ALAS2 overexpression alleviates oxidative stress-induced ferroptosis in aortic aneurysms via GATA1 activation.

Background: Aortic aneurysm, characterized by abnormal dilation of the aorta, poses significant health risks. This study aims to investigate the interaction between 5-aminolevulinate synthase 2 (ALAS2) and GATA-binding protein 1 (GATA1) in ferroptosis and oxidative stress responses in aortic aneurysm. Methods: A weighted gene co-expression network analysis (WGCNA) was performed on the differentially expressed genes (DEGs) within the GSE9106 dataset to identify the key module. Subsequently, protein-protein interaction (PPI) network analysis was performed on the key module. Mouse aortic vascular smooth muscle cells (MOVAS) were treated with hydrogen peroxide (H2O2) to induce oxidative stress, and ferroptosis inducers and inhibitors were added to evaluate their effects on iron content and oxidative stress markers. Through a series of in vitro cellular experiments, we assessed cell viability, expression levels of GATA1 and iron mutation-associated proteins, as well as cellular phenotypes such as inflammatory responses and apoptosis rates. Results: Three candidate genes (ALAS2, GYPA, and GYPB) were upregulated in the thoracic aortic aneurysm (TAA) samples of the GSE9106 dataset. The H2O2 treatment increased the MOVAS cells' iron content and oxidative stress, upregulated ALAS2 protein levels, and decreased the ferroptosis-related protein levels. ALAS2 overexpression reversed H2O2-induced apoptosis and increased the inflammatory cytokine levels. Additionally, the knockdown of GATA1 partially reversed the protective mechanism of overexpressed ALAS2 on H2O2-induced ferroptosis. Conclusions: ALAS2 overexpression reduced H2O2-induced oxidative damage and iron-induced apoptosis in MOVAS cells, and GATA1 knockdown partially reversed this protective effect. These findings suggested that the ALAS2 and GATA1 regulatory pathways may be potential therapeutic targets in aortic aneurysms.

Neutrophil extracellular traps promoting fibroblast activation and aggravating limb ischemia through Wnt5a pathway.

Although the formation of NETs contributes to cancer cell invasion and distant metastasis, its role in the pathological progression of limb ischemia remains unknown. This study investigated the functional significance of NETs in cell-cell crosstalk during limb ischemia. The changes of cell subsets in lower limb ischemia samples were detected by single-cell RNA sequencing. The expression of neutrophil extracellular traps (NETs) related markers in lower limb ischemia samples was detected by immunohistochemistry and Western blotting. The signaling pathway of NETs activation in fibroblasts was verified by immunofluorescence, PCR and Western blotting. Through single-cell RNA sequencing (scRNA-seq), we identified 9 distinct cell clusters, with significantly upregulated activation levels in fibroblasts and neutrophils and phenotypic transformation of smooth muscle cells (SMCs) into a proliferative state in ischemic tissue. At the same time, the interaction between fibroblasts and smooth muscle cells was significantly enhanced in ischemic tissue. NETs levels rise and fibroblast activation is induced in ischemic conditions. Mechanistically, activated fibroblasts promote smooth muscle cell proliferation through the Wnt5a pathway. In ischemic mice, inhibition of Wnt5a mitigated vascular remodeling and subsequent ischemia. These findings highlighting the role of cell-cell crosstalk in ischemia and vascular remodeling. We found that the NETs-initiated fibroblast-SMC interaction is a critical regulator of limb ischemia via Wnt5a pathway, a potential therapeutic target for the treatment.

Hereditary hemochromatosis caused by a C282Y/H63D mutation in the HFE gene: A case report.

