Spontaneous coronary artery dissection in patients with prior psychophysical stress: a systematic review of case reports and case series

BACKGROUND

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event.

METHODS

We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis.

RESULTS

In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138).

CONCLUSION

While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.

In Vitro Anti-tumor Effects of Photodynamic Therapy on Oral Squamous Cell Carcinoma: A Review

Introduction: Due to the increasing prevalence and high mortality rate of oral squamous cell carcinoma (OSCC) and problems with its routine treatments, more recent modalities like photodynamic therapy (PDT) have been developed. PDT effectively destroys tumor cells with minimum side effects. Research on in vitro effects of PDT may be helpful in determining the molecular mechanisms responsible for its effectiveness and can lead to the development of more efficient techniques. The aim of this study was to review the use of PDT in OSCC among in vitro studies. Methods: A literature search for English articles on PDT in OSCC was performed in PubMed, Scopus, Google Scholar, and Web of Science. Data were extracted based on the inclusion/exclusion criteria, which were detailed using the PICO framework: all eligible in vitro studies evaluating the effects of PDT on the viability of OSCC compared to controls without PDT were included. Results: Forty-one out of 567 studies were selected. The tongue was the most common OSCC site, 5-aminolevulinic acid was the most used photosensitizer (PS), cell viability/toxicity and apoptosis were the most evaluated outcomes, and lasers with wavelengths of 600-700 nm were the most common light sources and wavelengths respectively. Conclusion: PDT showed promising effects on reducing the viability of OSCC cells. Cell lines from various sources or even those originating from the same location sometimes responded differently to the same protocol. Considering the favorable results obtained from natural PSs and regarding their additional health-promoting properties, their use in future investigations with different cell lines and light specifications is recommended.