BACKGROUND Understanding the type and extent of coronary artery involvement in patients with acute type A aortic dissection(ATAAD)is vital for surgical planning.The Neri classification has been proposed as a guide for...BACKGROUND Understanding the type and extent of coronary artery involvement in patients with acute type A aortic dissection(ATAAD)is vital for surgical planning.The Neri classification has been proposed as a guide for surgical strategies,however,its prognostic impact on postoperative mortality rates remains understudied in large-scale cohorts.METHODS We reviewed 600 ATAAD patients who underwent surgery and coronary computed tomography angiography from 2016 to 2020 at Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,China.Patients were classified based on the Neri classification system:no coronary artery involvement,type A(ostial involvement),type B(dissection in coronary body),and type C(circumferential detachment or complete avulsion).The primary endpoint was 30-day mortality.RESULTS Overall,28.3%of the patients had coronary artery involvement,with Neri type A,Neri type B,and Neri type C accounting for 13.3%,11.2%,and 3.8%,respectively.The right coronary artery was more frequently involved(25.3%)than the left coronary artery(8.0%).In the unadjusted analysis,patients with coronary artery involvement exhibited a numerically higher 30-day mortality compared to those without(5.3%vs.2.3%)(OR=2.35,95%CI:0.94–5.88,P=0.07),though this difference did not reach statistical significance.However,multivariable adjustment revealed significant association(adjusted OR=3.71,95%CI:1.05–13.13,P=0.04).Interestingly,after additional adjustment for coronary artery bypass grafting,the impact of coronary artery involvement on 30-day mortality no longer remained statistically significant(adjusted OR=3.13,95%CI:0.85–11.58,P=0.09).The 1-year mortality was higher in those with coronary artery involvement,but this significant association disappeared after adjusting for potential confounding variables.Furthermore,no significant difference in 30-day and 1-year mortality were observed among patients with different Neri classifications.CONCLUSIONS In patients with ATAAD who undergo surgery,the presence of coronary artery involvement is significantly associated with an increased risk of 30-day mortality.Proactive coronary artery bypass grafting may potentially mitigate the adverse impact of coronary artery involvement on 30-day mortality.展开更多
In recent years,ionic modulation,particularly hydrogen intercalation,has gained attention as a powerful method for tuning the properties of materials.Although the SrFeO_(x)system is similar to SrCoO_(x),which can be p...In recent years,ionic modulation,particularly hydrogen intercalation,has gained attention as a powerful method for tuning the properties of materials.Although the SrFeO_(x)system is similar to SrCoO_(x),which can be protonated to the HSrCoO_(2.5)phase,it remains a challenge for the hydrogenation of SrFeO_(2.5).In this study,starting from the perovskite SrFeO_(3−δ),we achieved hydrogen intercalation and obtained stable hydrogenated brownmillerite-phase HSrFeO_(2.5)via Pt-catalyzed H-spillover at room temperature.The results indicate that the hydrogenation process is accompanied by the simultaneous oxygen ionic release,that is,perovskite SrFeO_(3−δ)is the prerequisite for the hydrogen-induced phase transition.Subsequently,upon hydrogenation,the entire phase transition cycle among the perovskite SrFeO_(3−δ),brownmillerite SrFeO_(2.5),and the hydrogenated HSrFeO_(2.5)phase,is completed.Furthermore,SrFeO_(3−δ)exhibits a remarkable 9.4%lattice expansion,and its electronic state undergoes a multi-step evolution,transforming from a pristine helical antiferromagnetic insulator to a bad metal,eventually returning to an antiferromagnetic insulator.Based on the obtained results,we fabricated microscale patterns with varied surface morphologies and electrical conductivities that can be used in fabricating electronic devices.This study presents a novel approach for modulating the properties of correlated and functional materials.展开更多
基金supported by the National High Level Hospital Clinical Research Funding(No.2024-GSP-TJ-15&No.2023-GSP-QN-17)the Chinese Society of Cardiology’s Foundation(CSCF2023B03).
文摘BACKGROUND Understanding the type and extent of coronary artery involvement in patients with acute type A aortic dissection(ATAAD)is vital for surgical planning.The Neri classification has been proposed as a guide for surgical strategies,however,its prognostic impact on postoperative mortality rates remains understudied in large-scale cohorts.METHODS We reviewed 600 ATAAD patients who underwent surgery and coronary computed tomography angiography from 2016 to 2020 at Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,China.Patients were classified based on the Neri classification system:no coronary artery involvement,type A(ostial involvement),type B(dissection in coronary body),and type C(circumferential detachment or complete avulsion).The primary endpoint was 30-day mortality.RESULTS Overall,28.3%of the patients had coronary artery involvement,with Neri type A,Neri type B,and Neri type C accounting for 13.3%,11.2%,and 3.8%,respectively.The right coronary artery was more frequently involved(25.3%)than the left coronary artery(8.0%).In the unadjusted analysis,patients with coronary artery involvement exhibited a numerically higher 30-day mortality compared to those without(5.3%vs.2.3%)(OR=2.35,95%CI:0.94–5.88,P=0.07),though this difference did not reach statistical significance.However,multivariable adjustment revealed significant association(adjusted OR=3.71,95%CI:1.05–13.13,P=0.04).Interestingly,after additional adjustment for coronary artery bypass grafting,the impact of coronary artery involvement on 30-day mortality no longer remained statistically significant(adjusted OR=3.13,95%CI:0.85–11.58,P=0.09).The 1-year mortality was higher in those with coronary artery involvement,but this significant association disappeared after adjusting for potential confounding variables.Furthermore,no significant difference in 30-day and 1-year mortality were observed among patients with different Neri classifications.CONCLUSIONS In patients with ATAAD who undergo surgery,the presence of coronary artery involvement is significantly associated with an increased risk of 30-day mortality.Proactive coronary artery bypass grafting may potentially mitigate the adverse impact of coronary artery involvement on 30-day mortality.
基金supported by the National Key R&D Program of China(Grant Nos.2022YFA1403000 and 2024YFA1408302)the CAS Project for Young Scientists in Basic Research(Grant No.YSBR-047)the Strategic Priority Research Program of the Chinese Academy of Sciences of China(Grant No.XDB33000000)。
文摘In recent years,ionic modulation,particularly hydrogen intercalation,has gained attention as a powerful method for tuning the properties of materials.Although the SrFeO_(x)system is similar to SrCoO_(x),which can be protonated to the HSrCoO_(2.5)phase,it remains a challenge for the hydrogenation of SrFeO_(2.5).In this study,starting from the perovskite SrFeO_(3−δ),we achieved hydrogen intercalation and obtained stable hydrogenated brownmillerite-phase HSrFeO_(2.5)via Pt-catalyzed H-spillover at room temperature.The results indicate that the hydrogenation process is accompanied by the simultaneous oxygen ionic release,that is,perovskite SrFeO_(3−δ)is the prerequisite for the hydrogen-induced phase transition.Subsequently,upon hydrogenation,the entire phase transition cycle among the perovskite SrFeO_(3−δ),brownmillerite SrFeO_(2.5),and the hydrogenated HSrFeO_(2.5)phase,is completed.Furthermore,SrFeO_(3−δ)exhibits a remarkable 9.4%lattice expansion,and its electronic state undergoes a multi-step evolution,transforming from a pristine helical antiferromagnetic insulator to a bad metal,eventually returning to an antiferromagnetic insulator.Based on the obtained results,we fabricated microscale patterns with varied surface morphologies and electrical conductivities that can be used in fabricating electronic devices.This study presents a novel approach for modulating the properties of correlated and functional materials.