Hereditary hemochromatosis (HH) is a disease characterized by disordered iron metabolism. It often involves mutations of the HFE gene, which encodes the homeostatic iron regulator protein (HFE), as well as mutations affecting hepcidin antimicrobial peptide, hemojuvelin, or transferrin receptor 2. Historically, HH has been observed primarily in European and European diaspora populations, while classical HH is rare in Asian populations, including in China. In this article, we report a rare case of HH in a Chinese man that could be attributed to a heterozygous C282Y/H63D HFE mutation. Based on clinical examination, liver biopsy, and genetic testing results, the patient was diagnosed with HH. Clinical signs and symptoms and serum iron-related test results were recorded for a period of two years after the patient began treatment. Over this observation period, the patient was subjected to 25 phlebotomies (accounting for a total blood loss of 10.2 L). His serum ferritin levels decreased from 1550 µg/L to 454 µg/L, his serum iron concentration decreased from 40 µmol/L to 24.6 µmol/L, and his transferrin saturation decreased from 97.5% to 55.1%. Early diagnosis is essential for patients with HH to obtain good outcomes. Regular phlebotomy after diagnosis can improve HH symptoms and delay HH disease progression.

Neutrophil extracellular traps induced by IL-1ß promote endothelial dysfunction and aggravate limb ischemia.

Vascular inflammation and endothelial dysfunction contribute to vascular diseases. While neutrophil extracellular traps (NETs) participate in some vascular pathologies, their roles in lower limb ischemia remain poorly defined. This study investigated the functional significance of NETs in vascular inflammation and remodeling associated with limb ischemia. Single-cell RNA sequencing (scRNA-seq) and flow cytometry revealed neutrophil activation and upregulated NETs formation in human limb ischemia, with immunofluorescence confirming IL-1ß-induced release of NETs for vascular inflammation. Endothelial cell activation was examined via scRNA-seq and western blotting, indicating enhanced proliferation, expression of adhesion molecules (VCAM-1, ICAM-1), inflammatory cytokines (IL-1ß, IL-6) and decreased expression of VE-cadherin, that could be mediated by NETs to exacerbate endothelial inflammation. Mechanistically, NETs altered endothelial cell function via increased pSTAT1/STAT1 signaling. Vascular inflammation and subsequent ischemia were alleviated in vivo by NETosis or IL-1ß inhibition in ischemic mice. IL-1ß-NETs induce endothelial activation and inflammation in limb ischemia by stimulating STAT1 signaling. Targeting NETs may thus represent a novel therapeutic strategy for inflammatory vascular diseases associated with limb ischemia. Graphical abstract of NETs regulation of the development of vascular inflammation in lower limb ischemia via pSTAT1/STAT1 signaling pathway.

Role of Ferroptosis in the Progression of COVID-19 and the Development of Long COVID.

OBJECTIVES: To examine the role of ferroptosis on the pathogenesis and progression of COVID-19. MATERIALS AND METHODS: A total of 127 patients who were hospitalized for COVID-19 were categorized into two groups according to the intensity of oxygen therapy (high-flow or low-flow). Clinical characteristics, laboratory parameters, plasma markers, and peripheral blood mononuclear cell (PBMC) markers were measured at baseline and one or two weeks after treatment. Telephone follow-up was performed 3 months after discharge to assess long COVID. RESULTS: Patients receiving high-flow oxygen therapy had greater levels of neutrophils; D-dimer; C reactive protein; procalcitonin; plasma protein levels of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), IL-17, and acyl-CoA synthetase long-chain family member 4 (ACSL4); and PBMC mRNA level of TNF-α; but had lower levels of lymphocytes and plasma glutathione peroxidase 4 (GPX4). There were negative correlations of plasma GPX4 and cystine/glutamate transporter-11 (SLC7A11) with TNF-α, IL-6, and IL-17, and positive correlations of ACSL4 with inflammatory markers in plasma and PBMCs. The plasma levels of TNF-α, IL-6, IL-17, and ACSL4 were significantly lower after treatment than at baseline, but there were higher post-treatment levels of lymphocytes, GPX4, and SLC7A11. Patients with long COVID had a lower baseline level of plasma SLC7A11. CONCLUSION: Ferroptosis is activated during the progression of COVID-19, and a low baseline level of a ferroptosis marker (SLC7A11) may indicate an increased risk for long COVID-19. Ferroptosis has potential as a clinical indicator of long COVID and as a therapeutic target.

