The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discov...The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discovery.[2]Due to its rarity,knowledge mainly comes from case reports and small case series,though some decision algorithms have been proposed in systematic reviews.展开更多
Dear Editor,We extend our academic appreciation to the contributors of this pioneering study,1 which leverages Mendelian Randomization(MR)to investigate the causal relationship between immune cell phenotypes and intra...Dear Editor,We extend our academic appreciation to the contributors of this pioneering study,1 which leverages Mendelian Randomization(MR)to investigate the causal relationship between immune cell phenotypes and intracranial aneurysms(IAs),demonstrating a certain level of innovation.By extracting 731 immunophenotypes from publicly available genetic databases and conducting large-scale analyses,the study comprehensively evaluates the impact of immune cell traits on IAs.Moreover,multivariable MR analysis was employed to adjust for interactions between different immune phenotypes,providing a novel perspective on the interplay between the immune system and IAs.展开更多
The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleedin...The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.展开更多
The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which...The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.展开更多
Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We dis...Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms,particularly in the anterior circulation.The article compares various imaging modalities,including computer tomography angiogram,magnetic resonance imaging/angiography,and digital subtraction angiogram,highlighting their strengths and limitations.We emphasize the im-portance of accurate differentiation to avoid unnecessary surgical interventions.The potential of emerging technologies,such as high-resolution vessel wall ima-ging and deep neural networks for automated detection,is explored as promising avenues for improving diagnostic accuracy.This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.展开更多
BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel us...BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.展开更多
Intracranial aneurysm(IA)is a prevalent cerebrovascular disease associated with high mortality and disability rates upon rupture.The hemodynamics of IA,which are significantly influenced by geometric parameters,direct...Intracranial aneurysm(IA)is a prevalent cerebrovascular disease associated with high mortality and disability rates upon rupture.The hemodynamics of IA,which are significantly influenced by geometric parameters,directly impact its rupture.This study focuses on investigating the transient flow characteristics in saccular IA models fabricated using a water droplet-based method,specifically examining the influence of neck widths.Particle image velocimetry technique and numerical simulation were employed to investigate the dynamic evolution of flow structures within three IA models.The results reveal that neck width(W)has a substantial effect on flow characteristics in the neck region,subsequently impacting the deep flow inside the sac.Three distinct patterns were observed during flow evolution inside the sac:for W=2 mm,two vortices occur and then disappear with relatively low average flow velocity;for W=4 mm,enhanced effects of a high-speed jet result in periodic pulsatile flow velocity distribution while maintaining stable vortex core position;for W=6 mm,significant changes in flow velocity occur due to size expansion and intensity increase of vortices.These findings demonstrate that neck widths play a complex role in influencing transient flow characteristics within IAs.Overall,this research contributes to further understanding transient flow behaviors in IAs.展开更多
BACKGROUND Aneurysmal subarachnoid hemorrhage(aSAH),a particularly devastating subtype of stroke,is associated with substantial rates of mortality and long-term functional impairment.Despite notable progress in therap...BACKGROUND Aneurysmal subarachnoid hemorrhage(aSAH),a particularly devastating subtype of stroke,is associated with substantial rates of mortality and long-term functional impairment.Despite notable progress in therapeutic strategies,a considerable proportion of aSAH survivors continue to suffer from neuropsychiatric complications,most commonly anxiety and depression,which detrimentally impact their overall quality of life.AIM To investigate the prevalence of anxiety and depressive symptoms in patients with aSAH and to identify associated clinical risk factors.METHODS Clinical records of 1268 consecutive patients diagnosed with aSAH and treated between 2016 and 2022 were retrospectively reviewed.At follow-up,psychological assessments were performed using the Hospital Anxiety and Depression Scale to quantify symptoms of anxiety and depression.To identify independent predictors associated with these psychological outcomes post-aSAH,both univariate and multivariate statistical analyses were employed.RESULTS Among the studied cohort,34.9%of patients presented with anxiety symptoms,while 31.8%demonstrated depressive features.Multivariate analysis identified female sex,presence of multiple aneurysms,a positive family history of cerebral hemorrhage,and receiving surgical clipping as independent predictors of anxiety.In contrast,significant predictors of depression included female sex,multiplicity of aneurysms,posterior circulation aneurysm localization,and poor clinical outcome.Notably,age above 60 years and documented functional recovery were associated with a reduced risk of depression.CONCLUSION Anxiety and depression are common neuropsychiatric sequelae in survivors of aSAH,each associated with a distinct set of risk factors.Early identification and targeted management of these risk profiles may facilitate more effective intervention strategies for psychological comorbidities,ultimately contributing to improved long-term patient outcomes.展开更多
