Acute pulmonary edema is relatively uncommon during pregnancy. Due to its easy misdiagnosis or delayed diagnosis, the mortality rate of acute pulmonary edema in the postpartum period is very high. There is limited data in the literature on imaging analysis of acute pulmonary edema in the postpartum period, which may contribute to its misdiagnosis or delayed diagnosis.

This case describes a 28-year-old woman who was admitted to the respiratory intensive care unit with dyspnea that had been misdiagnosed as pneumonia 3 days after delivery.

After careful radiographic imaging analysis and bedside ultrasound monitoring, the patient was finally diagnosed with acute pulmonary edema.

Subsequently, oxygen inhalation, diuresis, human albumin supplementation, and other treatments were administered.

Her symptoms basically disappeared within 1 day, and the patient did not report any discomfort with 7 months of follow-up.

It has highlighted the importance of analyzing radiographic findings in the diagnosis of acute pulmonary edema during the postpartum period in this case. This analysis of radiographic findings requires multidisciplinary consultation between obstetricians and other specialties in the management of maternal health. It also reflects that early diagnosis and timely intervention are key to improving postpartum acute pulmonary edema.

Pulmonary embolism (PE) often presents with symptoms similar to acute coronary syndrome (ACS), making diagnosis challenging. We report a case of a 55-year-old male with hypertension, chronic kidney disease, and hyperuricemia who developed chest pain and shortness of breath. Initial evaluation suggested ACS due to electrocardiogram changes and elevated cardiac biomarkers. However, coronary angiography (CAG) showed no significant stenosis, prompting further diagnostic workup. Computed tomography pulmonary angiography (CTPA) confirmed PE, likely secondary to deep vein thrombosis (DVT) in the right lower extremity. The patient was treated with an inferior vena cava (IVC) filter and thrombus aspiration, followed by anticoagulation therapy. This case highlights the critical need to differentiate PE from ACS and emphasizes the importance of a multidisciplinary approach in managing thromboembolic events to ensure optimal patient outcomes.

Gender may contribute significantly to the variation in prognostic aspects and outcomes in various clinical conditions. We reviewed original studies to determine the impact of gender on the clinical outcomes in patients with pulmonary embolism.

A systematic review and meta-analysis synthesizing observational studies was conducted by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane through April 12, 2023. We reported dichotomous outcomes using risk ratio (RR) and the corresponding 95% confidence interval (CI).

We included 18 studies with a total of 1,339,937 patients. There was no difference between men and women for all-cause mortality (RR: 0.99; 95% CI [0.89, 1.10]; P = 0.81), in-hospital mortality (RR: 0.94; 95% CI [0.88, 1.02]; P = 0.13), PE-related mortality (RR: 0.86; 95% CI [0.68, 1.09]; P = 0.21), and recurrence (RR: 1.00; 95% CI [0.82, 1.22]; P = 0.99). However, the major bleeding rate was significantly higher among women (RR: 0.69; 95% CI [0.48, 0.98]; P = 0.04), as was hospital length of stay (mean difference: -0.29; 95% CI: [-0.36, -0.22], P < 0.00001; I2= 96%). Also, there was no difference between men and women regarding catheter-directed thrombolysis (RR: 0.96; 95% CI [0.81, 1.14]; P = 0.66) and risk of heparin infusion (RR: 1.00; 95% CI [0.95, 1.04]; P = 0.90).

There was no difference between men and women for the clinical outcomes and management of PE. However, women undergoing treatment for pulmonary thromboembolic disease had a significantly higher risk of major bleeding and longer length of stay compared to men. Further research is required to investigate the reasons behind these differences and assess their potential impact on patient management and prognosis.

Pulmonary embolism (PE) is a rare but devastating complication of shoulder surgery. Apart from increased morbidity and mortality rates, it may significantly impair postoperative recovery and functional outcome. Its frequency accounts for up to 5.7% of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years. It is most commonly associated with thrombophilia, diabetes mellitus, obesity, smoking, hypertension, and a history of malignancy. PE usually occurs secondary to upper or lower-extremity deep vein thrombosis (DVT). However, in rare cases, the source of the thrombi cannot be determined. Prophylaxis for PE following shoulder surgery remains a topic of debate, and the standard of care does not routinely require prophylactic medication for DVT prophylaxis. Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin, low-molecular-weight heparin, and vitamin K antagonists are indicated for high-risk patients, long-lasting operations, or concomitant severe acute respiratory syndrome coronavirus 2 infection. The most common symptoms of PE include chest pain and shortness of breath, but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia. Patients with DVT may also present with swelling and pain of the respective extremity. The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable, respectively. Hemodynamic instability may require transfer to the intensive care unit, and cardiovascular arrest can be implicated in fatal events. An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay. Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.

Positive airway pressure (PAP) therapy is widely used to manage both acute and chronic respiratory failure and plays an increasingly important role in cardiology, particularly in treating patients with respiratory comorbidities. PAP, including continuous positive airway pressure and noninvasive ventilation, significantly impacts hemodynamics by altering intrathoracic pressure, affecting preload, afterload, and stroke volume. These changes are crucial in conditions such as acute cardiogenic pulmonary edema, where PAP can enhance gas exchange, reduce the work of breathing, and improve cardiac output. PAP reduces the left ventricular afterload, which in turn increases stroke volume and myocardial contractility in patients with left-sided heart failure. However, the role of PAP in right ventricular function and its effects on venous return and cardiac output are critical in the cardiac intensive care setting. While PAP provides respiratory benefits, it must be used cautiously in patients with right heart failure or preload-dependent conditions to avoid adverse outcomes. Additionally, in recent years, the use of PAP has expanded in the treatment of severe obstructive sleep apnea and obesity hypoventilation syndrome, both of which significantly influence cardiovascular events and heart failure. This review provides an in-depth analysis of the hemodynamic effects of PAP in cardiovascular disease, focusing on its impact on ventricular function in both acute and chronic conditions. Evaluating clinical studies, guidelines, and recent advancements offers practical insights into the physiological mechanisms and key clinical considerations. Furthermore, this review aims to serve as a helpful guide for clinicians, assisting in decision-making processes where PAP therapy is applied.

