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1.
Clin Biomech (Bristol, Avon) ; 70: 249-256, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31675680

RESUMO

BACKGROUND: This study aimed to provide a comprehensive investigation into factors influencing the thermal effect in robot assisted osteotomies utilizing a piezoelectric osteotome and to identify an optimal combination of factors that minimize the thermal effect in an orthogonal experimental design. METHODS: Fresh bovine cortical bone was cut under standardized conditions using a robot arm, a piezoelectric osteotome, and a cooling system. Temperature was monitored and the histological depth of osteocyte thermal necrosis was examined to quantify the thermal effect(s). Eighteen experimental trials were conducted according to the standard L18 (21 × 37) orthogonal design table to explore the roles of 6 factors: power of the piezoelectric osteotome, cutting depth, cutting speed, coolant type, coolant flow velocity, and coolant temperature. FINDINGS: Our data showed that coolant flow velocity, coolant temperature and cutting speed significantly influenced temperature (p < .05), while no significant temperature increase was identified relating to cutting depth, power of the piezoelectric osteotome and coolant type. The findings of histological osteocyte thermal necrosis correlated with the results of the temperature change. INTERPRETATION: Coolant flow velocity, coolant temperature and cutting speed were key factors influencing the thermal impact of the piezoelectric osteotome. With proper combination of these 3 factors, a piezoelectric osteotome is safe to use from a thermal perspective.

2.
Phys Chem Chem Phys ; 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31697293

RESUMO

This paper deals with the investigations of terephthalic acid (TPA) molecules deposited on a low reactive Ag(111) surface and studied using scanning tunneling microscopy (STM) at low temperature and DFT calculations. These investigations show that two deprotonation states energetically equivalent can be produced at the single molecule level. On self assemblies, the mobility of H atoms at 77 K favours the motion of created defects in the layer. STM observations and DFT calculations show that the most stable structures are obtained when only one hydrogen atom is removed from an O-HO bond and when these deprotonated molecules are located in adjacent TPA rows.

3.
Nat Commun ; 10(1): 5088, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31704933

RESUMO

Tropical forests play an important role in the global carbon cycle. High-resolution remote sensing techniques, e.g., spaceborne lidar, can measure complex tropical forest structures, but it remains a challenge how to interpret such information for the assessment of forest biomass and productivity. Here, we develop an approach to estimate basal area, aboveground biomass and productivity within Amazonia by matching 770,000 GLAS lidar (ICESat) profiles with forest simulations considering spatial heterogeneous environmental and ecological conditions. This allows for deriving frequency distributions of key forest attributes for the entire Amazon. This detailed interpretation of remote sensing data improves estimates of forest attributes by 20-43% as compared to (conventional) estimates using mean canopy height. The inclusion of forest modeling has a high potential to close a missing link between remote sensing measurements and the 3D structure of forests, and may thereby improve continent-wide estimates of biomass and productivity.

4.
Adv Mater ; : e1905624, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31613398

RESUMO

Topological phases play a novel and fundamental role in matter and display extraordinary robustness to smooth changes in material parameters or disorder. A crossover between topological material and quantum information may lead to inherent fault-tolerant quantum simulations and quantum computing. Quantum features may be preserved by being encoded among topological structures of physical evolution systems. This requires stimulation, manipulation, and observation of topological phenomena at the single quantum particle level, which has not, however, yet been realized. It is asked whether the quantum features of single photons can be preserved in topological structures. The boundary states are experimentally observed at the genuine single-photon level and the performance of the topological phase is demonstrated to protect the quantum features against diffusion-induced decoherence in coupled waveguides and noise decoherence from the ambient environment. Compatibility between macroscopic topological states and microscopic single photons in the ambient environment is thus confirmed, leading to a new avenue to "quantum topological photonics" and providing more new possibilities for quantum materials and quantum technologies.