Background Abdominal aortic aneurysm(AAA)is a life-threatening vascular disease associated with endothelial cell senescence.Resveratrol(RSV),a natural polyphenol,exerts potent anti-senescent and anti-inflammatory effe...Background Abdominal aortic aneurysm(AAA)is a life-threatening vascular disease associated with endothelial cell senescence.Resveratrol(RSV),a natural polyphenol,exerts potent anti-senescent and anti-inflammatory effects.However,its molecular mechanism in treating AAA remains unclear.Methods An AAA model was established in mice via angiotensin Ⅱ(AngⅡ)infusion[1000 ng/(kg·min)],with a subset receiving RSV treatment[100 mg/(kg·day)by gavage].Aortic diameter was measured,and histopathological changes were assessed by Hematoxylin-Eosin(HE)and Elastica Van Gieson(EVG)staining.Vascular aging was evaluated by senescence-associatedβ-galactosidase(SA-β-gal)activity and pulse wave velocity(PWV).In vitro,human umbilical vein endothelial cells(HUVECs)were treated with AngⅡ(10-6 M)with or without RSV(40μM)and/or the sirtuin 1(SIRT1)inhibitor EX527(10μM).Senescence markers,senescence-associated secretory phenotype(SASP)factor expression[interleukin-1 beta(IL-1β),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],and SIRT1/p21 pathway proteins were analyzed.Results In vivo,RSV significantly attenuated Ang Ⅱ-induced AAA formation,reducing aortic diameter,preserving elastic fiber integrity,and suppressing vascular senescence and stiffness.In HUVECs,Ang Ⅱ-induced senescence and SASP expression were markedly inhibited by RSV.However,these protective effects were abolished by EX527.Mechanistically,RSV reversed the Ang Ⅱ-induced downregulation of SIRT1 and upregulation of p21,which was also blocked by SIRT1 inhibition.Conclusions RSV effectively prevented experimental AAA formation by alleviating vascular aging and endothelial cell senescence.This protective effect was abrogated by the SIRT1 inhibitor EX527,confirming that RSV mitigated AAA development and vascular senescence through the SIRT1/p21 signaling pathway.These findings highlighted RSV as a promising therapeutic candidate for AAA treatment.展开更多
Chlorfenapyr poisoning is associated with high mortality due to the absence of evidence-based treatment strategies or specific antidotes.[1,2]Chlorfenapyr is a novel N-substituted halogenated pyrrole pro-insecticide.T...Chlorfenapyr poisoning is associated with high mortality due to the absence of evidence-based treatment strategies or specific antidotes.[1,2]Chlorfenapyr is a novel N-substituted halogenated pyrrole pro-insecticide.The active metabolite of tralopyril(a metabolite of chlorfenapyr)can uncouple oxidative phosphorylation and impair adenosine triphosphate(ATP)production.[3]Blood purification techniques,including hemoperfusion(HP),may facilitate tralopyril clearance.[4,5]Here,we present a case of severe chlorfenapyr poisoning that was treated with intensive HP.H owever,during follow-up,we unexpectedly found a ventricular aneurysm in the left ventricle that was not fully explained by coronary artery lesions.展开更多
The mortality rate of patients with abdominal aortic aneurysm(AAA) after rupture is extremely high,and this disease has become an important disease endangering the health of the Chinese population.Methods used to mode...The mortality rate of patients with abdominal aortic aneurysm(AAA) after rupture is extremely high,and this disease has become an important disease endangering the health of the Chinese population.Methods used to model AAA include intraluminal pressurized elastase infusion,chronic infusion of angiotensin Ⅱ(Ang Ⅱ) via an osmotic pump,periarterial application of calcium chloride,vascular grafting,and gene modification.AAA models induced by elastase and Ang Ⅱ are the two most widely used animal models.In the elastase-induced model,because intraluminal infusion is transient,with the cessation of initial stimulation,the aneurysm lesion tends to be stable and rarely ruptures.The model induced by Ang Ⅱ infusion often presents with a typical aortic dissection with a false lumen,whereas clinical AAA patients do not necessarily have dissection.Currently,the treatment of AAA in clinical practice remains endovascular,and there is a lack of pharmacological therapy,which is also related to the fact that the pathogenic mechanism has not been fully elucidated.Smoking,old age,male sex,and hypertension are the main risk factors for AAA,but these risk factors have not been fully investigated in the current modeling methods,which may affect the clinical translational application of research results based on animal models.Therefore,this article reviews the most commonly used AAA modeling methods,comments on their applications and limitations,and provides a perspective on the development of novel animal models.展开更多
Vocal cord paralysis that presents as hoarseness due to an underlying cardiovascular pathology is a rare clinical entity known as Ortner’s syndrome(OS).The syndrome was first described in 1897 by Norbert Ortner in a ...Vocal cord paralysis that presents as hoarseness due to an underlying cardiovascular pathology is a rare clinical entity known as Ortner’s syndrome(OS).The syndrome was first described in 1897 by Norbert Ortner in a report of three patients with severe mitral stenosis.[1]Notably,a review of published cases showed that between 1955 and 1990,mitral stenosis was the primary cause of OS.However,since the 1990s,vascular lesions(especially thoracic aortic aneurysms)have become the most common cause of OS.[2]This epidemiologic shift may be due to improved early detection and treatment of mitral stenosis.展开更多
