Roles of Upper-Level Descending Inflow in Moat Development in Simulated Tropical Cyclones with Secondary Eyewall Formation

This study investigated the effects of upper-level descending inflow(ULDI)associated with inner-eyewall convection on the formation of the moat in tropical cyclones(TCs)with secondary eyewall formation(SEF).In our numerical experiments,a clear moat with SEF occurred in TCs with a significant ULDI,while no SEF occurred in TCs without a significant ULDI.The eyewall convection developed more vigorously in the control run.A ULDI occurred outside the inner-eyewall convection,where it was symmetrically unstable.The ULDI was initially triggered by the diabatic warming released by the inner eyewall and later enhanced by the cooling below the anvil cloud.The ULDI penetrated the outer edge of the inner eyewall with relatively dry air and prevented excessive solid-phase hydrometeors from being advected further outward.It produced extensive sublimation cooling of falling hydrometeors between the eyewall and the outer convection.The sublimation cooling resulted in negative buoyancy and further induced strong subsidence between the eyewall and the outer convection.As a result,a clear moat was generated.Development of the moat in the ongoing SEF prevented the outer rainband from moving farther inward,helping the outer rainband to symmetrize into an outer eyewall.In the sensitivity experiment,no significant ULDI formed since the eyewall convection was weaker,and the eyewall anvil developed relatively lower,meaning the formation of a moat and thus an outer eyewall was less likely.This study suggests that a better-represented simulation of inner-eyewall convective structures and distribution of the solid-phase hydrometeors is important to the prediction of SEF.

The Alienation and Loneliness in Orpheus Descending

Orpheus Descending is written by American famous playwright Tennessee Williams. According to the portrayal of a series marginalized people, this drama presents the solitude in human beings' heart and the estrangement in interpersonal relations. This paper tries to analyze the solitude theme in this drama from philosophic aspect and realistic aspect, combining alienation theory and existentialism theory to analyze the reason and the manifestation of solitude.

Negative pressure catheter drainage and jejunal feeding for descending necrotizing mediastinitis by interventional techniques:a retrospective study

Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage and transnasal jejunal feeding by interventional techniques. Materials and Methods: We retrospectively analyzed relevant clinical data of patients with DNM who underwent continuous negative pressure catheter drainage and transnasal jejunal feeding. All drainage catheters and jejunal feeding tubes were inserte d by interventional techniques. Results: In total, 21 patients were diagnosed with DNM by esophagography and computed tomography(CT). Catheters for the drainage of mediastinal abscesses as well as transnasal jejunal feeding tubes were successfully placed in all patients, indicating a 100% success rate. Of all patients, 13 underwent insertion of abscess drainage catheters through percutaneous puncture under DynaCT guidance, while eight had drainage catheter insertion through fistula orifices in the posterior nasopharyngeal wall or esophagus under fluoroscopic guidance. In total, 26 drainage tubes were inserted. One patient with diabetes died of sepsis and diabetic ketoacidosis 5 days postoperatively, while the remaining 20 patients showed good recovery with successful removal of the drainage catheters. Durations of catheterization were 45.2±50.44 days. The overall clinical success rate was 95.2%. Conclusion: The above described methods are non-surgical, minimally invasive and efficacious, and may be alternative therapeutic tools for patients who are not eligible for surgical operation, have a high postoperative risk, or are more likely to choose minimally invasive techniques.

Metabolite profile comparisons between ascending and descending colon tissue in healthy adults

