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Notch signaling in the pathogenesis of thoracic aortic aneurysms: A bridge between embryonic and adult states.

Notch信号在胸主动脉瘤发病机制中的作用: 胚胎状态与成人状态之间的桥梁。

  • 影响因子:4.78
  • DOI:10.1016/j.bbadis.2019.165631
  • 作者列表:"Malashicheva A","Kostina A","Kostareva A","Irtyuga O","Gordeev M","Uspensky V
  • 发表时间:2020-03-01
Abstract

:Aneurysms of the thoracic aorta are a "silent killer" with no evident clinical signs until the fatal outcome. Molecular and genetic bases of thoracic aortic aneurysms mainly include transforming growth factor beta signaling, smooth muscle contractile units and metabolism genes, and extracellular matrix genes. In recent studies, a role of Notch signaling, among other pathways, has emerged in disease pathogenesis. Notch is a highly conserved signaling pathway that regulates the development and differentiation of many types of tissues and influences major cellular processes such as cell proliferation, differentiation and apoptosis. Mutations in several Notch signaling components have been associated with a number of heart defects, demonstrating an essential role of Notch signaling both in cardiovascular system development and its maintenance during postnatal life. This review discusses the role of Notch signaling in the pathogenesis of thoracic aortic aneurysms considering development and maintenance of the aortic root and how developmental regulations by Notch signaling may influence thoracic aortic aneurysms.

摘要

: 胸主动脉的动脉瘤是一种 “沉默的杀手”,在致命结果之前没有明显的临床症状。胸主动脉瘤的分子和遗传基础主要包括转化生长因子 β 信号、平滑肌收缩单位和代谢基因以及细胞外基质基因。在最近的研究中,除其他途径外,Notch信号传导的作用已经在疾病发病机制中出现。Notch是一种高度保守的信号通路,调节许多类型组织的发育和分化,并影响主要的细胞过程,如细胞增殖、分化和凋亡。几种Notch信号传导组分中的突变已经与许多心脏缺陷相关,表明Notch信号传导在心血管系统发育及其在出生后生命期间的维持两者中发挥重要作用。本综述讨论了Notch信号在胸主动脉瘤发病机制中的作用,考虑了主动脉根部的发育和维持,以及Notch信号的发育调节如何影响胸主动脉瘤。

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影响因子:1.05
发表时间:2020-02-01
DOI:10.23736/S0021-9509.18.10206-0
作者列表:["Peters AS","Hatzl J","Bischoff MS","Böckler D"]

METHODS:BACKGROUND:Due to recent advances in endograft design and percutaneous access, technical success could be increased during endovascular aneurysm repair (EVAR). Beside EVAR, endovascular aneurysm sealing (EVAS) provides an alternative procedure to treat aneurysms. To compare the two methods, additional benchmark criteria should be evaluated: Screening time, dose area product (DAP), procedure time and contrast use. In this study these technical variables are analyzed for EVAS vs. EVAR in comparable patient cohorts. METHODS:It is a retrospective, single-center study. Only elective cases of infrarenal aortic aneurysms were included, all treated by the same surgeon (D.B.). Procedures were performed within the instructions for use without additional procedures. All operations were undertaken in a hybrid operating theatre. For EVAR, only the Medtronic Endurant® and the Gore C3 Excluder® were included. For EVAS the Nellix® from Endologix was used. RESULTS:Between 2012 and 2016, 67 patients were treated with EVAS and 40 with EVAR; of these 20 and 16 could be introduced into the study respectively. Median age was 73 and 72 years respectively (only men). The two groups were comparable in terms of BMI, GFR and ASA-status. Screening time was reduced for EVAS (10.6 vs. 14.5 min., P<0.01), while the DAP was not significantly different. Procedural time and contrast use were increased for EVAS (120 vs. 96 min., 120 vs. 79 mL, P<0.01). CONCLUSIONS:Especially the younger EVAS-procedure requires ongoing review in order to further reduce contrast agent. Reduced screening time for EVAS does not have a significant impact on radiation dose.