Intracranial aneurysms,characterized by focal arterial wall dilation,pose significant neurosurgical challenges due to their potential for rupture and hemorrhage,leading to severe clinical outcomes,including fatality.P...Intracranial aneurysms,characterized by focal arterial wall dilation,pose significant neurosurgical challenges due to their potential for rupture and hemorrhage,leading to severe clinical outcomes,including fatality.Patients often experience profound psychological and social impacts,such as depression,anxiety,and cognitive impairment,affecting their quality of life.Rapid progression and high mortality necessitate timely intervention.Advances in neurosurgical techniques,including microscopic surgery and neuroendoscopy,offer distinct advantages.Microscopic surgery provides precision and direct visualization,while neuroendoscopy ensures minimally invasive access and reduced tissue trauma.Integrating these methods optimizes treatment efficacy and clinical outcomes.AIM To evaluate the impact of combined microscopic and neuroendoscopic techniques on psychological,cognitive outcomes,and quality of life in patients with ruptured intracranial aneurysms.METHODS The study focused on 189 patients with intracranial aneurysm rupture and hemorrhage from January 2020 to May 2024 as the objects of observation and analysis.They were randomly divided into a control group(treated with simple microscope surgery,n=94)and an observation group(treated with microscope combined with neuroendoscopy,n=95).The treatment effects of the two groups were observed,mainly including depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data.RESULTS Before treatment,the depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data of the two groups of patients at different time points were compared,and there was no statistically significant difference(P>0.05).After microscope combined with neuroendoscopy treatment,the study revealed that the observation group surpassed the control group in alleviating depression and anxiety,accelerating cognitive function recovery,and enhancing quality of life,with these differences being statistically significant(P<0.05).CONCLUSION Surgical treatment combined with microscopy and neuroendoscopy has a significant positive effect on the mental health,cognitive function and overall quality of life of patients with intracranial aneurysm rupture and bleeding,can shorten the operation time and treatment time,and provides a new strategic reference for clinical treatment.展开更多
BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresecta...BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresectable tumors,present a challenge for orthopedic surgeons and require new treatment approaches.Antiresorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis.Denosumab induces tumor ossification,but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells.Bisphosphonates(BPs)may induce apoptosis of tumor cells and allow for long-term local control.We hypothesized that after denosumab treatment,BPs would better accumulate in the tumor and exert an irreversible antitumor effect.AIM To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.METHODS Using data from five electronic databases(Scopus,MEDLINE,EMBASE,PubMed,Web of Science),we aimed to identify all patients who received denosumab therapy(DT)for unresectable ABCs.Among published case reports and case series,we identified patients who discontinued denosumab for various reasons and divided them into two groups:Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia.Local control rates in both groups were analyzed.RESULTS As of December 2024,43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs.There were 27 males and 16 females with a mean age of 15.8 years.At a median follow-up time of 15.5 months,there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation.All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months.Among patients in Group 2,with a median follow-up time of 12.5 months after completion of therapy,no local relapses were observed.The difference between local recurrence rates(32%vs 0%)is statistically significant(P value=0.02).Kaplan-Meier estimates show the same trend with marginal statistical significance(P value=0.085).Here we put forward a novel treatment algorithm.CONCLUSION BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes,presumably by targeting residual tumor cells.Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.展开更多
BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slo...BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression,commonly referred to as the“double-rupture phenomenon”.The reported incidence of the double-rupture phenomenon ranges 12%-21%in patients with ruptured SAAs,potentially due to variations in intra-abdominal pressure.Following anesthesia induction,muscle relaxation can decrease intra-abdominal pressure,potentially triggering the double-rupture phenomenon and leading to circulatory collapse.CASE SUMMARY A 61-year-old female presented to the Department of Emergency with upper abdominal pain,abdominal distension,dizziness,and vomiting.Her vital signs were initially stable.Physical examination revealed abdominal tenderness and positive-shifting dullness.Abdominal contrast-enhanced computed tomography revealed cirrhosis,severe portal hypertension,and splenomegaly.Acute rupture was suggested by a hematoma on the upper left side outside the SAA.Surgeons deemed intravascular intervention challenging and open splenectomy inevitable.Circulatory collapse occurred after anesthesia induction,likely due to a double rupture of the SAA.This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa,forming a hematoma that exerted a tamponade effect.A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction.The patient’s life was saved through early,coordinated,multidisciplinary significant postoperative bleeding or hypoxic encephalopathy.CONCLUSION Anesthesia-induced pressure reduction may trigger a second SAA rupture,causing collapse.Early diagnosis and multidisciplinary teamwork improve outcomes.This is a rare and life-threatening case of SAA rupture,which is of great significance to the medical community for understanding and handling such emergencies.展开更多