BACKGROUND Obesity is a risk factor for colorectal cancer,yet metabolic distinctions between healthy right and left colon tissue,before cancer is diagnosed,remains largely unknown.This study compared right-ascending and left-descending colon tissue metabolomes to identify differences from the stool metabolome in normal weight,overweight,and obese adults.AIM To examine right and left colon tissue metabolites according to body mass index that may serve as mechanistic targets for interventions and biomarkers for colon cancer risk.METHODS Global,non-targeted metabolomics was applied to assess right-ascending and left-descending colon tissue collected from healthy adults undergoing screening colonoscopies to test the hypothesis that BMI differentially impacts colon tissue metabolite profiles.The colon tissue and stool metabolome of healthy adults(n=24)was analyzed for metabolite signatures and metabolic pathway networks implicated in progression of colorectal cancer.RESULTS Ascending and descending colon contained 504 host,food,and microbiotaderived metabolites from normal weight,overweight and obese adults grouped according to body mass index.Amino acids,lipids,and nucleotides were among the chemical types that further differentiated from the stool metabolite profiles.Normal weight adults had 46 significantly different metabolites between ascending and descending colon tissue locations,whereas there were 37 metabolite differences in overweight and 28 metabolite differences for obese adults(P<0.05).Obese adults had trimethylamine N-oxide,endocannabinoids and monoacylglycerols with different relative abundances identified between ascending and descending colon.Primary and secondary bile acids,vitamins,and fatty acids also showed marked relative abundance differences in colon tissue from overweight/obese adults.CONCLUSION There were metabolite profile differences between right-ascending and leftdescending colon tissue in healthy adults.Colon lipids and other metabolites in obese and overweight adults were distinguished from normal weight participants and associated with gut inflammation,nutrient absorption,and products of microbiota metabolism.

Relationships between In SAR Seismic Deformation and Fault Motion Sense,Fault Strike,and Ascending/Descending Modes

Based on the working principle of satellite radars, the earthquake deformation field measured by interferometric synthetic aperture（InSAR） is the projection of ground displacement associated with the seismogenic fault in the line of sight（LOS） of the satellite. However, LOS projections are complex, and are not only related to the ascending/descending modes and incidence angles of SAR data, but also related to the strike and motion senses of the fault. Even for the same earthquake, the LOS deformation derived from different ascending/descending data can be almost identical in one case, but quite different in another case, which makes the interpretation of InSAR seismic deformation and its comparison with field observations difficult. In this study, we undertook a quantitative analysis of the relationships between LOS observation sensitivity of InSAR and fault strike, fault motion sense, and ascending/descending modes, as well as 3D deformation fields. We studied the features and differences of the LOS deformation fields in different types of earthquakes using ascending/descending modes, with a particularly detailed analysis of the relations for a strikeslip type of earthquake. We also summarized the characteristics of LOS deformation fields of faults with different strikes and optimal observational data modes. Taking the strike-slip Yushu earthquake and the normal Gaize event as examples, we used SAR data of the ascending/descending modes to verify the results of quantitative calculations. These analyses will not only provide a more reasonable interpretation of InSAR seismic deformation fields and but also help understand the differences of seismic deformation fields revealed by data with different observational modes, therefore promoting the application of InSAR technology in seismology.

Central neuromechanisms underlying control of intragastric pressure through acupuncture at Zusanli(ST36) in rats: the upper cervical cord is the key link between the ascending and descending pathways

Sensory inputs stimulated by Zusanli（ST36） acupuncture in the abdomen are known to converge in the upper cervical cord. However, it is unclear whether these inputs are subsequently conveyed to the hypothalamic paraventricular nucleus and what kind of afferent fibers are involved. We focused on the upper cervical cord, where afferent inputs converge, and detected c-fos expression in oxytocinergic neurons. We found that Zusanli acupuncture therapy effectively elevated intragastric pressure, but inhibited expression of c-fos in oxytocinergic neurons of the paraventricular nucleus in upper cervical cord injured rats. These Zusanli acupuncture effects remained even after complete dorsal cord transection. However, after complete transection of the spinal cord or dorsolateral funiculus, the effects were significantly attenuated and even disappeared. These findings suggest that the paraventricular nucleus is responsible for pooling and integrating signals from the Zusanli acupuncture and sensory information from the intragastric pressure variation, thereby contributing to the regulation of intragastric pressure. The upper cervical cord serves as the key link between ascending and descending pathways, which conveys afferent inputs to the paraventricular nucleus through the dorsolateral funiculus.

