Asymmetric one-carbon ring expansion of diverse N-heterocycles via copper-catalyzed diyne cyclization.

One-carbon ring expansion reaction of N-heterocycles has gained particular attention in the past decade because this method allows for the conversion of readily available N-heterocycles into potentially useful complex ring-expanded N-heterocycles, which are inaccessible by traditional methods. However, the catalytic asymmetric variant of this reaction has been rarely reported to date. Herein, we disclose an enantioselective one-carbon ring expansion reaction through chiral copper-catalyzed diyne cyclization, leading to the practical, atom-economic and divergent assembly of an array of valuable chiral N-heterocycles bearing a quaternary stereocenter in generally good to excellent yields with excellent enantioselectivities (up to >99% ee). This protocol represents the first example of asymmetric one-carbon ring expansion reaction of N-heterocycles based on alkynes.

Halogen-Bond-Assisted NHC-Catalyzed (Dynamic) Kinetic Resolution for the Atroposelective Synthesis of Heterobiaryls.

We report a novel halogen-bond-assisted NHC-catalyzed (dynamic) kinetic resolution strategy for the synthesis of axially chiral heterobiaryls. A class of axially chiral quinolines are prepared efficiently in excellent enantioselectivities (≤98% ee) employing 3-5 mol % NHC catalyst. Mechanistic studies reveal the indispensability of 5-bromo-2-iodobenzaldehyde in this reaction, in which a pivotal halogen bonding interaction plays a crucial role in the process.

[Retracted] Role of long non­coding RNA MALAT1 in chronic obstructive pulmonary disease.

[This retracts the article DOI: 10.3892/etm.2020.8996.].

Parental Hesitancy toward Seasonal Influenza Vaccination for Children under the Age of 18 Years and Its Determinants in the Post-Pandemic Era: A Cross-Sectional Survey among 1175 Parents in China.

Children's susceptibility to influenza increased after COVID-19 control measures were lifted. This study investigated parental hesitancy toward seasonal influenza vaccination (SIV) for children and its determinants in the post-pandemic era. An online survey of full-time adult factory workers was conducted in Shenzhen, China in December 2023. This analysis was based on 1175 parents who had at least one child under the age of 18 years. Among all parents, 37.1% were hesitant to have their index child receive SIV. Mothers exhibited lower parental hesitancy toward SIV compared to fathers (31.9% versus 41.3%, p < 0.001). After adjusting for significant background characteristics, mothers and fathers who were more satisfied with the SIV health promotion materials, perceived more severe consequences of seasonal influenza for their children, and perceived more benefits, cues to action, and self-efficacy related to their children's SIV were less likely to exhibit hesitancy toward SIV. Higher frequency of exposure to information about the increasing number of patients or severe cases due to seasonal influenza and other upper respiratory infections on social media was associated with lower parental hesitancy toward SIV among fathers but not mothers. There is a strong need to address parental hesitancy toward SIV for children in the post-pandemic era.

Gender-based differences in the association of self-reported sleep duration with cardiovascular disease and diabetes.

OBJECTIVE: Insufficient or prolonged sleep each day may contribute to the onset of cardiovascular disease and diabetes, and there may be some variability between genders; however, current research evidence is limited. We aimed to investigate the effects of gender on self-reported sleep duration and the prevalence of cardiovascular disease and diabetes. RESEARCH DESIGN AND METHODS: This study is a population-based, cross-sectional analysis. Data from a nationally representative sample of US adults obtained from the National Health and Nutrition Examination Survey (NHANES) (2005-2020), and 13,002 participants, including 6,774men and 6,228women, were obtained by excluding the missing values for each variable self-reported sleep duration data obtained by using a habitual baseline questionnaire. Logistic regression models investigated the associations between gender-specific self-reported sleep duration, CVDs, and diabetes events. RESULT: In all participants, respectively, compared with sleep 7-8 h/day, the multivariable-adjusted odds ratios significantly associated with < 7 h /day and > 8 h /day were (1.43[1.15, 1.78]) and (1.34[1.01, 1.76]) for CHF, (1.62[1.28, 2.06]) for Angina, (1.42[1.17, 1.71]) for heart attack, (1.38[1.13, 1.70]) and (1.54[1.20, 1.97]) for Stroke, (1.21[1.09, 1.35]) and (1.28[1.11, 1.48]) for diabetes. In men, CHF (1.67[1.21, 2.14]), Angina (1.66[1.18, 2.15]), Stroke (1.55[1.13,1.97]), and diabetes (1.15[1.00, 1.32]) were significantly associated with < 7 h /day, and stroke (1.73[1.16, 2.32]) and diabetes (1.32[1.06, 1.52]) were significantly associated with > 8 h /day. In women, angina(1.83[1.16, 2.50]), heart attack(1.63[1.11, 2.15]), and diabetes (1.32[1.11, 1.54]) were significantly associated with < 7 h /day, while diabetes (1.31[1.03, 1.59]) was significantly associated with > 8 h /day. CONCLUSION: Self-reported long and short sleep duration was independently associated with partial CVDs and diabetes risk. However, sleep duration and gender did not have multiplicative or additive interactions with the onset of diabetes and CVDs.