BACKGROUND Giant coronary artery aneurysms(CAA),entailing thrombosis,myocardial infarction,and sudden death,are the most severe and life-threatening complications of Kawasaki disease(KD).Giant aneurysms rarely regress...BACKGROUND Giant coronary artery aneurysms(CAA),entailing thrombosis,myocardial infarction,and sudden death,are the most severe and life-threatening complications of Kawasaki disease(KD).Giant aneurysms rarely regress and can later transform into stenoses.Data on dynamic follow-up are scarce in the literature.AIM To evaluate clinical features and long-term outcomes of giant CAA in children with KD.METHODS A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region(2012-2023).CAA criteria according to the American Heart Association guidelines of 2017 were used:(1)Dilated coronary artery with diameter Z-score>2 standard deviations(SD)but<2.5 SD;(2)Small CAA with Z-score>2.5 SD but<5 SD;(3)Medium CAA with Z-score>5 SD but<10 SD;and(4)Giant CAA with Z-score>10 SD or≥8 mm.RESULTS The mean age of children with coronary dilatation/aneurysms was 2.5 years,and the male-to-female ratio was 3:1.Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate(Z-score<5 SD but>2.0 SD)coronary dilatation(62.0%vs 21.0%,P=0.019).Major cardiovascular events(myocardial infarction,coronary artery bypass grafting,acute coronary syndrome,ischemic cardiomyopathy,left ventricular aneurysm,and giant extracardiac aneurysm)occurred in 55.5%of patients who had giant CAA.At follow-up the complete regression of giant/medium CAA was observed in 58.0%and partial regression in 42.0%after a mean of 2.3 and 5.5 years,respectively.All thrombi detected by echocardiography,CT,and angiography in giant/medium CAA disappeared between 1 year and 5 years(mean:15 months).All patients survived.CONCLUSION Risk factors for giant CAA were male sex,early age,and cerebral dysfunction.Complete regression of giant coronary aneurysms occurred in 58.0%of patients after follow-up of 2.3 years.展开更多
Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracrani...Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.展开更多
Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,...Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,the authors present matrix metalloproteinases(MMPs)and their inhibitors in immunohistological analyses as contributing factors in the pathophysiology of aortic aneurysms(AA).Data analysis of MMP-1,MMP-9,tissue inhibitors of metalloproteinases(TIMPs),including TIMP-1 and TIMP-2 expression reveals a varied distribution between the adventitia and media and a non-uniform expression of the investigated markers.These elements,as key components of the extracellular matrix(ECM),indicate that the formation of AA is not solely driven by endoluminal pressure loading of the aortic wall.Instead,degenerative processes within ECM elements contribute significantly.Importantly,AA do not necessarily imply dissection.Tissue destruction,allowing blood flow entry,arises from reduced oxygen supply to the media,primarily due to incomplete capillarization or neocapillarization.展开更多
Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left ...Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.展开更多
Thoracic aortic aneurysm(TAA)significantly endangers the lives of individuals with Marfan syndrome(MFS),yet the intricacies of their biomechanical origins remain elusive.Our investigation delves into the pivotal role ...Thoracic aortic aneurysm(TAA)significantly endangers the lives of individuals with Marfan syndrome(MFS),yet the intricacies of their biomechanical origins remain elusive.Our investigation delves into the pivotal role of hemodynamic disturbance in the pathogenesis of TAA,with a particular emphasis on the mechanistic contributions of the mammalian target of rapamycin(mTOR)signaling cascade.We uncovered that activation of the mTOR complex 1(mTORC1)within smooth muscle cells,instigated by the oscillatory wall shear stress(OSS)that stems from disturbed flow(DF),is a catalyst for TAA progression.This revelation was corroborated through both an MFS mouse model(Fbn1+/C1039G)and clinical MFS specimens.Crucially,our research demonstrates a direct linkage between the activation of the mTORC1 pathway and the intensity in OSS.Therapeutic administration of rapamycin suppresses mTORC1 activity,leading to the attenuation of aberrant SMC behavior,reduced inflammatory infiltration,and restoration of extracellular matrix integrity—collectively decelerating TAA advancement in our mouse model.These insights posit the mTORC1 axis as a strategic target for intervention,offering a novel approach to manage TAAs in MFS and potentially pave insights for current treatment paradigms.展开更多
文摘The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discovery.[2]Due to its rarity,knowledge mainly comes from case reports and small case series,though some decision algorithms have been proposed in systematic reviews.
