Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective anal...Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective analysis of 553 ATAAD patients from Tongji Hospital divided into malperfusion and non-malperfusion groups was conducted.Logistic regression was used to identify independent predictors of the outcome.Model performance via the Hosmer–Lemeshow test,decision curve analysis(DCA),the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,and predictive values.Results Malperfusion was observed in 28.4%of ATAAD patients.Significant predictors included elevated lactate dehydrogenase(LDH)(OR:1.0019,95%CI:1.0002–1.0036,P=0.027),alanine aminotransferase(ALT)(OR:0.9936,95%CI:0.987–1.000,P=0.046)and estimated glomerular filtration rate(eGFR)(OR:0.9877,95%CI:0.977–0.998,P=0.021),suggesting roles for tissue ischemia and impaired renal or hepatic function.Other variables,such as D-dimer,uric acid,creatinine,and NT-proBNP,showed trends toward significance but did not reach the 0.05 threshold.The model demonstrated good calibration(Hosmer–Lemeshow P=0.318),moderate discriminatory power(AUC=0.725),high specificity(93.62%),and low sensitivity(26.75%).Conclusion The model based on routine biochemical markers provides a practical approach for the early identification of malperfusion in ATAAD patients.It shows strong specificity and clinical utility,although its limited sensitivity highlights the need for further refinement.Future improvements should focus on incorporating additional clinical or imaging data to increase diagnostic accuracy.展开更多
Coronary malperfusion associated with aortic dissection is relatively rare,which has been reported at 5.7%-11.3%,[1]but when it occurs,it is fatal to the patient.Despite improved therapeutic techniques for aortic diss...Coronary malperfusion associated with aortic dissection is relatively rare,which has been reported at 5.7%-11.3%,[1]but when it occurs,it is fatal to the patient.Despite improved therapeutic techniques for aortic dissection over the years,surgical treatment for the uncommon condition of aortic dissection with coronary malperfusion is still premature.Prompt coronary revascularization and concomitant surgical repair of the aorta are essential for dealing with this problem.To date,the surgical management for this condition relies on various techniques,which include coronary artery bypass grafting(CABG)and repair coronary vessels.[1,2]However,the optimal surgical strategy for coronary revascularization is still debated.In this study,we reviewed our experience with aortic dissection involving the coronary artery in 36 patients,which evolved over a 14-year period,aiming to provide alternative options in the face of this scenario.展开更多
Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antena...Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antenatal corticosteroids(ACS)is inevitably discussed.The placenta is an important,transient fetal-derived organ and is the embodiment of maternal or fetal well-being.However,few studies provide histological evidence of the placenta in GOS.This study aims to address these issues.Methods A total of 831 pregnant women were prospectively recruited.Placenta tissue was collected immediately and fixed with 4%paraformaldehyde solution for future H&E analysis.A novel checklist was devised to evaluate maternal vascular malperfusion sections on the basis of the commonly accepted Amsterdam placental workshop group consensus statement.Results A total of 131 patients were classified as having GOS.Comparisons between those with and without GOS revealed significant differences,including higher levels of distal villous hypoplasia,increased syncytial knots,accelerated villous maturation,and higher total scores in GOS.We found significant negative associations between GOS and neonatal weight,neonatal height,head circumference,placental surface area,placental volume,and placenta gross examination score.GOS neonates were 1.25 times more likely to have hyperbilirubinemia.Regarding the effect of ACS,a significant reduction in birthweight,height,and head circumference was observed,along with an increased risk of hyperbilirubinemia.Conclusion This study provides histological evidence of the GOS that supports the defective deep placentation hypothesis.Our research also contributes to benefit-risk consultation in the GOS,such as in cases of PE and FGR,where a balance between fetal lung maturation and short-term neonatal outcomes is crucial.展开更多
Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Comp...Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.展开更多
Introduction:Acute type A aortic dissection(ATAAD)is a catastrophic disease with fatal outcomes.Malperfusion syndrome(MPS)is a serious complication of ATAAD,with an incidence of 20–40%.Many studies have shown that MP...Introduction:Acute type A aortic dissection(ATAAD)is a catastrophic disease with fatal outcomes.Malperfusion syndrome(MPS)is a serious complication of ATAAD,with an incidence of 20–40%.Many studies have shown that MPS is the main risk factor for poor ATAAD prognosis.However,a risk scoring system for ATAAD based on MPS is lacking.Here,we designed a risk scoring system for ATAAD to assess mortality through quantitative assessment of relevant organ malperfusion and subsequently develop rational treatment strategies.Methods and analysis:This was a prospective observational study.Patients’perioperative clinical data were col-lected to establish a database of ATAAD(N≥3000)and determine whether these patients had malperfusion complica-tions.The Anzhen risk scoring system was established on the basis of organ malperfusion by using a random forest survival model and a logistics model.The better method was then chosen to establish a revised risk scoring system.Ethics and dissemination:This study received ethical approval from the Ethics Committees of Beijing Anzhen Hospital,Capital Medical University(KS2019034-1).Patient consent was waived because biological samples were not collected,and no patient rights were violated.Findings will be disseminated at scientific conferences and in peer-reviewed publications.展开更多
Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was co...Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.展开更多
Umbilical cord(UC)embolism is a rare,life-threatening complication of pregnancy.The exact cause of this condition is not yet known.Women with more than one UC abnormality are at risk of UC obstruction;this condition c...Umbilical cord(UC)embolism is a rare,life-threatening complication of pregnancy.The exact cause of this condition is not yet known.Women with more than one UC abnormality are at risk of UC obstruction;this condition can lead to stasis,ischemia,and in some cases,thrombosis.However,many women with UC abnormalities remain undetected and may not be recognized until after birth.Here,we present a case involving the prenatal diagnosis and successful treatment of umbilical artery embolism in the third trimester with good maternal and fetal outcomes.The risk of UC embolism increases when more than one UC abnormality is identified in a single case.Ultrasound examination in the third trimester of pregnancy should be able to verify the existence of two arteries and one vein in the UC.If necessary,these results can be compared with ultrasound imaging acquired during the first trimester of pregnancy.展开更多
Aortic dissection with neurological symptoms is a usual presentation and rarecondition. It poses a major diagnostic challenge due to the risk of misdiagnosisand worse prognosis (functional or vital). We present the cl...Aortic dissection with neurological symptoms is a usual presentation and rarecondition. It poses a major diagnostic challenge due to the risk of misdiagnosisand worse prognosis (functional or vital). We present the clinical case of a 53-year-old female patient admitted for chest pain and sudden onset paraplegiain cardiology department. Her medical history included hypertension and diabetesmellitus. Physical examination showed paraplegia associated to anesthesiaof legs and painless back. BP: 120/60 mmHG. Cariopulmonary auscultationwas normal. Pulses presents. Chest X-ray revealed mediastinal widening.Cardiac ultrasound revealed an intimal tear of aortic dissection and severeaortic insufficiency. Chest CT angiography showed a Stanford type A aorticdissection with left renal infarction. Spinal cord MRI was not available. In theabsence of a cardiac surgery center, the patient died one month later fromtrophic and infectious complications. Paraplegia leads to aortic dissectionwhen there is no pain in the back and occurs suddenly. Hypertension is thecommon cause in subafrica. Early diagnosis and management prevent death.展开更多
文摘Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective analysis of 553 ATAAD patients from Tongji Hospital divided into malperfusion and non-malperfusion groups was conducted.Logistic regression was used to identify independent predictors of the outcome.Model performance via the Hosmer–Lemeshow test,decision curve analysis(DCA),the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,and predictive values.Results Malperfusion was observed in 28.4%of ATAAD patients.Significant predictors included elevated lactate dehydrogenase(LDH)(OR:1.0019,95%CI:1.0002–1.0036,P=0.027),alanine aminotransferase(ALT)(OR:0.9936,95%CI:0.987–1.000,P=0.046)and estimated glomerular filtration rate(eGFR)(OR:0.9877,95%CI:0.977–0.998,P=0.021),suggesting roles for tissue ischemia and impaired renal or hepatic function.Other variables,such as D-dimer,uric acid,creatinine,and NT-proBNP,showed trends toward significance but did not reach the 0.05 threshold.The model demonstrated good calibration(Hosmer–Lemeshow P=0.318),moderate discriminatory power(AUC=0.725),high specificity(93.62%),and low sensitivity(26.75%).Conclusion The model based on routine biochemical markers provides a practical approach for the early identification of malperfusion in ATAAD patients.It shows strong specificity and clinical utility,although its limited sensitivity highlights the need for further refinement.Future improvements should focus on incorporating additional clinical or imaging data to increase diagnostic accuracy.
基金a grant from the National Natural Science Foundation of China
文摘Coronary malperfusion associated with aortic dissection is relatively rare,which has been reported at 5.7%-11.3%,[1]but when it occurs,it is fatal to the patient.Despite improved therapeutic techniques for aortic dissection over the years,surgical treatment for the uncommon condition of aortic dissection with coronary malperfusion is still premature.Prompt coronary revascularization and concomitant surgical repair of the aorta are essential for dealing with this problem.To date,the surgical management for this condition relies on various techniques,which include coronary artery bypass grafting(CABG)and repair coronary vessels.[1,2]However,the optimal surgical strategy for coronary revascularization is still debated.In this study,we reviewed our experience with aortic dissection involving the coronary artery in 36 patients,which evolved over a 14-year period,aiming to provide alternative options in the face of this scenario.
