximation <0.08, parsimonious goodness-of-fit index, and parsimonious normed fit index >0.50; all other model fitting requirements were satisfied, indicating that the model fitting was acceptable.

We compiled the postoperative self-management assessment scale for patients with AD, which has demonstrated excellent reliability and validity and can be used as a tool to evaluate the postoperative self-management level in patients with aortic dissection.

Vascular cell adhesion molecule-1 (VCAM-1) was identified over 2 decades ago as an endothelial adhesion receptor involved in leukocyte recruitment and cell-based immune responses. In atherosclerosis, a chronic inflammatory disease of the blood vessels that is the leading cause of death in the USA, endothelial VCAM-1 is robustly expressed beginning in the early stages of the disease. The interactions of circulating immune cells with VCAM-1 on the activated endothelial cell surface promote the uptake of monocytes and the progression of atherosclerotic lesions in susceptible vessels. Herein, we review the role of VCAM-1 in atherosclerosis and the use of VCAM-1 binding peptides, antibodies and aptamers as targeting agents for nanoplatforms for early detection and treatment of atherosclerotic disease.