文摘Dear Editor,We extend our academic appreciation to the contributors of this pioneering study,1 which leverages Mendelian Randomization(MR)to investigate the causal relationship between immune cell phenotypes and intracranial aneurysms(IAs),demonstrating a certain level of innovation.By extracting 731 immunophenotypes from publicly available genetic databases and conducting large-scale analyses,the study comprehensively evaluates the impact of immune cell traits on IAs.Moreover,multivariable MR analysis was employed to adjust for interactions between different immune phenotypes,providing a novel perspective on the interplay between the immune system and IAs.
文摘The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.
基金Supported by the Science and Technology Program of Nantong Health Committee,No.MA2019003 and No.MA2021017Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD019,and No.KD2022KYJJZD022+1 种基金Research Project of Nantong Health and Health Commission,No.MS2023041the Science and Technology Program of Nantong City,No.Key003 and No.JCZ2022040.
文摘The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.
文摘Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms,particularly in the anterior circulation.The article compares various imaging modalities,including computer tomography angiogram,magnetic resonance imaging/angiography,and digital subtraction angiogram,highlighting their strengths and limitations.We emphasize the im-portance of accurate differentiation to avoid unnecessary surgical interventions.The potential of emerging technologies,such as high-resolution vessel wall ima-ging and deep neural networks for automated detection,is explored as promising avenues for improving diagnostic accuracy.This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.
基金Supported by the Taichung Veterans General Hospital,No.TCVGH-1125401B.
文摘BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
基金supported by the National Natural Science Foundation of China(Grant Nos.12172017 and 11872083)Project of Beijing Municipal Education Commission(Grant Nos.KZ202210005006 and KZ202110005007).
文摘Intracranial aneurysm(IA)is a prevalent cerebrovascular disease associated with high mortality and disability rates upon rupture.The hemodynamics of IA,which are significantly influenced by geometric parameters,directly impact its rupture.This study focuses on investigating the transient flow characteristics in saccular IA models fabricated using a water droplet-based method,specifically examining the influence of neck widths.Particle image velocimetry technique and numerical simulation were employed to investigate the dynamic evolution of flow structures within three IA models.The results reveal that neck width(W)has a substantial effect on flow characteristics in the neck region,subsequently impacting the deep flow inside the sac.Three distinct patterns were observed during flow evolution inside the sac:for W=2 mm,two vortices occur and then disappear with relatively low average flow velocity;for W=4 mm,enhanced effects of a high-speed jet result in periodic pulsatile flow velocity distribution while maintaining stable vortex core position;for W=6 mm,significant changes in flow velocity occur due to size expansion and intensity increase of vortices.These findings demonstrate that neck widths play a complex role in influencing transient flow characteristics within IAs.Overall,this research contributes to further understanding transient flow behaviors in IAs.
基金Supported by Shenzhen Medical Academy of Research and Translation Program,No.A2302031.
文摘BACKGROUND Aneurysmal subarachnoid hemorrhage(aSAH),a particularly devastating subtype of stroke,is associated with substantial rates of mortality and long-term functional impairment.Despite notable progress in therapeutic strategies,a considerable proportion of aSAH survivors continue to suffer from neuropsychiatric complications,most commonly anxiety and depression,which detrimentally impact their overall quality of life.AIM To investigate the prevalence of anxiety and depressive symptoms in patients with aSAH and to identify associated clinical risk factors.METHODS Clinical records of 1268 consecutive patients diagnosed with aSAH and treated between 2016 and 2022 were retrospectively reviewed.At follow-up,psychological assessments were performed using the Hospital Anxiety and Depression Scale to quantify symptoms of anxiety and depression.To identify independent predictors associated with these psychological outcomes post-aSAH,both univariate and multivariate statistical analyses were employed.RESULTS Among the studied cohort,34.9%of patients presented with anxiety symptoms,while 31.8%demonstrated depressive features.Multivariate analysis identified female sex,presence of multiple aneurysms,a positive family history of cerebral hemorrhage,and receiving surgical clipping as independent predictors of anxiety.In contrast,significant predictors of depression included female sex,multiplicity of aneurysms,posterior circulation aneurysm localization,and poor clinical outcome.Notably,age above 60 years and documented functional recovery were associated with a reduced risk of depression.CONCLUSION Anxiety and depression are common neuropsychiatric sequelae in survivors of aSAH,each associated with a distinct set of risk factors.Early identification and targeted management of these risk profiles may facilitate more effective intervention strategies for psychological comorbidities,ultimately contributing to improved long-term patient outcomes.