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影响因子:4.91
发表时间:2020-04-01
来源期刊:Annals of surgery
DOI:10.1097/SLA.0000000000003050
作者列表:["Karthaus EG","Vahl A","van der Werf LR","Elsman BHP","Van Herwaarden JA","Wouters MWJM","Hamming JF"]

METHODS:OBJECTIVE:To evaluate reasons to deviate from aneurysm diameter thresholds, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. BACKGROUND:Guidelines recommend surgical treatment for asymptomatic abdominal aortic aneurysms (AAAs) with a diameter of at least 55 mm for men and 50 mm for women. We evaluate reasons to deviate from these guidelines, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. METHODS:All patients undergoing elective AAA repair between 2013 and 2016 registered in the Dutch Surgical Aneurysm Audit (DSAA) were included. Surgery at diameters of <55 mm for men and <50 mm for women were considered guideline deviations. National deviation and hospital variation in deviation were evaluated over time. Questionnaires were distributed among all Dutch VSUs, inquiring for acceptable reasons for guideline deviation. VSUs were asked to estimate the guideline deviation percentage in their hospital which was then compared with their DSAA percentage. RESULTS:In all, 9039 patients were included. In 15%, we found guideline deviation, varying from 2% to 40% between VSUs. Over time, 21 VSUs were identified with a lower percentage of deviation than the national mean each year and 8 VSUs with a higher percentage. 44/60 VSUs completed the questionnaire. Most commonly reported reasons to deviate were concomitant large iliac diameter (91%) and saccular aneurysm (82%). The majority of the VSUs (77%) estimated their guideline deviation to be <5%. Eleven VSUs (25%) estimated their deviation concordant with their DSAA percentage, but 75% of VSUs underestimated their deviation. CONCLUSIONS:Dutch VSUs regularly deviate from the guidelines regarding aneurysm diameter, with variation between VSUs. Consensus exists amongst VSUs on acceptable reasons for guideline deviations; however, the majority underestimates their actual deviation percentage.

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影响因子:1.05
发表时间:2020-04-01
DOI:10.23736/S0021-9509.18.10639-2
作者列表:["Kodama H","Takahashi S","Okazaki T","Morita S","Go S","Watanabe M","Yamane Y","Katayama K","Kurosaki T","Sueda T"]

METHODS:BACKGROUND:Spinal cord ischemia (SCI) and paraplegia are complications of surgery for type A acute aortic dissection (TAAAD). Since the segmental arteries play a key role in SCI, this study evaluated the association between SCI and false lumen segmental arteries (FLSAs: segmental arteries originating from the false lumen). METHODS:The study included 101 consecutive TAAAD patients (mean age, 66±13; range, 34-89 years) who underwent surgery from January 2011 to April 2017. The diagnosis of TAAAD and the number of FSLAs were determined by preoperative computed tomography (CT). Patients were divided into two groups according to the number of FLSAs at the Th9-L2 level: Group A (N.=13), ≥8 FLSAs; and group B (N.=88), ≤7 FLSAs. Preoperative, perioperative, and postoperative findings were compared between the groups, and risk factors for SCI were evaluated. RESULTS:The frequency of preoperative paralysis was significantly higher in Group A than Group B (P=.0070). The overall incidence of postoperative SCI was 8% (8/101) and significantly higher in Group A than Group B (5/13 [45%] vs. 3/88 (4%), P<0.0001). Hospital mortality was 8% (8/101) and significantly higher in Group A than Group B (3/13 [23%] vs. 5/88 [6%], P=.0302). Multivariate analysis showed that the independent risk factors for SCI were ≥8 FLSAs at Th9-L2 (odds ratio [OR], 20.4; 95% confidence interval [95% CI], 3.34-124.9, P=0.0011) and diabetes mellitus (OR, 22.3; 95% CI, 1.69-294.5; P=0.0184). CONCLUSIONS:In patients who underwent surgery for TAAAD, ≥8 FLSAs at the Th9-L2 levels on preoperative CT was a risk factor for SCI.

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动脉瘤方向

动脉瘤是由于动脉壁的病变或损伤,形成动脉壁局限性或弥漫性扩张或膨出,以膨胀性、搏动性肿块为主要表现,可以发生在动脉系统的任何部位,而以肢体主干动脉、主动脉和颈动脉较为常见。

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