Data-driven learning of chaotic dynamical systems using Discrete-Temporal Sobolev Networks.

We introduce the Discrete-Temporal Sobolev Network (DTSN), a neural network loss function that assists dynamical system forecasting by minimizing variational differences between the network output and the training data via a temporal Sobolev norm. This approach is entirely data-driven, architecture agnostic, and does not require derivative information from the estimated system. The DTSN is particularly well suited to chaotic dynamical systems as it minimizes noise in the network output which is crucial for such sensitive systems. For our test cases we consider discrete approximations of the Lorenz-63 system and the Chua circuit. For the network architectures we use the Long Short-Term Memory (LSTM) and the Transformer. The performance of the DTSN is compared with the standard MSE loss for both architectures, as well as with the Physics Informed Neural Network (PINN) loss for the LSTM. The DTSN loss is shown to substantially improve accuracy for both architectures, while requiring less information than the PINN and without noticeably increasing computational time, thereby demonstrating its potential to improve neural network forecasting of dynamical systems.

Single-Cell Mapping of Large and Small Arteries During Hypertensive Aging.

Vascular aging is directly related to several major diseases including clinical primary hypertension. Conversely, elevated blood pressure itself accelerates vascular senescence. However, the interaction between vascular aging and hypertension has not been characterized during hypertensive aging. To depict the interconnectedness of complex mechanisms between hypertension and aging, we performed single-cell RNA sequencing of aorta, femoral and mesentery arteries, respectively, from male Wistar Kyoto rats and male spontaneously hypertensive rats aging 16 or 72 weeks. We integrated 12 data sets to map the blood vessels of senile hypertension from 3 perspective: vascular aging, hypertension, and vascular type. We found that aging and hypertension independently exerted a significant impact on the alteration of cellular composition and artery remodeling, even greater when superimposed. Consistently, smooth muscle cells (SMCs) underwent phenotypic switching from contractile toward synthetic, apoptotic, and senescent SMCs with aging/hypertension. Furthermore, we identified 3 subclusters of Spp1high, encoding protein osteopontin (OPN), synthetic SMCs, Spp1high matrix activated fibroblasts, and Spp1high scar-associated macrophage involved in hypertensive aging. Spp1high scar-associated macrophage enriched for reactive oxygen species metabolic process and cell migration-associated function. Cell-cell communication analysis revealed Spp1-Cd44 receptor pairing was markedly aggravated in the hypertensive aging condition. Importantly, the concentration of serum OPN significantly potentiated in aged hypertensive patients compared with the normal group. Thus, we provide a comprehensive cell atlas to systematically resolve the cellular diversity and dynamic cellular communication changes of the vessel wall during hypertensive aging, identifying a protein marker OPN as a potential regulator of vascular remodeling during hypertensive aging.

Determination of mycobiota and aflatoxin contamination in commercial bee pollen from eight provinces and one autonomous region of China.

The co-occurrence of fungi and mycotoxins in various foods has been frequently reported in many countries, posing a serious threat to the health and safety of consumers. In this study, the mycobiota in five types of commercial bee pollen samples from China were first revealed by DNA metabarcoding. Meanwhile, the content of total aflatoxins in each sample was investigated by high-performance liquid chromatography with fluorescence detection. The results demonstrated that Cladosporium (0.16 %-89.29 %) was the most prevalent genus in bee pollen, followed by Metschnikowia (0-81.12 %), unclassified genus in the phylum Ascomycota (0-81.13 %), Kodamaea (0-73.57 %), and Penicillium (0-36.13 %). Meanwhile, none of the assayed aflatoxins were determined in the 18 batches of bee pollen samples. In addition, the fungal diversity, community composition, and trophic mode varied significantly among five groups. This study provides comprehensive information for better understanding the fungal communities and aflatoxin residues in bee pollen from different floral origins in China.