基金supported by the grant from the Fujian Province Natural Science Foundation(No.2024J01608)。
文摘Background Abdominal aortic aneurysm(AAA)is a life-threatening vascular disease associated with endothelial cell senescence.Resveratrol(RSV),a natural polyphenol,exerts potent anti-senescent and anti-inflammatory effects.However,its molecular mechanism in treating AAA remains unclear.Methods An AAA model was established in mice via angiotensin Ⅱ(AngⅡ)infusion[1000 ng/(kg·min)],with a subset receiving RSV treatment[100 mg/(kg·day)by gavage].Aortic diameter was measured,and histopathological changes were assessed by Hematoxylin-Eosin(HE)and Elastica Van Gieson(EVG)staining.Vascular aging was evaluated by senescence-associatedβ-galactosidase(SA-β-gal)activity and pulse wave velocity(PWV).In vitro,human umbilical vein endothelial cells(HUVECs)were treated with AngⅡ(10-6 M)with or without RSV(40μM)and/or the sirtuin 1(SIRT1)inhibitor EX527(10μM).Senescence markers,senescence-associated secretory phenotype(SASP)factor expression[interleukin-1 beta(IL-1β),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],and SIRT1/p21 pathway proteins were analyzed.Results In vivo,RSV significantly attenuated Ang Ⅱ-induced AAA formation,reducing aortic diameter,preserving elastic fiber integrity,and suppressing vascular senescence and stiffness.In HUVECs,Ang Ⅱ-induced senescence and SASP expression were markedly inhibited by RSV.However,these protective effects were abolished by EX527.Mechanistically,RSV reversed the Ang Ⅱ-induced downregulation of SIRT1 and upregulation of p21,which was also blocked by SIRT1 inhibition.Conclusions RSV effectively prevented experimental AAA formation by alleviating vascular aging and endothelial cell senescence.This protective effect was abrogated by the SIRT1 inhibitor EX527,confirming that RSV mitigated AAA development and vascular senescence through the SIRT1/p21 signaling pathway.These findings highlighted RSV as a promising therapeutic candidate for AAA treatment.
基金supported by the National Key Research and Development Program of China(2023YFC3603100 and 2023YFC3603105)"Leading Goose"R&D Program of Zhejiang(2022C03076-4).
文摘Chlorfenapyr poisoning is associated with high mortality due to the absence of evidence-based treatment strategies or specific antidotes.[1,2]Chlorfenapyr is a novel N-substituted halogenated pyrrole pro-insecticide.The active metabolite of tralopyril(a metabolite of chlorfenapyr)can uncouple oxidative phosphorylation and impair adenosine triphosphate(ATP)production.[3]Blood purification techniques,including hemoperfusion(HP),may facilitate tralopyril clearance.[4,5]Here,we present a case of severe chlorfenapyr poisoning that was treated with intensive HP.H owever,during follow-up,we unexpectedly found a ventricular aneurysm in the left ventricle that was not fully explained by coronary artery lesions.
基金Natural Science Foundation of Shaanxi Province,Grant/Award Number:2023-CX-PT-17General Project of Natural Science Research in Luoyang Polytechnic College,Grant/Award Number:2024B01。
文摘The mortality rate of patients with abdominal aortic aneurysm(AAA) after rupture is extremely high,and this disease has become an important disease endangering the health of the Chinese population.Methods used to model AAA include intraluminal pressurized elastase infusion,chronic infusion of angiotensin Ⅱ(Ang Ⅱ) via an osmotic pump,periarterial application of calcium chloride,vascular grafting,and gene modification.AAA models induced by elastase and Ang Ⅱ are the two most widely used animal models.In the elastase-induced model,because intraluminal infusion is transient,with the cessation of initial stimulation,the aneurysm lesion tends to be stable and rarely ruptures.The model induced by Ang Ⅱ infusion often presents with a typical aortic dissection with a false lumen,whereas clinical AAA patients do not necessarily have dissection.Currently,the treatment of AAA in clinical practice remains endovascular,and there is a lack of pharmacological therapy,which is also related to the fact that the pathogenic mechanism has not been fully elucidated.Smoking,old age,male sex,and hypertension are the main risk factors for AAA,but these risk factors have not been fully investigated in the current modeling methods,which may affect the clinical translational application of research results based on animal models.Therefore,this article reviews the most commonly used AAA modeling methods,comments on their applications and limitations,and provides a perspective on the development of novel animal models.