Resorbable medical devices provide temporary functionality before degrading into safe byproducts. One application is absorbable inferior vena cava filters (IVCFs), which prevent pulmonary embolism in high-risk patients with contraindications to anticoagulants. However, current absorbable IVCFs are limited by radiolucency and local clot formation risks. This study aimed to develop radiopaque, drug-loaded resorbable IVCFs with enhanced imaging and therapeutic capabilities. Poly-p-dioxanone (PPDO) sutures were infused with gadolinium nanoparticles (GdNPs) and dipyridamole (DPA), an anti-thrombotic agent. GdNPs were synthesized with an average diameter of 35.76 ± 3.71 nm. Gd content was 371 ± 1.6 mg/g (PPDO-Gd) and 280 ± 0.3 mg/g (PPDO-Gd + DPA), while the DPA content was 18.20 ± 5.38 mg/g (PPDO-DPA) and 12.91 ± 0.83 mg/g (PPDO-Gd + DPA). Suture thickness (0.39-0.49 cm, p = 0.0143) and melting temperature (103.61-105.90, p = 0.0002) statistically differed among the different groups, while load-at-break did not (4.39-5.38, p = 0.2367). Although suture thickness and melting temperatures differed significantly, load-at-break was preserved and did not alter the mechanical and degradation properties of the various IVCFs. Micro-computed tomography revealed enhanced radiopacity for Gd-containing IVCFs (2713 ± 105 HU for PPDO-Gd, 1516 ± 281 HU for PPDO-Gd + DPA). Radiopacity decreased gradually over 10-12 weeks. Clot-trapping efficacy was maintained, and no hemolysis or cellular toxicity was observed. In conclusion, the GdNP- and DPA-infused PPDO IVCFs demonstrated improved radiopacity, anti-thrombotic potential, and compatibility with routine imaging, without compromising mechanical strength or safety.

Hereditary antithrombin deficiency, an autosomal-dominant thrombotic disease caused by a SERPINC1 gene deficiency, is extremely rare, although it is the leading cause of hereditary thrombophilias. Herein we report a novel SERPINC1 gene mutation in a Chinese family and one case of pulmonary embolism associated with the mutation. We also discuss the latest diagnostic and treatment strategies for antithrombin deficiency.

The 33-year-old Chinese male proband had a pulmonary embolism and there was no evidence of thromboembolism in the other family members. In the pulmonary embolism case, treatment with nadroparin calcium combined with warfarin failed; however, rivaroxaban was effective. No emboli were evident in the follow-up computed tomography pulmonary angiography. Antithrombin activity fluctuated approximately 50% during hospitalization and follow-up. The antithrombin activity of the proband, his 58-year-old father, and his 5-year-old son was significantly low (44-48%). A novel missense variant c.1148 T > A (p.L383H) in the SERPINC1 gene was identified in these three family members. The pathogenesis predictions from Mutation-Taster, Provean, and SIFT were "disease-causing," "deleterious," and "damaging," respectively.

The novel c.1148 T > A (p.L383H) pathogenic mutation in the SERPINC1 gene updated the gene mutation spectrum of hereditary antithrombin deficiency. Direct oral anticoagulation with rivaroxaban may be a more effective and selective anticoagulant in patients with hereditary antithrombin deficiency over warfarin or heparin.

Acute pulmonary embolism represents the third most prevalent cardiovascular pathology, following coronary heart disease and hypertension. Its untreated mortality rate is as high as 20-30%, which represents a significant threat to patient survival. In view of the current lack of real-time monitoring techniques for acute pulmonary embolism, this study primarily investigates the potential of the pulsatility electrical impedance tomography (EIT) technique for the detection and real-time monitoring of acute pulmonary embolism through the collection and imaging of the pulsatile signal of pulmonary blood flow.

A before-and-after self-control experiment was conducted on anaesthetised domestic pigs (N = 12, 20.75 ± 2.56 kg). The changes in pulmonary perfusion caused by an acute pulmonary embolism (artificially induced) were monitored in real time using the pulsation method. This enabled the extraction of indicators such as Amplitude, Forward (Negative) Slope, and SARC, which were used to assess the local pulmonary blood flow perfusion state. Furthermore, the degree of ventilation/perfusion matching in the lungs was evaluated concurrently with the analysis of the pulmonary ventilation area. Subsequently, a control verification was conducted utilising the conventional invasive hypertonic saline (5 ml 10% NaCl) contrast technique.

The perfusion alterations subsequent to embolism in the pulsatility method are highly concordant with those observed in the hypertonic saline method, as evidenced by the imaging and indicator data. In particular, the perfusion area on the side of the embolism is markedly diminished, and the absolute values of all perfusion indicators are significantly reduced. Among these, Amplitude (P < 0.001) and SARC (P < 0.001) exhibit the most pronounced alterations. Furthermore, the extracted indicators from regional ventilation demonstrated notable discrepancies, the V/Q match% (P < 0.001) and Dead Space% (P < 0.001) exhibited the most pronounced sensitivity to alterations in acute pulmonary embolism. Subsequently, a control verification was conducted utilising the hypertonic saline method, which revealed a high degree of consistency between the two methods in the detection of acute pulmonary embolism (Kappa = 0.75, P < 0.05).

The EIT imaging method, which is based on the analysis of blood flow pulsation, has the potential to reflect in real time the changes in pulmonary blood flow that occur before and after an embolism. This provides a new avenue for the non-invasive real-time monitoring of patients with acute pulmonary embolism in a clinical setting.

Acute pulmonary thromboembolism (PTE) is one of the leading causes of death and severe disability. Considering the impact of inflammation and lipid profile on prevalence and prognosis of deep vein thrombosis and PTE, this study was conducted to assess the predictive value of lipid-to-neutrophil count ratios for the short-term survival of PTE patients.

This study is an analytical cross-sectional study. Data regarding the demographics, past medical history, vital signs, laboratory variables, and the outcomes of hospitalization were gathered from the Tabriz PTE registry. The receiver operating characteristics (ROC) curve and area under curve (AUC) were utilized for assessing the prognostic values. SPSS 26 was used for all of the statistical analysis.

The population of this analytical cross-sectional study consists of 547 PTE patients of which 41 patients (7.5%) died during hospitalization. There was a significant difference between death and survived groups regarding cholesterol (146.00[60.50] vs. 165.50[59.75]; p-value<0.01), LDL (80.00[48.00] vs. 102.00[52.00]; p-value<0.01), HDL (31.00[19.00] vs. 35.00[14.00]; p-value=0.04). Cholesterol/neutrophil*1000 with a cut-off value of 22.014 (sensitivity: 56.7%; specificity: 61.3%), LDL/neutrophil*1000 with a cut-off value of 10.909 (sensitivity: 69.3%; specificity: 51.9%) and HDL/neutrophile *1000 with a cut-off value of 4.150 (sensitivity: 61.9%; specificity: 58.1%) can predict short-term survival in patients with acute PTE.

Based on our findings, patients with higher cholesterol/neutrophil, LDL/neutrophil, and HDL/neutrophil ratios have a better in-hospital prognosis and measurement of lipid-to-neutrophil ratio in the first 24 hours of hospitalization may be a valuable marker for determining the early prognosis of PTE. However, additional clinical studies are suggested for a more definitive conclusion.