An overview of green synthesized silver nanoparticles towards bioactive antibacterial, antimicrobial and antifungal applications.

Present review emphatically introduces the synthesis, biocompatibility, and applications of silver nanoparticles (AgNPs), including their antibacterial, antimicrobial, and antifungal properties. A comprehensive discussion of various synthesis methods for AgNPs, with a particular focus on green chemistry mediated by plant extracts has been made. Recent research has revealed that the optical properties of AgNPs, including surface plasmon resonance (SPR), depend on the particle size, as well as the synthesis methods, preparation synthesis parameters, and used reducing agents. The significant emphasis on the use of synthesized AgNPs as antibacterial, antimicrobial, and antifungal agents in various applications has been reviewed. Furthermore, the application areas have been thoroughly examined, providing a detailed discussion of the underlying mechanisms, which aids in determining the optimal control parameters during the synthesis process of AgNPs. Furthermore, the challenges encountered while utilizing AgNPs and the corresponding advancements to overcome them have also been addressed. This review not only summarizes the achievements and current status of plant-mediated green synthesis of AgNPs but also explores the future prospects of these materials and technology in diverse areas, including bioactive applications.

SmartSpring: A Low-Cost Wearable Haptic VR Display with Controllable Passive Feedback.

With the development of virtual reality, the practical requirements of the wearable haptic interface have been greatly emphasized. While passive haptic devices are commonly used in virtual reality, they lack generality and are difficult to precisely generate continuous force feedback to users. In this work, we present SmartSpring, a new solution for passive haptics, which is inexpensive, lightweight and capable of providing controllable force feedback in virtual reality. We propose a hybrid spring-linkage structure as the proxy and flexibly control the mechanism for adjustable system stiffness. By analyzing the structure and force model, we enable a smart transform of the structure for producing continuous force signals. We quantitatively examine the real-world performance of SmartSpring to verify our model. By asymmetrically moving or actively pressing the end-effector, we show that our design can further support rendering torque and stiffness. Finally, we demonstrate the SmartSpring in a series of scenarios with user studies and a just noticeable difference analysis. Experimental results show the potential of the developed haptic display in virtual reality.

Deep learning-based multi-stage postoperative type-b aortic dissection segmentation using global-local fusion learning.

Objective.Type-b aortic dissection (AD) is a life-threatening cardiovascular disease and the primary treatment is thoracic endovascular aortic repair (TEVAR). Due to the lack of a rapid and accurate segmentation technique, the patient-specific postoperative AD model is unavailable in clinical practice, resulting in impracticable 3D morphological and hemodynamic analyses during TEVAR assessment. This work aims to construct a deep learning-based segmentation framework for postoperative type-b AD.Approach.The segmentation is performed in a two-stage manner. A multi-class segmentation of the contrast-enhanced aorta, thrombus (TH), and branch vessels (BV) is achieved in the first stage based on the cropped image patches. True lumen (TL) and false lumen (FL) are extracted from a straightened image containing the entire aorta in the second stage. A global-local fusion learning mechanism is designed to improve the segmentation of TH and BR by compensating for the missing contextual features of the cropped images in the first stage.Results.The experiments are conducted on a multi-center dataset comprising 133 patients with 306 follow-up images. Our framework achieves the state-of-the-art dice similarity coefficient (DSC) of 0.962, 0.921, 0.811, and 0.884 for TL, FL, TH, and BV, respectively. The global-local fusion learning mechanism increases the DSC of TH and BV by 2.3% (p< 0.05) and 1.4% (p< 0.05), respectively, based on the baseline. Segmenting TH in stage 1 can achieve significantly better DSC for FL (0.921 ± 0.055 versus 0.857 ± 0.220,p< 0.01) and TH (0.811 ± 0.137 versus 0.797 ± 0.146,p< 0.05) than in stage 2. Our framework supports more accurate vascular volume quantifications compared with previous segmentation model, especially for the patients with enlarged TH+FL after TEVAR, and shows good generalizability to different hospital settings.Significance.Our framework can quickly provide accurate patient-specific AD models, supporting the clinical practice of 3D morphological and hemodynamic analyses for quantitative and more comprehensive patient-specific TEVAR assessments.