基金supported by the National Science Foundation of China(No.81873843)the National Science and Technology Pillar Program of China during the Twelfth Five-Year Plan Period(No.2014BA105B05)the Fundamental Research Funds for the Central Universities(No.2017 KFYXJJ102 and No.2019 KFYXKJC053).
文摘Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antenatal corticosteroids(ACS)is inevitably discussed.The placenta is an important,transient fetal-derived organ and is the embodiment of maternal or fetal well-being.However,few studies provide histological evidence of the placenta in GOS.This study aims to address these issues.Methods A total of 831 pregnant women were prospectively recruited.Placenta tissue was collected immediately and fixed with 4%paraformaldehyde solution for future H&E analysis.A novel checklist was devised to evaluate maternal vascular malperfusion sections on the basis of the commonly accepted Amsterdam placental workshop group consensus statement.Results A total of 131 patients were classified as having GOS.Comparisons between those with and without GOS revealed significant differences,including higher levels of distal villous hypoplasia,increased syncytial knots,accelerated villous maturation,and higher total scores in GOS.We found significant negative associations between GOS and neonatal weight,neonatal height,head circumference,placental surface area,placental volume,and placenta gross examination score.GOS neonates were 1.25 times more likely to have hyperbilirubinemia.Regarding the effect of ACS,a significant reduction in birthweight,height,and head circumference was observed,along with an increased risk of hyperbilirubinemia.Conclusion This study provides histological evidence of the GOS that supports the defective deep placentation hypothesis.Our research also contributes to benefit-risk consultation in the GOS,such as in cases of PE and FGR,where a balance between fetal lung maturation and short-term neonatal outcomes is crucial.
文摘Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.
基金This work was supported by the Beijing Municipal Science and Technology Commission[No.Z191100006619093&Z191100006619094]the National Science Foundation of China(No.81970393).
文摘Introduction:Acute type A aortic dissection(ATAAD)is a catastrophic disease with fatal outcomes.Malperfusion syndrome(MPS)is a serious complication of ATAAD,with an incidence of 20–40%.Many studies have shown that MPS is the main risk factor for poor ATAAD prognosis.However,a risk scoring system for ATAAD based on MPS is lacking.Here,we designed a risk scoring system for ATAAD to assess mortality through quantitative assessment of relevant organ malperfusion and subsequently develop rational treatment strategies.Methods and analysis:This was a prospective observational study.Patients’perioperative clinical data were col-lected to establish a database of ATAAD(N≥3000)and determine whether these patients had malperfusion complica-tions.The Anzhen risk scoring system was established on the basis of organ malperfusion by using a random forest survival model and a logistics model.The better method was then chosen to establish a revised risk scoring system.Ethics and dissemination:This study received ethical approval from the Ethics Committees of Beijing Anzhen Hospital,Capital Medical University(KS2019034-1).Patient consent was waived because biological samples were not collected,and no patient rights were violated.Findings will be disseminated at scientific conferences and in peer-reviewed publications.
文摘Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.
基金This study was funded by the National Health and Family Planning Commission Science Foundation(2019-WJ-04)the Guide Fund for the Development of Local Science and Technology from the Central Government(2020L3019).
文摘Umbilical cord(UC)embolism is a rare,life-threatening complication of pregnancy.The exact cause of this condition is not yet known.Women with more than one UC abnormality are at risk of UC obstruction;this condition can lead to stasis,ischemia,and in some cases,thrombosis.However,many women with UC abnormalities remain undetected and may not be recognized until after birth.Here,we present a case involving the prenatal diagnosis and successful treatment of umbilical artery embolism in the third trimester with good maternal and fetal outcomes.The risk of UC embolism increases when more than one UC abnormality is identified in a single case.Ultrasound examination in the third trimester of pregnancy should be able to verify the existence of two arteries and one vein in the UC.If necessary,these results can be compared with ultrasound imaging acquired during the first trimester of pregnancy.
文摘Aortic dissection with neurological symptoms is a usual presentation and rarecondition. It poses a major diagnostic challenge due to the risk of misdiagnosisand worse prognosis (functional or vital). We present the clinical case of a 53-year-old female patient admitted for chest pain and sudden onset paraplegiain cardiology department. Her medical history included hypertension and diabetesmellitus. Physical examination showed paraplegia associated to anesthesiaof legs and painless back. BP: 120/60 mmHG. Cariopulmonary auscultationwas normal. Pulses presents. Chest X-ray revealed mediastinal widening.Cardiac ultrasound revealed an intimal tear of aortic dissection and severeaortic insufficiency. Chest CT angiography showed a Stanford type A aorticdissection with left renal infarction. Spinal cord MRI was not available. In theabsence of a cardiac surgery center, the patient died one month later fromtrophic and infectious complications. Paraplegia leads to aortic dissectionwhen there is no pain in the back and occurs suddenly. Hypertension is thecommon cause in subafrica. Early diagnosis and management prevent death.