This study aimed to investigate the role of Nuclear Protein 1 (NUPR1) in pulmonary embolism (PE) and its impact on the phenotypic transformation of pulmonary artery smooth muscle cells (PASMCs).

A PE model was established via autologous pulmonary emboli infusion into the jugular vein. Partial Pressure of Oxygen (PaO2), Oxygenation Index (OI), Brain Natriuretic Peptide (BNP), and Troponin I (TnI) were measured, and lung tissue was subjected to hematoxylin-eosin (HE) staining. NUPR1 expression was assessed through Immunofluorescence and Western blot analyses. To investigate role of NUPR1, PE rats were treated with lentiviral vectors for NUPR1 knockdown (si-NUPR1) or overexpression (ov-NUPR1), and the effects on lung pathology were examined. NUPR1 expression was evaluated in human PASMCs. Additionally, PASMCs from SD rats were cultured under normoxic and hypoxic conditions to evaluate NUPR1 expression. Transfection of NUPR1 expression vectors into PASMCs allowed monitoring of phenotypic transformation-associated protein changes and PASMCs activity.

Increased NURP1 was observed in human-derived PASMCs. In PE rats, histological examination revealed ruptured pulmonary alveoli, exudate accumulation, interstitial edema, and infiltration of inflammatory cells, concomitant with elevated NUPR1 expression levels. Knockdown of NUPR1 in PE rats significantly improved lung tissue structure, reducing alveolar rupture and interstitial edema. Conversely, NUPR1 overexpression exacerbated lung damage, leading to increased inflammatory infiltration. NUPR1 expression in rat PASMCs remained stable under normoxic conditions; however, under hypoxic conditions, NUPR1 protein expression increased progressively over time. Subsequent upregulation of NUPR1 expression led to a decrease in the levels of contractile phenotype markers α-SMA and SM22α in PASMCs, accompanied by increased expression of synthetic phenotype markers Vimentin and OPN. This phenotypic shift was associated with enhanced cellular proliferation, invasion, and migration.

Elevated NUPR1 expression in PE exacerbates abnormal PASMCs proliferation by promoting their phenotypic transformation, thereby fostering the pathological progression of PE.

This study aimed to establish the prevalence of pulmonary embolism (PE) in chronic obstructive pulmonary disease (COPD) patients with secondary polycythemia (SP) and explore the risk factors for PE in COPD patients with SP.

We analyzed the prevalence of PE among COPD patients with SP who were hospitalized at Qinghai Provincial People's Hospital between January 2015 and December 2020. From January 2021 to January 2024, we enrolled patients into three groups (COPD+SP+PE, COPD+SP, and control) and performed laboratory measurements, biomarkers, echocardiography, and pulmonary function tests. Patients in the COPD+SP group received clinical treatment, and biomarkers were measured again seven days after treatment.

The prevalence of PE in patients with COPD SP was 5.21%. We found that COPD+SP+PE group had significantly higher levels of erythrocyte distribution width (RDW), platelet volume distribution width (PDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte to large platelet ratio (MLPR), 5-hydroxytryptamine (5-HT), activated protein C (APC), urokinase-type plasminogen activator (u-PA), thrombomodulin (TM), interleukin-38 (IL-38), tissue factor (TF), and fractalkine (FKN) in contrast to COPD+SP group. Biomarkers, such as FKN, β-thromboglobulin (β-TG), APC, u-PA, TM, TF, and IL-38, were risk factors for COPD patients with SP who are complicated by PE. Clinical treatment significantly reduced the levels of β-TG, IL-38, APC, endothelin-1 (ET-1), u-PA, FKN, TM, 5-HT, and neutrophil extracellular traps (NETs) in patients with COPD+SP.

PE incidence was significantly higher in patients with COPD and SP. In COPD patients with SP, routine joint detection of blood and cardiac markers, blood gas analysis, and pulmonary function tests can help to identify patients with PE. APC, u-PA, TF, FKN, TM, and IL-38 are risk factors for PE in patients with COPD and SP, and clinical treatment can effectively reduce this risk.

Pulmonary embolism is a common cause of morbidity and mortality. Numerous risk factors have been identified that predispose patients to this disease. This study aims to identify these risk factors and the possible outcomes (recovery or mortality) after receiving treatment from any hospital. Healthcare is expensive in Africa, hence hindering its easy accessibility.  PubMed, Scopus, and African Journals Online were searched from the database inception to October 2024 to identify relevant studies. A total of 719 articles were identified, for which 172 duplicate articles were removed. After screening 592 articles by title and abstract, 508 were excluded. Eighty-four articles were screened by full text to determine their eligibility. Finally, 13 articles were used in the final qualitative analysis. We included original research published in English in peer-reviewed journals from January 2000 to September 2024 that reported the risk factors and outcomes of pulmonary embolism, and studies that used computed tomography pulmonary angiography as a diagnosis of acute pulmonary embolism in patients more than 18 years old, irrespective of gender and medical or surgical condition, managed in any African hospital, were included. In total, 7650 patients were included in 13 articles, from 10 countries (Nigeria, Togo, Angola, Kenya, Cameroon, South Africa, Sierra Leone, Egypt, DR Congo, and Ethiopia), and 861 patients had pulmonary embolism. The mean age of the reported patients ranged from 40.8 to 64.4 years across the studies. There were 309 male and 552 female patients diagnosed with pulmonary embolism. The study types included in this review are retrospective studies, cross-sectional studies, and case-control studies. Deep vein thrombosis (DVT), heart disease, immobilization, obesity, smoking, recent surgery, and malignancy were the most commonly identified risk factors across the included articles. Pulmonary embolism contributes significantly to morbidity and mortality among African patients, with key risk factors including DVT, immobilization, heart disease, obesity, smoking, recent surgery, malignancy, pregnancy, and contraceptive use. Limited diagnostic resources in low-resource settings pose a major challenge, but adopting affordable diagnostic alternatives and clinical algorithms could improve outcomes by enabling earlier diagnosis and timely treatment. The availability and implementation of a standardized PE treatment protocol will ensure quality care, decrease mortality, and increase recovery rates.