文摘Vocal cord paralysis that presents as hoarseness due to an underlying cardiovascular pathology is a rare clinical entity known as Ortner’s syndrome(OS).The syndrome was first described in 1897 by Norbert Ortner in a report of three patients with severe mitral stenosis.[1]Notably,a review of published cases showed that between 1955 and 1990,mitral stenosis was the primary cause of OS.However,since the 1990s,vascular lesions(especially thoracic aortic aneurysms)have become the most common cause of OS.[2]This epidemiologic shift may be due to improved early detection and treatment of mitral stenosis.
文摘Intracranial aneurysms,characterized by focal arterial wall dilation,pose significant neurosurgical challenges due to their potential for rupture and hemorrhage,leading to severe clinical outcomes,including fatality.Patients often experience profound psychological and social impacts,such as depression,anxiety,and cognitive impairment,affecting their quality of life.Rapid progression and high mortality necessitate timely intervention.Advances in neurosurgical techniques,including microscopic surgery and neuroendoscopy,offer distinct advantages.Microscopic surgery provides precision and direct visualization,while neuroendoscopy ensures minimally invasive access and reduced tissue trauma.Integrating these methods optimizes treatment efficacy and clinical outcomes.AIM To evaluate the impact of combined microscopic and neuroendoscopic techniques on psychological,cognitive outcomes,and quality of life in patients with ruptured intracranial aneurysms.METHODS The study focused on 189 patients with intracranial aneurysm rupture and hemorrhage from January 2020 to May 2024 as the objects of observation and analysis.They were randomly divided into a control group(treated with simple microscope surgery,n=94)and an observation group(treated with microscope combined with neuroendoscopy,n=95).The treatment effects of the two groups were observed,mainly including depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data.RESULTS Before treatment,the depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data of the two groups of patients at different time points were compared,and there was no statistically significant difference(P>0.05).After microscope combined with neuroendoscopy treatment,the study revealed that the observation group surpassed the control group in alleviating depression and anxiety,accelerating cognitive function recovery,and enhancing quality of life,with these differences being statistically significant(P<0.05).CONCLUSION Surgical treatment combined with microscopy and neuroendoscopy has a significant positive effect on the mental health,cognitive function and overall quality of life of patients with intracranial aneurysm rupture and bleeding,can shorten the operation time and treatment time,and provides a new strategic reference for clinical treatment.
文摘BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresectable tumors,present a challenge for orthopedic surgeons and require new treatment approaches.Antiresorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis.Denosumab induces tumor ossification,but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells.Bisphosphonates(BPs)may induce apoptosis of tumor cells and allow for long-term local control.We hypothesized that after denosumab treatment,BPs would better accumulate in the tumor and exert an irreversible antitumor effect.AIM To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.METHODS Using data from five electronic databases(Scopus,MEDLINE,EMBASE,PubMed,Web of Science),we aimed to identify all patients who received denosumab therapy(DT)for unresectable ABCs.Among published case reports and case series,we identified patients who discontinued denosumab for various reasons and divided them into two groups:Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia.Local control rates in both groups were analyzed.RESULTS As of December 2024,43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs.There were 27 males and 16 females with a mean age of 15.8 years.At a median follow-up time of 15.5 months,there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation.All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months.Among patients in Group 2,with a median follow-up time of 12.5 months after completion of therapy,no local relapses were observed.The difference between local recurrence rates(32%vs 0%)is statistically significant(P value=0.02).Kaplan-Meier estimates show the same trend with marginal statistical significance(P value=0.085).Here we put forward a novel treatment algorithm.CONCLUSION BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes,presumably by targeting residual tumor cells.Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-119.
文摘BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression,commonly referred to as the“double-rupture phenomenon”.The reported incidence of the double-rupture phenomenon ranges 12%-21%in patients with ruptured SAAs,potentially due to variations in intra-abdominal pressure.Following anesthesia induction,muscle relaxation can decrease intra-abdominal pressure,potentially triggering the double-rupture phenomenon and leading to circulatory collapse.CASE SUMMARY A 61-year-old female presented to the Department of Emergency with upper abdominal pain,abdominal distension,dizziness,and vomiting.Her vital signs were initially stable.Physical examination revealed abdominal tenderness and positive-shifting dullness.Abdominal contrast-enhanced computed tomography revealed cirrhosis,severe portal hypertension,and splenomegaly.Acute rupture was suggested by a hematoma on the upper left side outside the SAA.Surgeons deemed intravascular intervention challenging and open splenectomy inevitable.Circulatory collapse occurred after anesthesia induction,likely due to a double rupture of the SAA.This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa,forming a hematoma that exerted a tamponade effect.A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction.The patient’s life was saved through early,coordinated,multidisciplinary significant postoperative bleeding or hypoxic encephalopathy.CONCLUSION Anesthesia-induced pressure reduction may trigger a second SAA rupture,causing collapse.Early diagnosis and multidisciplinary teamwork improve outcomes.This is a rare and life-threatening case of SAA rupture,which is of great significance to the medical community for understanding and handling such emergencies.