5.
Molecules ; 24(20)2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31627373

RESUMO

Sweet potato anthocyanins are water-soluble pigments with many physiological functions. Previous research on anthocyanin accumulation in sweet potato has focused on the roots, but the accumulation progress in the leaves is still unclear. Two purple sweet potato cultivars (Fushu No. 23 and Fushu No. 317) with large quantities of anthocyanin in the leaves were investigated. Anthocyanin composition and content were assessed with ultra-performance liquid chromatography diode-array detection (UPLC-DAD) and ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS), and the expressions of genes were detected by qRT-PCR. The two cultivars contained nine cyanidin anthocyanins and nine peonidin anthocyanins with an acylation modification. The acylation modification of anthocyanins in sweet potato leaves primarily included caffeoyl, p-coumaryl, feruloyl, and p-hydroxy benzoyl. We identified three anthocyanin compounds in sweet potato leaves for the first time: cyanidin 3-p-coumarylsophoroside-5-glucoside, peonidin 3-p-coumarylsophoroside-5-glucoside, and cyanidin 3-caffeoyl-p-coumarylsophoroside-5-glucoside. The anthocyanidin biosynthesis downstream structural genes DFR4, F3H1, anthocyanin synthase (ANS), and UDP-glucose flavonoid 3-O-glucosyltransferase (UFGT3), as well as the transcription factor MYB1, were found to be vital regulatory genes during the accumulation of anthocyanins in sweet potato leaves. The composition of anthocyanins (nine cyanidin-based anthocyanins and nine peonidin-based anthocyanins) in all sweet potato leaves were the same, but the quantity of anthocyanins in leaves of sweet potato varied by cultivar and differed from anthocyanin levels in the roots of sweet potatoes. The anthocyanidin biosynthesis structural genes and transcription factor together regulated and controlled the anthocyandin biosynthesis in sweet potato leaves.

6.
J Biomech ; : 109415, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31630776

RESUMO

Intraoperative measurement of hip posture is the basis for assessing hip range of motion (ROM) and predicting postoperative functional limits allowable for activities of daily living. Although computer navigation for total hip arthroplasty (THA) has improved the accuracy of intraoperative ROM evaluation, it has not gained widespread popularity due to its complex and time-consuming protocol. We therefore developed an inertial measurement unit-based hip smart trial system (IMUHST) for intraoperative monitoring of hip posture. An in vitro validation experiment was conducted using bone models with a three-dimensional measurement model as the reference standard. The absolute mean error, Bland - Altman analysis and intra-class correlation coefficient demonstrated that the validity and reliability of this system meets the requirement for clinical application. Given that monitoring posture is the basis for evaluating the direction(s) of potential impingement, subluxation and dislocation, the IMUHST is a promising development direction of computer assisted surgery in THA.

7.
BMC Nephrol ; 20(1): 364, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601196

RESUMO

BACKGROUND: Chronic allograft damage (CAD) is the leading cause of long-term graft dysfunction. A noninvasive method that can diagnose CAD early and monitor its development is needed. METHODS: Kidneys from Fisher rats were transplanted into Lewis rats to establish a CAD model (n = 20). The control group underwent syngeneic kidney transplantation (n = 20). The serum creatinine of the rats was monitored. At 4, 12, and 20 weeks after modeling, a magnetic resonance imaging (MRI) examination was performed. The apparent diffusion coefficient (ADC), pseudo diffusion coefficient (D*), true diffusion coefficient (D) and perfusion fraction (f) of the two groups were analyzed. Chronic allograft damage index (CADI) scoring was used to evaluate the transplanted kidney specimens. Immunohistochemistry was used to detect the expression of fibrosis markers in the transplanted kidney tissues and to analyze their correlations with all MRI parameters. RESULTS: The transplanted kidneys in the experimental group developed CAD changes before the appearance of elevated creatinine. The MRI parameters in the experimental group [ADC (1.460 ± 0.109 VS 2.095 ± 0.319, P < 0.001), D (1.435 ± 0.102 VS 1.969 ± 0.305, P < 0.001), and f (26.532 ± 2.136 VS 32.255 ± 4.013, P < 0.001)] decreased, and D* (20.950 ± 2.273 VS 21.415 ± 1.598, P = 0.131) was not significantly different from those in the control group. ADC, D and f were negatively correlated with the CADI and the α-SMA and vimentin expression levels. CONCLUSION: Intravoxel incoherent motion (IVIM) imaging could detect CAD earlier than creatinine and reflect the degree of fibrosis in grafts quantitatively.