Doppler measurements in fetal descending aorta and umbilical artery can predict borderline oxygenation in pre-eclampsia and HELLP syndrome

Objective: To determine diagnostic utility of Doppler measurements in fetal descending aorta and umbilical arteries in predicting intrauterine growth retarded (IUGR) fetuses at risk in pregnancies complicated by preeclampsia and/or HELLP syndrome. Methods: Doppler measurements were taken in fetal descending aorta and umbilical arteries of 53 patients with pre-eclampsia, 10 of whom had HELLP syndrome using fetometry (ACUSON 128XP/10, 3.5 MHz probe). These values were compared with those of 44 appropriate-for-gestational age singleton pregnancies (AGA). Doppler Indices (Resistance Index (RI), Systolic/Diastolic (S/D) ratio) and end-diastolic flows were related to fetal heart rate (FHR) during contraction stress test, to cord blood parameters (pH, Base Excess) and to Apgar Scores. Results: In contrast to AGA fetuses, IUGR fetuses had decreased end-diastolic flow and an increase of Doppler Indices significantly earlier in the descending aorta (p < 0.05), compared to umbilical artery. Increased RI’s, S/D ratios and a decrease of end-diastolic flow in fetal aorta were significantly correlated to frequency of FHR decelerations during contraction stress tests, pH, Base Excess (p < 0.01) and Apgar Scores in IUGR fetuses. Conclusion: A decrease in end-diastolic flow paralleled with an increase in Doppler indices in fetal descending aorta reflect oxygen deprivation in IUGR fetuses during pre-eclamptic pregnancies with or without HELLP syndrome. While ductus venosus and umbilical artery are more frequently used nowadays to determine fetal oxygen deprivation, Doppler measurements in fetal descending aorta provide additional information for early detection of fetuses at risk for IUGR in pregnancies complicated with pre-eclampsia and/or HELLP

Acute Type A Aortic Dissection—Replacement of Ascending Aorta, Aortic Arch and Antegrade Stenting of the Descending Thoracic Aorta Using the Thoraflex™Hybrid Plexus Device (Terumo Aortic)—“Frozen Elephant Trunk”: The Plymouth Way!

Objectives: To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. Materials: Thoraflex™ Hybrid Plexus Device (Terumo Aortic). Design: Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. Method/ Results: Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. Conclusions: We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.

A DEM fusion method for ascending and descending orbit StereoSAR DEMs in complicated mountain areas considering SAR echo intensity

To extract the high-quality DEM in complicated mountain areas,a DEM fusion method for ascending and descending orbit StereoSAR DEMs considering Synthetic Aperture Radar(SAR)echo intensity is proposed.After the analysis for the influence of terrain features and SAR side-looking imaging characteristics on radar echo intensity and DEM accuracy,four Terras AR-X images with the stripmap mode and the 3 m spatial resolution covering a certain area of Maoxian County,Sichuan Province,China,was selected as the experimental area.StereoSAR technology was used to extract the ascending orbit StereoSAR DEM and the descending orbit StereoSAR DEM,respectively,and the corresponding radar echo intensity map was calculated.Then,while comparing the radar echo intensity corresponding to the same point position,DEM fusion was carried out,and the accuracy of DEM before and after the fusion was analyzed with the ground points measured by GNSS-RTK as reference data.Finally,a high-quality DEM with a 3 m spatial resolution in the experimental area was obtained.The DEM accuracy was improved on all slopes,and the mean absolute deviation(MAD)improved to 4.798 m,the standard deviation(SD)improved to 6.087 m and the LE90 improved to 40.48 m.The experimental results indicate that the fusion method of highresolution ascending and descending orbit StereoSAR DEMs considering SAR echo intensity can effectively extract DEM with high accuracy and reliability,which can provide technical support for obtaining highquality terrain information in similar areas.

Rare multiple fistulas with large saccular aneurysms originating from left anterior descending artery and left main coronary artery

A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment.