Machine learning of independent conservation laws through neural deflation.

We introduce a methodology for seeking conservation laws within a Hamiltonian dynamical system, which we term "neural deflation." Inspired by deflation methods for steady states of dynamical systems, we propose to iteratively train a number of neural networks to minimize a regularized loss function accounting for the necessity of conserved quantities to be in involution and enforcing functional independence thereof consistently in the infinite-sample limit. The method is applied to a series of integrable and nonintegrable lattice differential-difference equations. In the former, the predicted number of conservation laws extensively grows with the number of degrees of freedom, while for the latter, it generically stops at a threshold related to the number of conserved quantities in the system. This data-driven tool could prove valuable in assessing a model's conserved quantities and its potential integrability.

Effects of Long Term Fatigue Cycling on In Situ Fenestrations of Polyethylene Terephthalate and Expanded Polytetrafluorethylene Thoracic Aortic Stent grafts: An Experimental Study.

OBJECTIVE: In this study, the long term durability of fenestrations after in situ fenestration (ISF) of five commercial thoracic aortic stent grafts was evaluated in an in vitro experiment after a simulated 10 year period. METHODS: Five different thoracic aortic stent grafts (Relay, Valiant, Hercules, TAG, and Ankura, with a diameter of 34 mm) received both needle and laser ISF in vitro. A Viabahn (11 × 50 mm) was released in each fenestration as a bridging stent graft. Long term fatigue tests (simulating 10 years) of each of the fenestrated stent grafts were then conducted in a flow fatigue test system. The area, shape, margin, and the long and short axis of all the fenestrations were evaluated with light microscopy before and after the fatigue test. The leakage from the fenestration junction before and after the long term fatigue was also measured. RESULTS: The experimental results showed no obvious difference between needle and laser fenestrations. The long axes of all the fenestrations remained unchanged, while the short axes increased after the fatigue test, which was significant in Relay, Valiant, and Hercules polyethylene terephthalate stent grafts. The shape scores of fenestrations improved after the fatigue test in Valiant and Hercules, remained unchanged in Relay and Ankura, and worsened in the TAG. After the fatigue cycling, the average leakage from the fenestration junction decreased in all the stent grafts, and the Ankura had the maximum decline rate. CONCLUSION: The ISF technique was durable over a simulated 10 year period. The fenestrations were positively remodelled to be more circular, and the leakage from the junction decreased after long term fatigue testing.

Online view enhancement for exploration inside medical volumetric data using virtual reality.

BACKGROUND AND OBJECTIVE: Medical image visualization is an essential tool for conveying anatomical information. Ray-casting-based volume rendering is commonly used for generating visualizations of raw medical images. However, exposing a target area inside the skin often requires manual tuning of transfer functions or segmentation of original images, as preset parameters in volume rendering may not work well for arbitrary scanned data. This process is tedious and unnatural. To address this issue, we propose a volume visualization system that enhances the view inside the skin, enabling flexible exploration of medical volumetric data using virtual reality. METHODS: In our proposed system, we design a virtual reality interface that allows users to walk inside the data. We introduce a view-dependent occlusion weakening method based on geodesic distance transform to support this interaction. By combining these methods, we develop a virtual reality system with intuitive interactions, facilitating online view enhancement for medical data exploration and annotation inside the volume. RESULTS: Our rendering results demonstrate that the proposed occlusion weakening method effectively weakens obstacles while preserving the target area. Furthermore, comparative analysis with other alternative solutions highlights the advantages of our method in virtual reality. We conducted user studies to evaluate our system, including area annotation and line drawing tasks. The results showed that our method with enhanced views achieved 47.73% and 35.29% higher accuracy compared to the group with traditional volume rendering. Additionally, subjective feedback from medical experts further supported the effectiveness of the designed interactions in virtual reality. CONCLUSIONS: We successfully address the occlusion problems in the exploration of medical volumetric data within a virtual reality environment. Our system allows for flexible integration of scanned medical volumes without requiring extensive manual preprocessing. The results of our user studies demonstrate the feasibility and effectiveness of walk-in interaction for medical data exploration.