8.
Biomed Pharmacother ; 119: 109432, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521892

RESUMO

OBJECTIVE: Methotrexate (MTX) is a commonly used drug for the treatment of rheumatoid arthritis (RA) and it has been studied in RA resistance recently. P-glycoprotein (P-gp) is one of the important transporters that mediate MTX resistance. This study investigated the effect of Paeoniflorin-6'-O-benzene sulfonate (code: CP-25) in the resistance of P-gp-mediated MTX to RA. METHODS: Adjuvant arthritis (AA) was induced in rats via complete Freund's adjuvant. The experimental groups were divided into normal group; AA model group; monotherapy groups, including CP-25, MTX and dexamethasone; and CP-25 combined with MTX group. The expression of P-gp in synovial tissue was measured by western blot and histochemistry. Besides, P-gp high expression of human hepatoma cell line Bel7402/5-FU and Bel7402 were chose to study in MTX resistance and the function of P-gp was detected by Flow cytometry. RESULTS: CP-25 had a good therapeutic effect on AA rats, significantly improved manifestations and reduced the expression of P-gp in synovial tissue, spleen medulla and small intestinal epithelial cells in the apical tissues of AA rats. In addition, CP-25 significantly inhibited the up-regulation of P-gp induced by TNF-α stimulation in synoviocytes. Furthermore, according to the accumulation and efflux of rhodamine 123 in Bel7402/5-FU resistant cells and Bel7402 sensitive cells, CP-25 could reverse the resistance of MTX in Bel7402/5-FU cells compared with Bel7402 cells, which was reflected by the reduced IC50 values of MTX. Further study indicated that CP-25 could decrease P-gp expression and inhibit P-gp function in Bel7402/5-FU cells. CONCLUSION: CP-25 regulates the expression of P-gp and inhibits the function of P-gp, thereby improving the resistance of MTX.

9.
Sci Rep ; 9(1): 12847, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492915

RESUMO

Internal hernia (IH)-related surgical acute abdomen is not well understood because of the rarity of cases and underdiagnosis. This study was performed to further understand the clinicopathological features and multi-detector computed tomography (MDCT) findings of IH in cases confirmed by surgery. In all, 51 patients with a definite diagnosis of IH confirmed during surgical exploration from Feb. 2012 to Feb. 2018 in our hospital were included in this research. Medical records, including MDCT images and intra-operative findings, were collected retrospectively. In all, 39 and 12 cases were categorized as adhesive IH (76.5%) and non-adhesive IH (23.5%), respectively. Among the patients with adhesive IH, 73% had a history of abdominal or pelvic surgery. Additionally, the mesentery was the most common component of adhesive bands (64.1%). Congenital peritoneal abnormalities and gastrointestinal reconstruction were the main causes of non-adhesive IH.As a specific sign, the fat notch sign was much more common in adhesive IH than in non-adhesive IH (P = 0.023). Bowel wall thickening (P = 0.041), abnormal bowel wall enhancement (P = 0.006) and twisted bowels with the vessel swirl sign (P = 0.004) were indicators of bowel necrosis. Among all of the cases of IH, 34 (66.7%) were complicated by bowel necrosis, and 1 patient died. In conclusion, non-adhesive IH has different clinicopathological features and MDCT findings from those of adhesive IH. MDCT is a useful tool with high sensitivity for confirming IH and may help to guide the early treatment of IH.

10.
Cardiology ; 143(3-4): 136-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476758

RESUMO

IgG4-related disease (IgG4-RD) is a newly recognized but rare entity involving multiple organs, with autoimmune pancreatitis, retroperitoneal mass, and the inflammation of glands being typical in most cases. IgG4-related perivascular lesions, although uncommon, have been increasingly reported in recent years. Diagnosis of IgG4-RD relies on comprehensive consideration of characteristic histopathological and immunostaining results, clinical and imaging findings, and serological results according to several widely recognized diagnostic criteria. This benign disorder frequently presenting tumefactive lesions should be distinguished from malignancy and other inflammatory mimics. Here we report a case of tumefactive mass at the bifurcation of the pulmonary trunk causing stenosis of the proximal left and right pulmonary artery (PA) and resultant pulmonary hypertension (PH). Bypass from the PA trunk to the right branch distal to stenosis was performed to resolve the obstructive hemodynamic disturbance and PH. Glucocorticoid monotherapy was performed after a diagnosis of definite IgG4-RD. Longitudinal disease activity assessment via imaging modalities, serological parameters, and IgG4-RD responder index verified no relapse during follow-up and the validity of the treatment strategy.

