ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.
Objective To explore the key roles of cancer-associated fibroblasts (CAFs) in the pathogenesis, development, therapeutic resistance, and immune microenvironment modulation of colorectal cancer (CRC). MethodsThrough a systematic review of existing literature, this article summarizes the origin and heterogeneity of CAFs, their mechanisms of action in CRC occurrence and progression, and reviews potential CAF-targeting therapeutic strategies. ResultsCAFs are highly heterogeneous cell populations that drive CRC progression by promoting tumor proliferation, invasion, metastasis, angiogenesis, and inducing therapy resistance. Targeting specific CAF subsets or their key signaling pathways has demonstrated significant tumor-suppressive effects in preclinical studies. ConclusionsAs a crucial component of the tumor microenvironment, CAFs play important roles in the development and therapeutic resistance of CRC. Theoretically, CAF-targeting strategies hold great potential for optimizing CRC treatment. However, translating the therapeutic potential of CAFs into clinical practice still faces numerous challenges, primarily due to limited understanding of their origins, functions, and mechanisms of action. Future research needs to further decipher the subtype-specific functions of CAFs to advance the development of precise treatment strategies.