Endovascular Treatment of Superior Mesenteric Artery Pseudoaneurysm Due to Infective Endocarditis With Stent-Graft.

PURPOSE: To report a successful case of pseudoaneurysm of the superior mesenteric artery (SMA) caused by infected endocarditis treated with a covered stent. CASE REPORT: A patient was diagnosed with infective endocarditis and 2 months later a proximal SMA pseudoaneurysm was identified on computed tomography. Daptomycin was started on admission and continued for approximately 4 months until the inflammatory markers normalized, and then the SMA pseudoaneurysm was successfully excluded with a stent-graft and antibiotics were continued for 1 year after the procedure. There were no associated complications or recurrences at the 3-year follow-up. CONCLUSION: Placing a covered stent with a full course of antibiotics before and after surgery may be a successful alternative to open surgery in the treatment of pseudoaneurysms of the SMA due to infective endocarditis. CLINICAL IMPACT: This case report reports a rare case of pseudoaneurysm of the superior mesenteric artery due to infective endocarditis, which was successfully treated with an overlapping stent and confirmed by complete imaging data at a three-year follow-up. This report suggests that endovascular treatment may be an alternative to open surgery in the treatment of pseudoaneurysms of the superior mesenteric artery caused by infective endocarditis.

Thermodynamics 2.0: Bridging the natural and social sciences.

Thermodynamics is a universal science. The language of thermodynamics is energy and its derivatives such as entropy and power. The physical theory of thermodynamics reigns across a full spectrum of non-living objects as well as living beings. In the traditions of the past, the dichotomy between matter and life resulted in the natural sciences studying matter while the social sciences focused on living beings. As the state of human knowledge continues to evolve, anticipating the sciences of matter (natural science) and of life (social science) becoming unified under a single overarching theory is not unnatural. This article is part of the theme issue 'Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)'.

Yes-associated protein inhibition ameliorates liver fibrosis and acute and chronic liver failure by decreasing ferroptosis and necroptosis.

Background/aims: This study aims to determine which cell death modes contribute most in the progression of cirrhosis and acute-on-chronic liver failure (ACLF), and to investigate whether Yes associated protein (YAP) affects the disease process by regulating cell death. Materials and methods: 30C57BL/6 male mice were divided into five groups: control, carbon tetrachloride (CCl4)-induced liver fibrosis model, CCl4+verteporfin, CCl4+lipopolysaccharides (LPS) combined with the D-(+)-Galactosamine (LPS/D-GalN)-induced ACLF model, and ACLF + verteporfin. Patients with chronic hepatitis B (CHB), hepatitis B virus (HBV) related liver cirrhosis or ACLF were enrolled. Histology, immunohistochemistry, transmission electron microscopy, Western blot and ELISA were conducted to assess the roles of YAP and cell death in liver cirrhosis and ACLF, and to explore the effect of YAP inhibition on cell deaths. Results: YAP was markedly increased in mice with liver fibrosis and ACLF, along with ferroptosis and necroptosis. Furthermore, YAP inhibition significantly suppressed fibrosis in CCl4-mediated liver fibrosis and ACLF-associated liver injury. Notably, CCl4 induced up-regulation of ACSL4 and RIPK3 and down-regulation of SLC7A11, key factors in ferroptosis and necroptosis. This was significantly abrogated by verteporfin treatment. Similar changes in ferroptosis and necroptosis were found in ACLF and ACLF + verteporfin groups. Consistent with the above findings in mice, we found that plasma YAP levels were gradually increased with the development of HBV-related liver fibrosis and ACLF. Conclusion: Ferroptosis and necroptosis are involved in the development of liver cirrhosis and ACLF. Inhibition of YAP improved liver fibrosis and liver damage in ACLF through a reduction in ferroptosis and necroptosis. Our findings may help better understanding the role of YAP in liver fibrosis and ACLF.