11.
Microbiol Res ; 230: 126343, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31539852

RESUMO

Identifying the direct target genes of response regulators (RRs) of a bacterial two-component system (TCS) is critical to understand the roles of TCS in bacterial environmental adaption and pathogenesis. Actinobacillus pleuropneumoniae is an important respiratory bacterial pathogen that causes considerable economic losses to swine industry worldwide. The targets of A. pleuropneumoniae NarP (nitrate/nitrite RR), which is the cognate RR of the nitrate/nitrite sensor histidine kinase NarQ, are still unknown. In the present study, a DNA-affinity-purified sequencing (DAP-Seq) approach was established. The upstream regions of a total of 131 candidate genes from the genome of A. pleuropneumoniae were co-purified with the activated NarP protein. Electrophoretic mobility shift assay (EMSA) results confirmed the interactions of NarP with the promoter regions of five selected target genes, including dmsA, pgaA, ftpA, cstA and ushA. The EMSA-confirmed target genes were significantly up-regulated in the narP-deleted mutant in the presence of additional nitrate, whilst the transcriptional changes were restored in the complemented strain. The NarP binding motif in the upstream regions of the target genes dmsA and ftpA were further identified and confirmed by EMSA using the truncated binding motif. The NarP binding sites were present in a total of 25.2% of the DNA fragments captured by DAP-Seq. These results demonstrated that the established DAP-Seq method is effective for exploring the direct targets of RRs of bacterial TCSs and that the A. pleuropneumoniae NarP could be a repressor in response to nitrate.

12.
Biosens Bioelectron ; 145: 111719, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31563066

RESUMO

Simultaneous detection of free and complexed prostate-specific antigen (f-PSA and c-PSA) is critical to the prostate cancer (PCa) diagnostic accuracy for clinical samples with PSA values in the diagnostic gray zone between 4 and 10 ng mL-1. Herein, red and green magnetic-quantum dot nanobeads (MQBs) with superior magnetic property and high luminescence were fabricated via polyethyleneimine-mediated electrostatic adsorption of numerous quantum dots onto superparamagnetic Fe3O4 magnetic cores, and were conjugated with f-PSA antibody and c-PSA antibody, respectively, as versatile fluorescent probes in test strip for immune recognition, magnetic enrichment, and simultaneous detection of f-PSA and c-PSA analytes in complex biological matrix with t-PSA antibody on the test line. A low-cost and portable smartphone readout device with an application was also developed for the imaging of dual-color test strips and data processing. This assay can simultaneously detect f-PSA and c-PSA with the limits of detection of 0.009 ng mL-1 and 0.087 ng mL-1, respectively. Clinical serum samples of PCa and benign prostatic hyperplasia patients were evaluated to confirm the clinical feasibility. The results suggest that the proposed dual-color MQBs-based fluorescent lateral flow immunoassay is a promising point-of-care diagnostics technique for the accurate diagnosis of PCa even in resource-limited settings.