文摘BACKGROUND Giant coronary artery aneurysms(CAA),entailing thrombosis,myocardial infarction,and sudden death,are the most severe and life-threatening complications of Kawasaki disease(KD).Giant aneurysms rarely regress and can later transform into stenoses.Data on dynamic follow-up are scarce in the literature.AIM To evaluate clinical features and long-term outcomes of giant CAA in children with KD.METHODS A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region(2012-2023).CAA criteria according to the American Heart Association guidelines of 2017 were used:(1)Dilated coronary artery with diameter Z-score>2 standard deviations(SD)but<2.5 SD;(2)Small CAA with Z-score>2.5 SD but<5 SD;(3)Medium CAA with Z-score>5 SD but<10 SD;and(4)Giant CAA with Z-score>10 SD or≥8 mm.RESULTS The mean age of children with coronary dilatation/aneurysms was 2.5 years,and the male-to-female ratio was 3:1.Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate(Z-score<5 SD but>2.0 SD)coronary dilatation(62.0%vs 21.0%,P=0.019).Major cardiovascular events(myocardial infarction,coronary artery bypass grafting,acute coronary syndrome,ischemic cardiomyopathy,left ventricular aneurysm,and giant extracardiac aneurysm)occurred in 55.5%of patients who had giant CAA.At follow-up the complete regression of giant/medium CAA was observed in 58.0%and partial regression in 42.0%after a mean of 2.3 and 5.5 years,respectively.All thrombi detected by echocardiography,CT,and angiography in giant/medium CAA disappeared between 1 year and 5 years(mean:15 months).All patients survived.CONCLUSION Risk factors for giant CAA were male sex,early age,and cerebral dysfunction.Complete regression of giant coronary aneurysms occurred in 58.0%of patients after follow-up of 2.3 years.
文摘Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.
文摘Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,the authors present matrix metalloproteinases(MMPs)and their inhibitors in immunohistological analyses as contributing factors in the pathophysiology of aortic aneurysms(AA).Data analysis of MMP-1,MMP-9,tissue inhibitors of metalloproteinases(TIMPs),including TIMP-1 and TIMP-2 expression reveals a varied distribution between the adventitia and media and a non-uniform expression of the investigated markers.These elements,as key components of the extracellular matrix(ECM),indicate that the formation of AA is not solely driven by endoluminal pressure loading of the aortic wall.Instead,degenerative processes within ECM elements contribute significantly.Importantly,AA do not necessarily imply dissection.Tissue destruction,allowing blood flow entry,arises from reduced oxygen supply to the media,primarily due to incomplete capillarization or neocapillarization.
文摘Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.
基金supported by the National Natural Science Foundation of China(Grant Nos.:82000429 and 81470574)Young Elite Scientists Sponsorship Program by CAST,China(Program No.:YESS20230395/2023QNRC001)+4 种基金Beijing Nova Program,China(Program No.:20230484308)Youth Elite Program of Beijing Friendship Hospital,China(Program No.:YYQCJH2022-9)Young Elite Scientists Sponsorship Program by BAST,China(Program No.:BYESS2024045)Capital's Funds for Health Improvement and Research,China(Grant No.:CFH2022-4-20217)Chinese Institutes for Medical Research,Beijing(CIMR)Organized Research Project,China(Project No.:CX23YQ07)。
文摘Thoracic aortic aneurysm(TAA)significantly endangers the lives of individuals with Marfan syndrome(MFS),yet the intricacies of their biomechanical origins remain elusive.Our investigation delves into the pivotal role of hemodynamic disturbance in the pathogenesis of TAA,with a particular emphasis on the mechanistic contributions of the mammalian target of rapamycin(mTOR)signaling cascade.We uncovered that activation of the mTOR complex 1(mTORC1)within smooth muscle cells,instigated by the oscillatory wall shear stress(OSS)that stems from disturbed flow(DF),is a catalyst for TAA progression.This revelation was corroborated through both an MFS mouse model(Fbn1+/C1039G)and clinical MFS specimens.Crucially,our research demonstrates a direct linkage between the activation of the mTORC1 pathway and the intensity in OSS.Therapeutic administration of rapamycin suppresses mTORC1 activity,leading to the attenuation of aberrant SMC behavior,reduced inflammatory infiltration,and restoration of extracellular matrix integrity—collectively decelerating TAA advancement in our mouse model.These insights posit the mTORC1 axis as a strategic target for intervention,offering a novel approach to manage TAAs in MFS and potentially pave insights for current treatment paradigms.