Objectives: To evaluate the prognostic utility of CT-imaging-derived biomarkers in distinguishing acute pulmonary embolism (PE) resolution and its progression to chronic PE, as well as their association with clot burden. Materials and Methods: We utilized a cohort of 45 patients (19 male (42.2%)) and 96 corresponding CT scans with exertional dyspnea following an acute PE. These patients were referred for invasive cardiopulmonary exercise testing (CPET) at the University of Pittsburgh Medical Center from 2018 to 2022, for whom we have ground truth classification of chronic PE, as well as CT-derived features related to body composition, cardiopulmonary vasculature, and PE clot burden using artificial intelligence (AI) algorithms. We applied Lasso regularization to select parameters, followed by (1) Ordinary Least Squares (OLS) regressions to analyze the relationship between clot burden and the selected parameters and (2) logistic regressions to differentiate between chronic and resolved patients. Results: Several body composition and cardiopulmonary factors showed statistically significant association with clot burden. A multivariate model based on cardiopulmonary features demonstrated superior performance in predicting PE resolution (AUC: 0.83, 95% CI: 0.71-0.95), indicating significant associations between airway ratio (negative correlation), aorta diameter, and heart volume (positive correlation) with PE resolution. Other multivariate models integrating demographic features showed comparable performance, while models solely based on body composition and baseline clot burden demonstrated inferior performance. Conclusions: Our analysis suggests that cardiopulmonary and demographic features hold prognostic value for predicting PE resolution, whereas body composition and baseline clot burden do not. Clinical Relevance: Our identified prognostic factors may facilitate the follow-up procedures for patients diagnosed with acute PE.

The association between uric acid and pulmonary embolism(PE) remains controversial, and there has been limited investigation into how uric acid influences pulmonary embolism across different age groups. Our study aimed to elucidate the relationship between uric acid levels and pulmonary embolism, considering variations across age groups.

A total of 368 patients who underwent computed tomography pulmonary angiography from July 2018 to May 2022 were included in the analysis. Subsequently, the cohort was stratified by age, with separate univariate and multivariate logistic regression analyses conducted for the elderly (aged ≥ 60 years) and non-elderly (aged < 60 years), respectively.

The study revealed that patients with PE exhibited higher uric acid levels compared to those without (325.11 ± 137.02 vs. 298.26 ± 110.54 (umol/l), p = 0.039). This disparity persisted even after adjusting for multiple confounders (OR = 1.002, 95% CI 1.000-1.005, p = 0.042). Additionally, a notable age difference was observed between PE and non-PE patients (65.7 ± 16.12 vs. 61.42 ± 15.03 (umol/l), p = 0.009). Subsequently, upon age stratification, significant differences (p < 0.05) in serum uric acid were noted between PE and non-PE patients in both elderly and non-elderly populations. However, elevated uric acid levels were independently associated with PE only in the elderly following adjustment for multiple confounders (OR = 1.003, 95% CI 1.001-1.005, p = 0.008).

High uric acid levels are an independent risk factor for pulmonary embolism in the elderly (≥ 60 years).

Both acute coronary syndrome (ACS) and pulmonary embolism (PE) are life-threatening medical emergencies with overlapping symptoms and laboratory findings. Differentiating these two emergencies and initiating proper treatment are of paramount importance for good outcomes. In this report, we present the case of a 60-year-old male with a history of seizure disorder and hyperlipidemia, who presented to the emergency department (ED) after a syncopal episode preceded by three days of brief episodes of chest pain. In the ED, the initial electrocardiogram (EKG) showed normal sinus rhythm with T wave inversions in the anterior leads, and elevated high-sensitivity troponin levels peaked at 58 ng/mL before declining to 38 ng/mL. Elevated lactic acid and anion gap suggested a seizure, and the patient was discharged after lab tests and clinical status normalized. The patient returned the next day with recurrent syncope, and this time troponin levels were significantly elevated to 151 ng/mL, with a pro-BNP (brain natriuretic peptide) of 1,705 pg/mL. The patient was admitted with an initial diagnosis of ACS. The initial evaluation, including chest X-ray and EKG, was unremarkable. However, echocardiography revealed an interesting finding of right ventricular free wall akinesia with sparing of the apex-McConnell's sign-suggestive of PE, which significantly changed the diagnostic approach. PE was later confirmed by computed tomography angiography. This case highlights the critical role of echocardiography in distinguishing PE from ACS, especially in emergency care settings in patients with atypical and rare presentations.

Deep vein thrombosis (DVT) affects vascular health and can even threaten life; however, its pathogenesis remains unclear. Cardiovascular disease (CVD) and DVT share common risk factors, such as dyslipidemia, aging, etc. We aimed to investigate the loci of published CVD susceptibility genes and their association with environmental factors that might be related to DVT. Genotyping by Kompetitive Allele Specific PCR (KASP), collection of lifestyle information, and determination of blood biochemical markers were performed in 165 DVT cases and 164 controls. The impact of six single nucleotide polymorphisms (SNPs) and additional potential variables on DVT morbidity was evaluated using unconditional logistic regression (ULR). To explore the high-order interactions related to genetics and the body's internal environment exposure that affect DVT, ULR, crossover analysis, and multifactor dimensionality reduction/generalized multifactor dimensionality reduction (MDR/GMDR) were employed. Sensitivity analyses were performed using the EpiR package. The polymorphisms of FGB rs1800790 and PLAT rs2020918 were significantly associated with DVT. The optimum GMDR interaction model for gene-gene (G × G) consisted of THBD rs1042579, PLAT rs2020918, and PON1 rs662. The PLAT rs2020918 and MTHFR rs1801133 polymorphisms together eliminated the maximum entropy by the MDR method. The optimum GMDR interaction model for gene-environment (G × E) consisted of MTHFR rs1801133, FGB rs1800790, PLAT rs2020918, PON1 rs662, and total homocysteine (tHcy). Those with high tHcy levels and three risk genotypes significantly increased the DVT risk. In conclusion, certain CVD-related SNPs and their interactions with tHcy may contribute to DVT. These have implications for investigating DVT etiology and developing preventive treatment plans.

Pulmonary embolism (PE) is a potentially fatal condition. Several non-invasive clinical decision rules (CDRs) were developed for the safe exclusion of PE. All CDRs used to safely rule out PE have been created and tested within hospital or acute care environments. However, CDRs that are designed in one specific setting may not perform as effectively when used in a different setting. In this study, we aimed to compare the performance of four common CDRs; Wells Score, Simplified Wells Score, revised Geneva Score, and simplified revised Geneva Score.

This was a cross-sectional study in which patients suspected of PE presenting to Imam Reza Hospital or Ghaem Hospital were recruited from September 23, 2013, to March 19, 2016 in Mashhad, Iran. The specificity, sensitivity, and accuracy were utilized as metrics to compare the CDRs in our region.

Two hundred and forty patients were included in the study. The mean age of patients was 57.91±19.97 years, and 54.16% of them (n=130) were female. 120 patients were confirmed to have PE with CT angiography. Wells score showed the highest sensitivity (90.4%) and revised Geneva score represented the highest specificity (84.9%). The highest accuracy belongs to the simplified Wells score (62.3%).

In this study, we demonstrated that the Wells criteria with its high sensitivity, can be used as a score for screening, and the revised Geneva score with its high specificity, can be used in the second stage for healthy people who have been diagnosed as unhealthy by the Wells score.

