Type A acute aortic dissection (TAAD) is a disease that has a catastrophic impact on a patient's life and emergent surgery represents a key goal of early treatment. Despite continuous improvements in imaging techniques, medical therapy and surgical management, early mortality in patients undergoing TAAD repair still remains high, ranging from 17% to 26%. In this setting, the International Registry of Acute Aortic Dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients. The present review aimed to evaluate and comment on outcomes of TAAD surgery as reported from IRAD series.

AAH8 may be a better alternative than traditional opioid analgesics, producing antinociception with less development of tolerance and dependence and may be less rewarding than morphine.

S45T he morbidity and mortality of acute type B aortic dissection (ABAD) are strongly related to the clinical presentation. 1,2 In contrast to patients with ascending involvement, medical treatment is the preferred therapy in all uncomplicated type B dissection patients, because current randomized controlled trials have failed to demonstrate a beneficial outcome of prophylactic endovascular repair in the shortterm.3,4 Surgical and endovascular approaches are reserved for patients presenting with complications such as shock, periaortic bleeding, organ malperfusion, limb ischemia, and rapidly expanding false lumen. However, these procedures are still associated with high mortality rates between 20% and 30% for surgery and 10% and 20% for endovascular repair in the acute setting, especially in the elderly.3-5 Because of the various clinical features of ABAD, the progress and outcome of individual patients with ABAD admitted to the emergency department remain unpredictable.6-8 Therefore, more insights into the early prognosis of ABAD based on patient characteristics and presenting symptoms are needed to optimize treatment strategies and inform patients and their family. A Background-The outcome of patients with acute type B aortic dissection (ABAD) is strongly related to their clinical presentation. The purpose of this study was to investigate predictors for mortality among patients presenting with ABAD and to create a predictive model to estimate individual risk of in-hospital mortality using the International Registry of Acute Aortic Dissection (IRAD). Methods and Results-All patients with ABAD enrolled in IRAD between 1996 and 2013 were included for analysis.Multivariable logistic regression analysis was used to investigate predictors of in-hospital mortality. Significant risk factors for in-hospital death were used to develop a prediction model. A total of 1034 patients with ABAD were included for analysis (673 men; mean age, 63.5±14.0 years), with an overall in-hospital mortality of 10.6%. In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: increasing age (odds ratio

The opioid receptor system plays a major role in the regulation of mood, reward, and pain. The opioid receptors therefore make attractive targets for the treatment of many different conditions, including pain, depression, and addiction. However, stimulation or blockade of any one opioid receptor type often leads to on-target adverse effects that limit the clinical utility of a selective opioid agonist or antagonist. Literature precedent suggests that the opioid receptors do not act in isolation and that interactions among the opioid receptors and between the opioid receptors and other proteins may produce clinically useful targets. Multifunctional ligands have the potential to elicit desired outcomes with reduced adverse effects by allowing for the activation of specific receptor conformations and/or signaling pathways promoted as a result of receptor oligomerization or crosstalk. In this chapter, we describe several classes of multifunctional ligands that interact with at least one opioid receptor. These ligands have been designed for biochemical exploration and the treatment of a wide variety of conditions, including multiple kinds of pain, depression, anxiety, addiction, and gastrointestinal disorders. The structures, pharmacological utility, and therapeutic drawbacks of these classes of ligands are discussed.