Long-Term Results (Seven and More Years) of Sparing Treatment of Subjects with Descending Aortic Aneurysms

Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. Objective: To investigate remote (7 and more years) results of treatment in patients with DAAs in operative treatment only if there is a danger of aneurysm rupture. A total of 82 patients with atherosclerotic DAA identified between 2008 and 2011, and 22 patients with type 1 or 3 DeBakey dissecting aneurysms (DA) who had not been operated in the acute period due to a number of reasons were examined. The follow-up period of these groups was 7 or more years. When using a sparing treatment to treat DAA, we saw survival of 90.1 at 2 years, 76.8% at 4 years, 59.4% at 6 years, and 57.5% at 7 years with the uniform increase in mortality rate, mainly due to a comorbidity. Survival in DA group (77.3%) was better due to a younger age and was 68.4% in operated and 54% in non-operated patients at 7 years. It is symptomatic that the aneurysm rupture rate was not always affected by operative treatment. Therefore, it seems like medical treatment is more consistent with etiopathogenesis of the disease compared to surgery during the stabilization period.

Atherosclerotic Descending Aortic Aneurysms. Pros and Cons of Surgery

Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among changes observed during the progression of the disease were not fully described, surgeons had successfully applied, although traumatic, but a rather radical method to rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes, mostly concerned mortality, we realized that surgery could not be the main tactical approach to AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required more sparing treatment strategies. The situation gave rise to a more argumentative and sparing medical-and-surgical approach to treatment based on a more in-depth understanding of the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate. The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial determination of indications for surgical correction with outlining the area of relative and absolute risk of aneurysm rupture;2) Method of conservative treatment aimed to attain and maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease and control co-morbidities. A four-year follow-up of patients using this developed technology has yielded more preferred results suggesting the need for narrowing indications for surgery to treat AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations and implantations of stent-grafts, considering the fact that medical treatment should be used in operated subjects, too.

Clinical observation on efficacy of compound of warming yang, descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with Yin-Yang deficiency and blood stasis syndrome

Objective:To observe the clinical efficacy of compound of owarming yang,descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome.Methods:Seventy-six patients of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome were randomly divided into observation group and control group,thirty-eight cases in each group.The control group was given conventional western medicine treatment,while the observation group took compound of owarming yang,descending turbidity and dredging collaterals orally on the basis of conventional western medicine treatment.The course of treatment covered for one month.Before and after treatment,we observed the scores of traditional Chinese medicine symptoms,indicators of renal function[serum creatinine(Scr),blood urea nitrogen(BUN),microalbuminuria(MALB)],indicators of glucose metabolism[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbAlc)],indicators of hemorheology[plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB)],Cystatin-C(Cys-C),C-reactive protein(CRP)in the two groups.Results:After treatment,the clinical effect of the observation group was significantly better than the control group(P<0.05).The scores of traditional Chinese medicine symptoms,indicators of renal function(Scr、BUN、UAER),indicators of glucose metabolism(FPG、2hPG、HbAlc),indicators of hemorheology(PV、PAR、FIB),Cys-C and CRP in the two groups were decreased significantly compared with those before treatment(P<0.05),and the decrease in the observation group was superior to that in the control group(P<0.05).Conclusion:Compound of warming yang,descending turbidity and dredging collaterals has remarkable efficacy in treating of diabetic kidney disease patients with yin-yang deficiency and blood stasis syndrome by alleviating clinical symptoms,glucose metabolism,renal function and microcirculatory disturbance,and the mechanism related to alleviation of microinflammation.

Deep Inspiration Breath Hold Reduces Dose to the Left Ventricle and Proximal Left Anterior Descending Artery during Radiotherapy for Left-Sided Breast Cancers