13.
Clin Biomech (Bristol, Avon) ; 70: 158-163, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31525656

RESUMO

BACKGROUND: The primary anti-rotational stability is critical to preventing cup tilting failure following revision total hip arthroplasty, but is frequently compromised by severe ischial bone loss. A novel technique of "inferior extended fixation" was introduced by securing a porous metal augment into the deficient ischium. This study evaluated the effect of this technique on primary anti-rotational stability in revision total hip arthroplasty. METHODS: Composite hemipelvis specimens, acetabular components and "lotus" augments were used to simulate total hip arthroplasty surgeries. Three different cementless operative settings of cup implantation were simulated: (1) native ischium without defects; (2) ischium with a defect not reconstructed; (3) ischial defect reconstructed with inferior extended fixation using a lotus augment. Lever-out testing was used to examine primary anti-rotational stability, which was measured as interface stiffness and yield moment. FINDINGS: Compared with the native ischium setting, the mean interface stiffness decreased by 53.1% in the ischial defect setting (p < 0.001). In the inferior extended fixation setting, the mean value was 110% greater than that in the ischial defect setting (p = 0.014), and comparable to that in the native ischium setting (p = 1). Similar results were observed for the yield moment (declined by 63.1%, p < 0.001; 200% higher, p < 0.001; and p = 0.395; respectively). INTERPRETATION: In revision total hip arthroplasty with severe ischial defects, inferior extended fixation with a lotus porous titanium augment restores anti-rotational stability of the acetabular component to the level of that with a native ischium, which provides the mechanical environment for bone ingrowth and prevents cup tilting failure.

14.
15.
J Med Chem ; 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31430136

RESUMO

The lysyl oxidase (LOX) family of extracellular proteins plays a vital role in catalyzing the formation of cross-links in fibrillar elastin and collagens leading to extracellular matrix (ECM) stabilization. These enzymes have also been implicated in tumor progression and metastatic disease and have thus become an attractive therapeutic target for many types of invasive cancers. Following our recently published work on the discovery of aminomethylenethiophenes (AMTs) as potent, orally bioavailable LOX/LOXL2 inhibitors, we report herein the discovery of a series of dual LOX/LOXL2 inhibitors, as well as a subseries of LOXL2-selective inhibitors, bearing an aminomethylenethiazole (AMTz) scaffold. Incorporation of a thiazole core leads to improved potency toward LOXL2 inhibition via an irreversible binding mode of inhibition. SAR studies have enabled the discovery of a predictive 3DQSAR model. Lead AMTz inhibitors exhibit improved pharmacokinetic properties and excellent antitumor efficacy, with significantly reduced tumor growth in a spontaneous breast cancer genetically engineered mouse model.

16.
Am J Physiol Cell Physiol ; 317(4): C762-C775, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365297

RESUMO

Compelling evidence indicates that epigenetic regulations orchestrate dynamic macrophage polarization. N6-methyladenosine (m6A) methylation is the most abundant epigenetic modification of mammalian mRNA, but its role in macrophage polarization is still completely unknown. Here, we show that the m6A-catalytic enzyme methyltransferase like 3 (METTL3) is specifically upregulated following the M1 polarization of mouse macrophages. Furthermore, METTL3 knockdown through siRNA transfection markedly inhibited M1, but enhanced M2, macrophage polarization. Conversely, its overexpression via plasmid transfection greatly facilitated M1, but attenuated M2, macrophage polarization. Further methylated RNA immunoprecipitation and in vitro m6A methylation assays suggested that METTL3 directly methylates mRNA encoding signal transducer and activator of transcription 1 (STAT1), a master transcription factor controlling M1 macrophage polarization, at its coding sequence and 3'-untranslated regions. In addition, METTL3-mediated STAT1 mRNA methylation significantly increased mRNA stability and subsequently upregulated STAT1 expression. In conclusion, METTL3 drives M1 macrophage polarization by directly methylating STAT1 mRNA, potentially serving as an anti-inflammatory target.

17.
J Exp Clin Cancer Res ; 38(1): 378, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455359

RESUMO

BACKGROUND: Cripto-1 (CR-1) has been reported to be involved in the development of several human cancers. The potential role of CR-1 in clear cell renal cell carcinoma (ccRCC) is still not clear. METHODS: CR-1 expression was evaluated in ccRCC tissues by Real-time quantitative PCR, Western blot and immunohistochemistry. Serum levels of CR-1 were tested by enzyme-linked immunosorbent assay (ELISA). The clinical significance of CR-1 was analyzed. The effects of CR-1 on cell proliferation, migration, invasion and angiogenesis were investigated in ccRCC cell lines in vitro and in vivo, and markers of the epithelial -mesenchymal transition (EMT) were analyzed. The impact of CR-1 on Wnt/ß-catenin signaling pathway was also evaluated in vitro and in vivo. RESULTS: CR-1 expression was elevated in ccRCC tumor tissues and serum samples. CR-1 expression was correlated with aggressive tumor phenotype and poor survival. Ectopic expression of CR-1 significantly promoted cell proliferation, migration, invasion and angiogenesis whereas knockdown of CR-1 inhibited these activities both in vitro and in vivo. Moreover, we found that CR-1 induced EMT and activated Wnt/ß-catenin signaling pathway both in vitro and in vivo. CONCLUSIONS: These results suggest that CR-1 is likely to play important roles in ccRCC development and progression, and that CR-1 is a prognostic biomarker and a promising therapeutic target for ccRCC.