Acute Renal Infarction Due to Symptomatic Isolated Spontaneous Renal Artery Dissection: A Rare and Fatal Disease.

OBJECTIVE: To report demographics and clinical, laboratory, and imaging features of acute renal infarction (ARI) due to symptomatic isolated spontaneous renal artery dissection (SISRAD) and to analyze outcomes after the initial therapy for SISRAD. METHODS: Thirteen patients with ARI due to SISRAD between January 2016 and March 2021 were enrolled in this retrospective study. We reviewed the demographics, clinical, laboratory, and imaging features (location of the infarct kidney, the branch artery involved by dissection, true lumen stenosis, false lumen thrombosis, and aneurysm), treatment modalities, and follow-up results; analyzed the difference between SISRAD and other causes of ARI; and propose an appropriate therapy strategy for SISRAD based on our data and literature. RESULT: Patients with ARI due to SISRAD were mostly young men (43 [24-53] years; 12/13 [92%]). No patients had atrial fibrillation or acute kidney injury at admission (0/13). All 13 patients received conservative treatment as the initial treatment. Sixty-two percent (8/13) of patients progressed, and 88% (7/8) of them had dissection aneurysm on the admission computed tomographic angiography (CTA) image. Seventy-five percent (6/8) of patients underwent endovascular intervention as follows, stent placement in 1 patient, renal artery embolization in 1, and stent placement with embolization in 4. Two patients with disease progression died: 1 during the conservative treatment period and 1 after the stent placement. Thirty-eight percent (5/13) of patients in remission continued to receive conservative treatment, none of whom had dissection aneurysm on the admission CTA. CONCLUSION: Symptomatic isolated spontaneous renal artery dissection is a rare and fatal disease. For young ARI patients with no previous history of tumors and cardiogenic diseases, CTA examination is recommended to exclude SISRAD. Dissection aneurysm seems to be a risk of progression for SISRAD in this series. Conservative treatment, a recognized initial treatment, has a good effect on patients without dissection aneurysm, and we recommend endovascular intervention as the initial treatment for the patient with dissection aneurysm at admission. Multicenter clinical studies are needed to explore a more-appropriate treatment for patients with SISRAD. CLINICAL IMPACT: This article report the related factors, risks, demographics and laboratory data of Acute renal infarction (ARI) due to Symptomatic isolated spontaneous renal artery dissection (SISRAD) and explore a better initial therapy strategy for SISRAD. It will help improve the effectiveness of SISRAD treatment and reduce the mortality rate from this rare but lethal disease.

Percutaneous snare-retrieval of intracardiac thrombus under fluoroscopic and transesophageal echocardiography guidance: case report and systematic review.

Intracardiac foreign bodies (IFB) are rare clinical conditions. There are now several reports on the percutaneous retrieval of IFB under fluoroscopy. However, some IFB are not radiopaque, and retrieval requires combined fluoroscopic and ultrasound guidance. We report the case of a bedridden 23-year-old male patient with T-lymphoblastic lymphoma treated with long-term chemotherapy. Ultrasound examination diagnosed a huge thrombus in the right atrium near the opening of the inferior vena cava which affected the patency of his PICC line. Ten days of anticoagulant therapy did not modify the thrombus size. Open heart surgery was not feasible because of the patient clinical condition. Snare-capture of the non-opaque thrombus was done from the femoral vein under fluoroscopic and ultrasound guidance with excellent outcomes. We also present a systematic review of IFB. We found out that percutaneous removal of IFBs is a safe and effective procedure. The youngest patient who received percutaneous IFB retrieval was 10 days old and weighed only 800 g, while the oldest patient was 70 years old. Port catheters (43.5%) and PICC lines (42.3%) were the most commonly found IFBs. Snare catheters and forceps were the most commonly used instruments.