The purpose of this study was to analyze motion of the left anterior descending coronary artery (LAD) and left ventricle during normal breathing and deep inspiration breath hold (DIBH). This is a dosimetric study utilizing free-breathing and static DIBH scans from eleven patients treated with radiotherapy for breast cancer. The anterior-posterior displacement along the length of the LAD was measured in each respiratory phase. Standard treatment plans targeting the whole breast without treatment of the internal mammary lymph nodes were generated and dose to the LAD and LV calculated. Non-uniform movement of the LAD during respiratory maneuvers with the proximal third exhibiting the greatest displacement was observed. In DIBH compared to end-expiration (EP), the mean posterior displacement of the proximal 1/3 of the LAD was 8.99 mm, the middle 1/3 of the artery was 6.37 mm, and the distal 1/3 was 3.27 mm. In end-inspiration (IP) compared to end-expiration the mean posterior displacements of the proximal 1/3 of the LAD was 2.08 mm, the middle 1/3 of the artery was 0.91 mm, and the distal 1/3 was 0.97 mm. Mean doses to the LAD using tangential treatment fields and a prescribed dose of 50.4 Gy were 11.32 Gy in EP, 8.98 Gy in IP, and 3.50 Gy in DIBH. Mean doses to the LV were 2.38 Gy in EP, 2.31 Gy in IP, and 1.24 Gy in DIBH. In conclusion, inspiration and especially DIBH, cause a displacement of the origin and proximal 2/3 of the LAD away from the chest wall, resulting in sparing of the most critical segment of the artery during tangential radiotherapy.

Discussion on the Application of Ascending and Descending Property of Traditional Chinese Medicine in Compatibility of Clinical Prescriptions

Through the method of literature mining,the classics of traditional Chinese medicine,materia medica works,medical cases and documents are studied.Based on common prescriptions for the treatment of diseases such as abnormal Zang-fu viscera and qi movement,dysfunction,etc.,and combined with the theory of ascending and descending property of traditional Chinese medicine,the application of ascending and descending property of traditional Chinese medicine in clinical prescription compatibility and the factors affecting the application are summarized.The ascending and descending properties of traditional Chinese medicine have been widely used in prescription compatibility for the clinical treatment of impairment of purifying and descending function of the lung,spleen and stomach's ascending and descending disorders and heart-kidney noninteractionpatte.

Multiple myocardial bridges affecting left anterior descending artery and right coronary artery with hypertrophic cardiomyopathy:a case report

The prevalence of myocardial bridging in hypertrophic cardiomyopathy （HCM） is relatively higher, and it usually occurs in the middle and distal portions of the left anterior descending artery. It is rarely reported that multiple lesions of myocardial bridging affecting not only the left anterior descending artery but also right coronary artery. We reported a 56-year-old man suffering from chest discomfort on exertion. Echocardiography and ventriculography showed hypertrophy of the apex involving the anterior and lateral wall. Coronary angiograph revealed multiple myocardial bridges affecting the left anterior descending artery and the right posterior descending artery.

Therapeutic efficacy of methylprednisolone sodium succinate via diverse administration routes for mid-to high-frequency sudden sensorineural hearing loss

BACKGROUND Sudden sensorineural hearing loss(SSNHL),characterized by a rapid and unexplained loss of hearing,particularly at moderate to high frequencies,presents a significant clinical challenge.The therapeutic use of methylprednisolone sodium succinate(MPSS)via different administration routes,in combination with conventional medications,remains a topic of interest.AIM To compare the therapeutic efficacy of MPSS administered via different routes in combination with conventional drugs for the treatment of mid-to high-frequency SSNHL.METHODS The medical records of 109 patients with mid-to high-frequency SSNHL were analyzed.The patients were divided into three groups based on the route of administration:Group A[intratympanic(IT)injection of MPSS combined with mecobalamin and Ginkgo biloba leaf extract injection],Group B(intravenous injection of MPSS combined with mecobalamin and Ginkgo biloba leaf extract injection),and Group C(single IT injection of MPSS).The intervention effects were compared and analyzed.RESULTS The posttreatment auditory thresholds in Group A(21.23±3.34)were significantly lower than those in Groups B(28.52±3.36)and C(30.23±4.21;P<0.05).Group A also exhibited a significantly greater speech recognition rate(92.23±5.34)than Groups B and C.The disappearance time of tinnitus,time to hearing recovery,and disappearance time of vertigo in Group A were significantly shorter than those in Groups B and C(P<0.05).The total effective rate in Group A(97.56%)was significantly greater than that in Groups B and C(77.14%and 78.79%,χ^(2)=7.898,P=0.019).Moreover,the incidence of adverse reactions in Groups A and C was significantly lower than that in Group B(4.88%,3.03%vs 2.57%,χ^(2)=11.443,P=0.003),and the recurrence rate in Group A was significantly lower than that in Groups B and C(2.44%vs 20.00%vs 21.21%,χ^(2)=7.120,P=0.028).CONCLUSION IT injection of MPSS combined with conventional treatment demonstrates superior efficacy and safety compared to systemic administration via intravenous infusion and a single IT injection of MPSS.This approach effectively improves patients'hearing and reduces the risk of disease recurrence.