Acute pulmonary embolism (APE) is a major type of venous thromboembolism (VTE) with a high risk of mortality and disability. There is a lack of biomarkers for APE to indicate deteriorating development and predict adverse outcomes. This study evaluated the significance of miR-150-5p in APE aiming to explore a novel potential biomarker for APE.

The study enrolled APE (n = 137) and deep wein thrombosis (DVT, n = 67) patients and collected plasma samples from all study subjects. The expression of miR-150-5p was analyzed by PCR and its significance in screening APE and pulmonary arterial hypertension (PAH) was assessed by receiver operating curve (ROC) and logistic analyses. The study established oxidized low-density lipoprotein (ox-LDL)-induced human venous endothelial cells (HUVECs). Through cell transfection combined with cell counting kit-8 (CCK8), flow cytometry, and enzyme-linked immunosorbent assay (ELISA), the effect of miR-150-5p on ox-LDL-induced HUVEC injury was evaluated.

Significant downregulation of miR-150-5p was observed in the plasma of APE patients compared with DVT patients (P < 0.0001). The plasma miR-150-5p levels in APE patients occurred PAH was much lower than in patients without PAH (P < 0.0001). Reducing miR-150-5p distinguished APE patients from DVT patients (AUC = 0.912) and was identified as a risk factor for the occurrence of PAH in APE patients (OR = 0.385, P = 0.010). In HUVECs, oxidized low-density lipoprotein (ox-LDL) caused inhibited cell proliferation, enhanced apoptosis, increased pro-inflammatory cytokines, reactive oxygen species (ROS), malondialdehyde (MDA), and decreased superoxide dismutase (SOD). Overexpressing miR-150-5p could promote proliferation, inhibit apoptosis, and alleviate inflammation and oxidative stress of ox-LDL-treated HUVECs.

Downregulated plasma miR-150-5p served as a diagnostic biomarker for APE and predicted the predisposition of PAH in APE patients. Overexpressing miR-150-5p could alleviate ox-LDL-induced endothelial cell injury in HUVECs.

The primary clinical manifestation of venous thrombosis is discomfort in the lower extremities. Some early Parkinson's disease (PD) patients feel discomfort in the lower limbs. Venous thrombosis can risk lives by causing pulmonary embolism. This study examines the incidence of DVT in early PD patients and its correlation with different clinical and lab features.

A cross-sectional study was conducted on 117 patients with early-stage PD. Ultrasonography was employed to detect the presence of DVT. Factors such as age, gender, body mass index, lifestyle habits (smoking and drinking), medical history (hypertension, diabetes, atrial fibrillation, and tumor), and other lab tests linked to thrombosis were analyzed.

In 117 patients, 11 (9.4%) had DVT, while 106 (90.6%) did not. There were no significant differences in gender, BMI, habits, medical history, or other thrombosis-related tests between both groups. However, DVT patients were older with higher d-dimer levels. They also showed an increased right substantia nigra ultrasound echo area, higher HY grades, higher UPDRS 3 scores, less improvement in UPDRS 3 scores and levodopa response.

The primary risk factors for lower extremity venous thrombosis were found to be age, d-dimer levels, and low-dose levodopa. Therefore, for elderly patients with early-stage PD, it is crucial to conduct d-dimer and lower extremity vascular ultrasound tests. The prevention of venous thrombosis in the lower extremities of early PD patients is of utmost importance.

Computed tomography pulmonary angiography (CTPA) simplifies the diagnosis of pulmonary embolism (PE) but is not suitable for all patients. Transthoracic lung ultrasound (LUS) is a potential alternative; this meta-analysis evaluates its accuracy for diagnosing PE.

We systematically searched PubMed, Embase and Cochrane Library from the inception of each database up to April 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies guidelines. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and a bivariate random effects model was used to pool sensitivity and specificity.

A total of 18 studies with 2158 patients were analyzed. Lung ultrasound showed a sensitivity of 0.80 (95 %, confidence interval (CI): 0.71-0.86; I2 = 85.2 %) and specificity of 0.87 (95 %, CI: 0.81-0.92; I2 = 87.3 %). The diagnostic score was 3.27 (95 %, CI: 2.75-3.78; I2 = 61.9 %), and the diagnostic odds ratio was 26 (95 %, CI: 16-44; I2 = 100.0 %). The pooled positive likelihood ratio was 6.2 (95 %, CI: 4.2-9.1; I2 = 79.2 %), and the negative likelihood ratio was 0.24 (95 %, CI: 0.16-0.34; I2 = 83.7 %). The summary area under the curve was 0.91 (95 %, CI: 0.88-0.93). Significant heterogeneity was observed, which may impact the generalisability of the results, and no publication bias was detected.

Transthoracic LUS shows potential as an alternative to CTPA for PE diagnosis, but further research is needed to improve its accuracy and establish standardised diagnostic criteria. The observed heterogeneity highlights the need for a cautious interpretation of the results.

Pulmonary embolisms are serious complications that can arise from surgical procedures involving the extremities due to the risk of deep vein thrombosis (DVT) and subsequent embolism. This life-threatening condition occurs when an embolus lodges at the bifurcation of the main pulmonary arteries, compromising blood flow to the lungs. Treatment options for pulmonary embolism primarily include anticoagulation therapy, thrombolysis, thrombectomy, and inferior vena cava (IVC) filter placement. Given that cases of saddle pulmonary embolism are rare but potentially fatal, healthcare providers must maintain a high index of suspicion and implement rigorous preventive measures to mitigate the risk in surgical patients.

The hemostatic system is characterized by a delicate balance between pro- and anticoagulant forces, and the smallest alteration can cause serious events such as hemorrhages or thrombosis. Although exercise has been shown to play a protective role in athletes, several factors may increase the risk of developing venous thromboembolism (VTE), including hemoconcentration induced by exertion, immobilization following sports injuries, frequent long-distance flights, dehydration, and the use of oral contraceptives in female athletes. Biomarkers such as D-dimer, Factor VIII, thrombin generation, inflammatory cytokines, and leukocyte count are involved in the diagnosis of deep vein thrombosis (DVT), although their interpretation is complex and may indicate the presence of other conditions such as infections, inflammation, and heart disease. Therefore, the identification of biomarkers with high sensitivity and specificity is needed for the screening and early diagnosis of thromboembolism. Recent evidence about the correlation between the intensity of physical activity and VTE is divergent, whereas the repeated gestures in sports such as baseball, hockey, volleyball, swimming, wrestling, or, on the other hand, soccer players, runners, and martial art training represent a risk factor predisposing to the onset of upper and lower DVT. Anticoagulant therapy is the gold standard, reducing the risk of serious complications such as pulmonary embolism. The aim of this review is to provide a general overview about the interplay between physical exercise and the risk of thromboembolism in athletes, focusing on the main causes of thrombosis in professional athletes and underlying the need to identify new markers and therapies that can represent a valid tool for safeguarding the athlete's health.