18.
Opt Lett ; 44(17): 4091-4094, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31465336

RESUMO

A 10-kHz one-dimensional Rayleigh-CH4 Raman instrument capable of achieving highly precise measurement of temperature and methane mole fraction is demonstrated. The system uses a pulse-burst laser as the light source and back-illuminated electron-multiplied CCD cameras as the detectors. The cameras are operated in the subframe burst gating mode, to combine a high sampling rate, low noise, and a slow readout. The improved precision of this configuration is demonstrated by measuring temperature and methane mole fractions in ambient temperature gas mixtures and in a non-premixed inverse diffusion flame.

19.
Endocrine ; 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31422527

RESUMO

PURPOSE: Treatment of space-occupying lesions (SOLs) in the sellar region is a clinical challenge, especially in pregnant women because many treatment decisions are restrained due to pregnancy. We attempt to discuss the surgical indications and timing for pregnant patients and highlight the importance of multidisciplinary team (MDT) treatment. METHODS: From August 2017 to February 2018, four pregnant women were admitted to our hospital with severe visual impairment due to sellar region SOLs, including two cases of tuberculum sellae meningioma, one case of giant pituitary adenoma and one case of a pituitary abscess. All four patients were safely treated by surgery during the second and third trimesters of pregnancy through concerted efforts of the MDT, including a neurosurgeon as the team leader in combination with experts in obstetrics, ophthalmology and endocrinology. RESULTS: The SOLs were removed completely from all four patients, resulting in significantly improved vision without operation-related complications. Pregnancy continued postoperatively to full-term delivery in three of the four patients. The other patient with a pituitary abscess selected to terminate the pregnancy at a gestational age of 20 weeks because of her own concerns. The four babies (including a pair of twins) were born healthy and had developed normally at the 6-week postpartum follow-up. CONCLUSIONS: With the MDT guiding the decision-making process, surgical resection of sellar region SOLs in pregnant women with severe visual impairment is practical to improve the prognosis without affecting the outcomes of pregnancy for either the mother or the infant.

20.
Abdom Radiol (NY) ; 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401677

RESUMO

PURPOSE: To determine the detailed computed tomography angiography (CTA) features of isolated superior mesenteric artery dissection (ISMAD), aiming to improve the current understanding of ISMAD. MATERIALS AND METHODS: We retrospectively analyzed 57 patients with confirmed diagnoses of ISMAD with CTA from June 2011 to June 2018 in our hospital. The superior mesenteric artery (SMA) angle, entry site of dissection, and features of both false and true lumen were analyzed individually. RESULTS: In general, middle-aged men with atherosclerosis (42.1%), hypertension (35.3%), or long-term smoking (33.3%) were the main populations. 80.7% of patients can be discharged successfully after conservative treatment. 87% of patients had a right (or almost right) SMA angle, and the entry site of dissection in 90% of patients occurred in the curved segment of the SMA. As a polymorphic disease, we can use the coded CTA features to delineate individual cases, including cases beyond the presenting classification systems. The diameter of the true lumen is the only different CTA feature between the conservative treatment group and the interventional treatment group (p = 0.000). The re-entry site (p = 0.501), thrombosis in the false lumen (p = 0.135), the distance between the entry site of dissection and SMA root (p = 0.133), and SMA branch involvement (p = 0.322) had no difference between the 2 groups. CONCLUSIONS: Based on CTA analysis, the bending area, especially in the SMA with right or nearly right SMA angle, is the most vulnerable anatomical region for the occurrence of ISMAD. The diameter of true lumen is the determined CTA feature for the decision of treatment. CTA should be recommended as a standardized diagnostic and classification tool for ISMAD.

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