High-resolution simulation for rotorcraft aerodynamics in hovering and vertical descending flight using a hybrid method

A high-resolution simulation tool for rotorcraft aerodynamics is developed by coupling CFD with a Vorticity Transport Model（VTM）. An Eulerian-based CFD module is used to model the blade near body flowfield, and a Lagrangian-based VTM module is employed for vortex tracking in the far wake. The coupling procedure is implemented by transmitting vortex sources to the VTM module and feeding boundary conditions back to the CFD module. The presented CFD/VTM hybrid solver is firstly validated by hover cases of three different rotor configurations. Simulation results, including the blade surface pressure distribution, rotor downwash, and hover figure of merit, exhibit favorable correlations with available experimental data. Then, a rotor operated in vertical descending flight with a fixed collective pitch is investigated. It is shown that the CFD/VTM coupling method is suitable for rotor wake simulation. Wake instabilities（far wake breakdown in hover and toroidal wake pattern in the vortex ring state） are successfully demonstrated with a moderate computational cost.

Influence of Screw Design on Burden Descending Velocity and Particle Segregation in COREX Shaft Furnace

COREX shaft furnace（SF）is an industrial system that employs screw feeders;thus,the burden descending velocity and particle segregation in the SF can be directly affected by the design of screw.A three-dimensional actual size model of COREX-3000 SF was established using the discrete element method.Four types of burdens,including pellet,ore,flux and coke,were considered in this model.With this consideration,the effect of screw design on solid flow was investigated.Results showed that,in the base case,burdens fell primarily down from the first flight of the screw.The burden descending velocities were nearly uniform in the peripheral direction and decreased along the radial direction.In addition,the normalized particle size increased in the center area and decreased in the wall area.Reducing the flight diameter of screw benefited an even flow pattern and restrained the rolling tendency of burden from the edge to center areas.An optimized case was also proposed,in which a uniform solid flow profile could be obtained and the evenness of descending velocity along the radius could be greatly improved.

Comparative study on the effect of interventional and conservative therapy on the prognosis of patients with ruptured descending thoracic aorta

Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients with feasible anatomy. Nevertheless,mortality remains high as well as morbidity despite successful operation. The purpose of this study was to compare TEVAR with conservative therapy on the 30-day mortality of patients with ruptured descending thoracic aorta. Methods Retrospective analysis of patients admitted to our hospital with descending thoracic aortic rupture was performed. Patients presented with rupture of descending thoracic aorta with feasible anatomy for TEVAR between Jan 2014 and June 2019 were included. Patients were divided into operative and conservative group depending on which therapy they received. Patients received TEVAR were defined as the operative group,while those received conservative therapy were defined as conservative treatment group. Results There were twenty-six patients in total,including fifteen aortic dissections,nine were thoracic aneurysms,and two were traumatic injuries. Theie mean age was 60±13 years with only two female. Seven patients(27%)presented with shock and twenty-two(85%)was accompanied with hemothorax on admission. Nineteen patients(73%)accepted emergent TEVAR with 100% primary technical success,and the other seven received conservative treatment. In operative group,infection(89%)and respiratory failure(63%)occurred after TEVAR. The in-hospital mortality for operative and conservative treatment group was 26% and 57% respectively(P=0.18). Operative group had lower 30-day mortality(26% vs. 86%,P=0.021). Conclusions TEVAR is associated with improved early outcome in patients with ruptured descending thoracic aorta.