This paper presents a case of a 63-year-old female patient who was initially misdiagnosed with mycoplasma pneumonia due to symptoms such as chest pain, hemoptysis, and fever, but was later confirmed to have pulmonary thromboembolism (PTE) through further examination. This case highlights the similarities between PTE and pneumonia in terms of symptoms, as well as the complexity of PTE diagnosis. The article provides a detailed description of the patient's medical history, symptoms, examination process, and treatment outcomes. Furthermore, it discusses the possible reasons for the misdiagnosis, including insufficient awareness of PTE among physicians, lack of in-depth investigation into the causes of abnormally elevated D-dimer levels, the non-specific clinical manifestations of PTE, and the concerns of the patient's family regarding pulmonary artery CTA examination. Additionally, the article emphasizes the importance of clinicians in improving their ability to differentiate and diagnose PTE, rationally utilizing clinical examination methods, and ensuring timely diagnosis and treatment of PTE.

 Given the current debate in clinical research about the relationship between tobacco smoking and the risk of venous thromboembolism (VTE), a Mendelian randomization (MR) study was conducted aimed at elucidating the causal associations of current and past tobacco smoking with the risk of VTE, from the perspective of genetics.

 Two-sample univariate and multivariable MR analyses were designed, using summary-level data from large genome-wide association studies involving European individuals. Causality was primarily assessed using multiplicative fixed-effects or random-effects model and inverse variance weighting, supplemented by MR-Egger regression, MR-PRESSO, Cochran's Q test, and leave-one-out for sensitivity analysis to test the reliability of the results.

 In the univariate MR analysis, no significant causal effects were found between current tobacco smoking and the risk of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE). Similarly, no significant causal effects were found between past smoking and VTE, DVT, and PE. As for the multivariable MR analysis, results were consistent with univariate MR analysis, with no significant causal effect of either current or past tobacco smoking on the risk of VTE, DVT, and PE.

 Evidence from both univariate and multivariable MR analyses demonstrated no significant causal relationships between current and past tobacco smoking and VTE, DVT, and PE. This contradicts positive correlations reported in some previous observational studies, which may be explained by other confounding factors. This provided genetic evidence for the conclusion reported in other observational studies that smoking did not affect VTE risk.

Systemic thrombolysis (ST) may not be ideal for many patients with acute pulmonary embolism (PE) due to bleeding risk. In this analysis, we evaluated the safety and effectiveness of mechanical thrombectomy (MT) as an alternative to ST for acute PE.

Patients aged ≥18 years who underwent MT and/or ST for PE were identified from the National Inpatient Sample database from 2016 to 2017. Patients who underwent catheter-directed thrombolysis were excluded. We compared in-hospital outcomes of both groups in this retrospective study.

Of 16 890 patients who received an intervention for acute PE, 1380 (8.2%) received MT and 15 510 (91.8%) received ST. There was no difference in age between both groups. In-hospital mortality was significantly lower in patients who received MT than that in those who received ST (11.9% vs 20.6%, odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.29-0.93, p=0.028). There was no statistically significant difference in terms of periprocedural bleeding, intracranial hemorrhage, and acute kidney injury between the 2 groups (p≥0.608 for all). Patients who received MT had a higher rate of respiratory complications (19.0% vs 11.6%, OR: 1.79, 95% CI: 1.06-3.03, p=0.030) and discharge to an outside facility (34.1% vs 19.2%, OR: 2.18, 95% CI: 1.41-3.37, p<0.001) than those who received ST.

Mortality was significantly lower with MT than that with ST, but larger randomized studies are needed to validate this. The use of MT should be individualized on the basis of the patients' clinical presentation, risk profile, and local resources.

In this study, we utilized the National Inpatient Sample database to study the in-hospital outcomes of pulmonary embolism patients who underwent mechanical thrombectomy compared to those who underwent systemic thrombolysis. We found that the patients who were diagnosed with pulmonary embolism and underwent mechanical thrombectomy had significantly lower mortality compared to those who were treated using systemic thrombolysis. This study was the first of its kind, utilizing the national inpatient sample database for evaluation of mechanical thrombectomy in comparison with the standard of care. These result would direct further randomized controlled trials for better evaluation of the utilization of mechanical thrombectomy in the correct clinical context. Furthermore, our study demonstrated comparable peri-operative complications between the mechanical thrombectomy group and the systemic thrombolysis group. These results would direct clinicians to consider mechanical thrombectomy if clinically indicated given the promising results.

This study was designed to assess the optimal access route for the endovascular treatment of acute lower extremity deep vein thrombosis. This was a retrospective analysis of patients with acute lower extremity deep venous thrombosis who underwent endovascular treatment from February 2009 to December 2020. Patients underwent non-direct calf deep vein puncture (NDCDVP) from February 2009 to December 2011 and direct calf deep vein puncture (DCDVP) from January 2012 to December 2020. Catheter directed thrombolysis (CDT) was used to treat all patients in the NDCDVP group, whereas patients in the DCDVP group were treated with CDT or the AngioJet rhyolitic thrombectomy system. In patients exhibiting iliac vein compression syndrome, the iliac vein was dilated and implanted with a stent. Technical success rates and perioperative complication rates were compared between these two treatment groups. The NDCDVP group included 83 patients (40 males, 43 females) with a mean age of 55 ± 16 years, while the DCDVP group included 487 patients (231 males. 256 females) with a mean age of 56 ± 15 years. No significant differences were observed between these groups with respect to any analyzed clinical characteristics. The technical success rates in the NDCDVP and DCDVP groups were 96.4 and 98.2%, respectively (P > 0.05). In the NDCDVP group, the small saphenous vein (SSV)or great saphenous vein (GSV)were the most common access routes (77.1%, 64/83), whereas the anterior tibial vein (ATV) was the most common access route in the DCDVP group (78.0%, 380/487), followed by the posterior tibial vein (PTV) and peroneal vein (PV)(15.6% and 6.4%, respectively). Relative to the NDCDVP group, more patients in the DCDVP group underwent the removal of deep vein clots below the knee (7.2% [6/83] vs. 24.2% [118/487], P < 0.001). Moreover, relative to the NDCDVP group, significantly lower complication rates were evident in the DCDVP group (local infection: 10.8% vs. 0.4%, P < 0.001; local hematoma: 15.7% vs. 1.0%, P < 0.001). The position change rate was also significantly lower in the DCDVP group relative to the NDCDVP group (0% [0/487] vs. 60.2% [50/83], P < 0.001). The calf deep veins (CDVs) represent a feasible and safe access route for the endovascular treatment of lower extremity deep vein thrombosis.

Pulmonary Embolism (PE) is the third leading cause of cardiovascular death, following myocardial infarction and stroke. The latest European Society of Cardiology (ESC) guidelines on PE recommend short-term prognostic stratification based on right ventricular (RV) overload detected by transthoracic echocardiography (TTE) or contrast-enhanced chest CT. The aim of the study is to find out which of the signs of right ventricular dysfunction best predicts in-hospital mortality (IHM).

This is a monocentric, retrospective study including adult patients admitted from the emergency department with a c-e cCT confirmed diagnosis of PE between January 2018 and December 2022 who underwent a TTE within 48 h.

509 patients (median age 76 years [IQR 67-84]) were included, with 7.1% IHM. At univariate analysis, RV/LV ratio > 1 (OR 2.23, 95% CI 1.1-4.5), TAPSE < 17 mm (OR 4.73, 95% CI 2.3-9.8), the D-shape (OR 3.73, 95% CI 1.71-8.14), and LVEF < 35% (OR 5.78, 95% CI 1.72-19.47) resulted significantly correlated with IHM. However, at multivariate analysis including also haemodynamic instability, PESI class > II, and abnormal hs-cTnI levels, only LVEF < 35% (OR 5.46, 95% CI 1.32-22.61) resulted an independent predictor of IHM.

Despite the recognised role of TTE in the early management of patients with circulatory shock and suspected PE, signs of RV dysfunction have been shown to be poor predictors of IHM, whereas severely reduced LVEF is an independent risk factor for in-hospital death.

Study and Evaluation of Two Scores: Shock Index (SI) and Physiological Stress Index (PSI) as discriminators for proactive treatment (reperfusion before decompensated shock) in a population of intermediate-high risk pulmonary embolism (PE).

Using a database from a retrospective cohort with clinical variables and the outcome variable of "proactive treatment", a comparison of the populations was conducted. Optimal cut-off for "proactive treatment" points were obtained according to the SI and PSI. Comparisons were carried out based on the cut-off points of both indices.

Patients admitted to a mixed ICU for PE.

Patients >18 years old admitted to the ICU with intermediate-high risk PE recruited from January 2015 to October 2022.

None.

Population comparison and metrics regarding predictive capacity when determining proactive treatment.

SI and PSI independently have a substandard predictive capacity for discriminating patients who may benefit from an early reperfusion therapy. However, their combined use improves detection of sicker intermediate-high risk PE patients (Sensitivity = 0.66) in whom an early reperfusion therapy may improve outcomes (Specificity = 0.9).

The use of the SI and PSI in patients with intermediate-high risk PE could be useful for selecting patients who would benefit from proactive treatment.

This case report highlights the diagnostic challenges posed by pulmonary embolism (PE) in a young, otherwise healthy 33-year-old African American male with no apparent risk factors. The patient presented with penile pain, swelling, hematuria, flank pain, and rash, and was admitted for balanoposthitis and acute urinary retention. Despite prophylactic heparin, he suffered two cardiac arrests secondary to PE on the fifth day of hospitalization. Prompt thrombolytic therapy and heparin infusion were initiated, but his course was complicated by anuric acute kidney injury requiring hemodialysis, shock liver, and gastrointestinal bleeding. Imaging revealed a substantial thrombus burden in the pulmonary arteries. Notably, a hypercoagulable workup was negative. The absence of typical risk factors, negative hypercoagulable workup, and occurrence of PE despite prophylaxis underscore the importance of vigilance in recognizing atypical presentations. This case emphasizes the need for a high index of suspicion and comprehensive evaluation to diagnose PE in young patients without clear predisposing factors.

For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.

To investigate the genetic underpinnings of the association between type 2 diabetes (T2D), glycemic indicators such as fasting glucose (FG), fasting insulin (FI), and glycated hemoglobin (GH), and venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), thereby contributing novel insights to the scholarly discourse within this domain.

Genome-wide association study (GWAS) summary data pertaining to exposures (T2D, FG, FI, GH) and outcomes (VTE, DVT, PE) were acquired from the IEU Open GWAS database, encompassing participants of European descent, including both male and female individuals. Two-sample Mendelian randomization (MR) analyses were conducted utilizing the TwoSampleMR and MRPRESSO packages within the R programming environment. The primary analytical approach employed was the random-effects inverse variance weighted (IVW) method. Heterogeneity was assessed via Cochran's Q statistic for MR-IVW and Rucker's Q statistic for MR-Egger. Horizontal pleiotropy was evaluated using the intercept test of MR Egger and MR pleiotropy residual sum and outlier (MR-PRESSO) analysis, with the latter also employed for outlier detection. Additionally, a "Leave one out" analysis was conducted to ascertain the influence of individual single nucleotide polymorphisms (SNPs) on MR results.

The random-effects IVW analysis revealed a negative genetic causal association between T2D) and VTE (P = 0.008, Odds Ratio [OR] 95% confidence interval [CI] = 0.896 [0.827-0.972]), as well as between FG and VTE (P = 0.002, OR 95% CI = 0.655 [0.503-0.853]), GH and VTE (P = 0.010, OR 95% CI = 0.604 [0.412-0.884]), and GH and DVT (P = 0.002, OR 95% CI = 0.413 [0.235-0.725]). Conversely, the random-effects IVW analysis did not detect a genetic causal relationship between FI and VTE (P > 0.05), nor between T2D, FG, or FI and DVT (P > 0.05), or between T2D, FG, FI, or GH and PE (P > 0.05). Both the Cochran's Q statistic for MR-IVW and Rucker's Q statistic for MR-Egger indicated no significant heterogeneity (P > 0.05). Moreover, the intercept tests of MR Egger and MR-PRESSO suggested the absence of horizontal pleiotropy (P > 0.05). MR-PRESSO analysis identified no outliers, while the "Leave one out" analysis underscored that the MR analysis was not influenced by any single SNP.

Our investigation revealed that T2D, FG, and GH exhibit negative genetic causal relationships with VTE at the genetic level, while GH demonstrates a negative genetic causal relationship with DVT at the genetic level. These findings furnish genetic-level evidence warranting further examination of VTE, DVT, and PE, thereby making a contribution to the advancement of related research domains.

Prevention of recurrence after an episode of venous thromboembolism (VTE), and also the post-thrombotic syndrome (PTS), is still a recognised challenge. In this meta-analysis, we will summarise existing evidence to compare intelligent system follow-up and routine follow-up for patients with VTE.

Relevant randomised controlled trials (RCTs) and cohort studies will be included from the following databases: MEDLINE/PubMed, Web of Science and the Cochrane Library. The last search time will be 31 March 2024. Two reviewers will independently identify RCTs and cohort studies according to eligibility and exclusion criteria. The risk of bias of included cohort studies will be assessed with the Newcastle-Ottawa Scale, Methodological Index of Non-Randomised Studies, and the risk of bias of RCTs will be assessed with and Cochrane Collaboration's tool. The primary outcomes include overall survival rate and PTS incidence rate. The Grades of Recommendations, Assessment, Development and Evaluation tool will be used to assess the level of evidence for outcome from RCTs. RevMan V.5.4 software will be used to pool outcomes.

Ethical approval was obtained from Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine Science Research Ethics Committee (SH9H-2023-T466-1). The findings will be disseminated to the public through conference presentations and publication in peer-reviewed scientific journals.

CRD42023410644.

Previous studies have reported that neutrophil extracellular traps (NETs) have been identified to be involved in thrombosis, but the clinical value in chronic heart failure (CHF) patients with venous thrombosis is unclear. This study focused on the expression level of NETs in the peripheral blood of patients with CHF complicated with venous thrombosis and its clinical value.

80 patients with CHF were included and divided into 2 groups according to the occurrence of venous thrombosis, and the expression levels of NETs in peripheral venous blood and lesion veins of the patients were detected through fluorescent staining. Myeloperoxidase-DNA (MPO-DNA) and citrullinated histone H3 (CitH3), markers of NETs, were detected by enzyme linked immunosorbent assay kit. The receiver operating characteristic (ROC) curve was used to analyze the value of peripheral venous blood NETs in the diagnosis of venous thrombosis in CHF patients, while the relationship between NETs in peripheral and lesion veins was analyzed by a unitary linear regression model.

The results showed that the concentration of NETs, MPO-DNA, and CitH3 in CHF patients combined with venous thrombosis was markedly higher than that in patients without venous thrombosis, and the concentration of NETs, MPO-DNA, and CitH3 in lesion venous blood was notably higher than that in peripheral venous blood. Binary logistics regression analysis showed that NETs in peripheral venous blood were an independent risk factor for venous thrombosis in patients with heart failure. The unitary linear regression model fitted well, indicating a notable positive correlation between NETs concentrations in peripheral and lesion veins. The area under the ROC curve for diagnosing venous thrombosis was 0.85, indicating that peripheral blood NETs concentration levels could effectively predict venous thrombosis in CHF patients.

The expression level of NETs was high in the peripheral blood of CHF patients combined with venous thrombosis and was the highest in lesion venous blood. NETs levels in peripheral blood had the value of diagnosing venous thrombosis in CHF patients, and the concentrations of NETs in peripheral and lesion veins are markedly positively correlated.

As there are no predictive models for pulmonary embolism (PE) in patients with suspected PE at cardiology department. This study developed a predictive model for the probability of PE development in these patients. This retrospective analysis evaluated data from 995 patients with suspected PE at the cardiology department from January 2012 to December 2021. Patients were randomly divided into the training and validation cohorts (7:3 ratio). Using least absolute shrinkage and selection operator regression, optimal predictive features were selected, and the model was established using multivariate logistic regression. The features used in the final model included clinical and laboratory factors. A nomogram was developed, and its performance was assessed and validated by discrimination, calibration, and clinical utility. Our predictive model showed that six PE-associated variables (age, pulse, systolic pressure, syncope, D-dimer, and coronary heart disease). The area under the curve - receiver operating characteristic curves of the model were 0.721 and 0.709 (95% confidence interval: 0.676-0.766 and 0.633-0.784), respectively, in both cohorts. We also found good consistency between the predictions and real observations in both cohorts. In decision curve analysis, the numerical model had a good net clinical benefit. This novel model can predict the probability of PE development in patients with suspected PE at cardiology department.

The purpose of this study was to propose a deep learning-based approach to detect pulmonary embolism and quantify its severity using the Qanadli score and the right-to-left ventricle diameter (RV/LV) ratio on three-dimensional (3D) computed tomography pulmonary angiography (CTPA) examinations with limited annotations.

Using a database of 3D CTPA examinations of 1268 patients with image-level annotations, and two other public datasets of CTPA examinations from 91 (CAD-PE) and 35 (FUME-PE) patients with pixel-level annotations, a pipeline consisting of: (i), detecting blood clots; (ii), performing PE-positive versus negative classification; (iii), estimating the Qanadli score; and (iv), predicting RV/LV diameter ratio was followed. The method was evaluated on a test set including 378 patients. The performance of PE classification and severity quantification was quantitatively assessed using an area under the curve (AUC) analysis for PE classification and a coefficient of determination (R²) for the Qanadli score and the RV/LV diameter ratio.

Quantitative evaluation led to an overall AUC of 0.870 (95% confidence interval [CI]: 0.850-0.900) for PE classification task on the training set and an AUC of 0.852 (95% CI: 0.810-0.890) on the test set. Regression analysis yielded R² value of 0.717 (95% CI: 0.668-0.760) and of 0.723 (95% CI: 0.668-0.766) for the Qanadli score and the RV/LV diameter ratio estimation, respectively on the test set.

This study shows the feasibility of utilizing AI-based assistance tools in detecting blood clots and estimating PE severity scores with 3D CTPA examinations. This is achieved by leveraging blood clots and cardiac segmentations. Further studies are needed to assess the effectiveness of these tools in clinical practice.

Diagnosing pulmonary embolism (PE) in older adults is relatively difficult because of the atypical clinical symptoms of PE in older adults accompanied by multiple complications. This study aimed to establish a nomogram model to better predict the occurrence of PE in older adults.

Data were collected from older patients (≥65 years old) with suspected PE who were hospitalized between January 2012 and July 2021 and received confirmatory tests (computed tomographic pulmonary angiography or ventilation/perfusion scanning). The PE group and non-PE (control) group were compared using univariable and multivariable analyses to identify independent risk factors. A nomogram prediction model was constructed with independent risk factors and verified internally. The effectiveness of the nomogram model, Wells score, and revised Geneva score was assessed using the area under the receiver operating characteristic curve (AUC).

In total, 447 eligible older patients (290 PE patients and 157 non-PE patients) were enrolled. Logistic regression analysis revealed nine independent risk factors: smoking, inflammation, dyspnea, syncope, mean corpuscular hemoglobin concentration, indirect bilirubin, uric acid, left atrial diameter, and internal diameter of the pulmonary artery. The AUC, sensitivity, and specificity of the nomogram prediction model were 0.763 (95 % confidence interval, 0.721-0.802), 74.48 %, and 67.52 %, respectively. The nomogram showed superior AUC compared to the Wells score (0.763 vs. 0.539, P < 0.0001) and the revised Geneva score (0.763 vs. 0.605, P < 0.0001).

This novel nomogram may be a useful tool to better recognize PE in hospitalized older adults.