Comparing the Efficacy of 2 WeChat Mini Programs in Reducing Nonmarital Heterosexual Contact by Male Factory Workers: Randomized Controlled Trial.

BACKGROUND: Male factory workers in China are vulnerable to HIV transmission. Commercial and nonmarital noncommercial contacts are the driving forces of heterosexual HIV transmission among male factory workers in China. There is a lack of effective HIV interventions for male factory workers in China. OBJECTIVE: The primary objective of this randomized controlled trial was to compare the efficacy of an enhanced versus the standard version of a WeChat mini program in reducing sexual intercourse with nonregular female sex partners and female sex workers among male factory workers in Shenzhen, China. METHODS: A nonblinded 2-arm parallel randomized controlled trial was conducted between December 2021 and April 2023. Participants were adult male factory workers in Shenzhen who had access to a smartphone and WeChat. Those who had oral or anal sex with a man or self-reported as HIV positive were excluded. A total of 247 participants were randomly assigned to the intervention group (n=125, 50.6%) or the control group (n=122, 49.4%); 221 (89.5%) and 220 (89.1%) completed follow-up surveys at T1 (6 months after completion of the interventions) and T2 (6 months after T1). Participants in the control group had access to the standard WeChat mini program that provided basic HIV-related knowledge and information about local free HIV testing services. Participants in the intervention group had access to the enhanced WeChat mini program. The enhanced mini program covered all the information in the standard mini program. In addition, the enhanced mini program assessed users' behaviors and invited users to watch different web-based videos on reducing nonmarital sexual contacts and promoting HIV testing based on their behavioral characteristics at months 0 and 1. The videos were developed based on in-depth interviews with male factory workers. Intention-to-treat analysis was used for outcome analyses. Multiple imputation was used to replace missing outcome values at T1 and T2. RESULTS: At T1, fewer participants in the intervention group reported sexual intercourse with a nonregular female sex partner in the past 6 months compared with the control group (1/125, 0.8% vs 8/122, 6.6%; relative risk=0.12, 95% CI 0.02-0.96; P=.02). However, there were no between-group differences in sexual intercourse with a nonregular female sex partner at T2 (10/125, 8% vs 14/122, 11.5%; P=.36) or sexual intercourse with a female sex worker at T1 (2/125, 1.6% vs 2/122, 1.6%; P=.98) or T2 (8/125, 6.4% vs 8/122, 6.6%; P=.96). CONCLUSIONS: The enhanced WeChat mini program was more effective than the standard WeChat mini program in reducing sexual intercourse with nonregular female sex partners among male factory workers in the short term but not in the longer term. Improvements should be made to the WeChat mini program before implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05811611; https://clinicaltrials.gov/study/NCT05811611.

Associations between social support and proactive health behaviours among Chinese adolescents: the mediating role of self-efficacy and peer relationships.

BACKGROUND: Proactive health behaviours are crucial for enhancing adolescent health. However, there is limited evidence on the potential pathways through which social support influences adolescents' proactive health behaviours. This cross-sectional study aimed to examine the relationships between social support, self-efficacy, peer relationships and proactive health behaviours in Chinese adolescents. METHODS: From October to December 2023, we recruited 6075 adolescents from Shandong Province, China. They completed self-report questionnaires on social support, self-efficacy, peer relationships and proactive health behaviours. RESULTS: Linear regression analysis indicated that social support was positively associated with proactive health behaviours among adolescents (ß = 0.571, 95% CI = 0.542, 0.600). Further mediation analyses revealed that self-efficacy (ß = 0.085, 95% CI = 0.069,0.101) and peer relationships (ß = 0.156, 95% CI = 0.136,0.177) mediated this relationship. CONCLUSIONS: Increased social support was associated with better proactive health behaviours in Chinese adolescents. Additionally, higher self-efficacy and positive peer relationships enhanced this association. Our findings emphasised the significance of providing supportive environments at home and at school to promote proactive health behaviours in adolescents.

Efficient Pb(II) removal from contaminated soils by recyclable, robust lignosulfonate/polyacrylamide double-network hydrogels embedded with Fe2O3 via one-pot synthesis.

Soil heavy metal removal strategies are increasingly valued for effectively reducing contamination and preventing secondary pollution. In this work, a double network hydrogel (Fe2O3@LH), consisting of lignosulfonate (LS) and polyacrylamide with embedded Fe2O3 nanoparticles, was synthesized successfully via a one-pot method and subsequently applied to adsorb lead (Pb) from contaminated soil. Incorporating Fe2O3 into the hydrogel enhances the adsorption capacity of Fe2O3@LH for Pb(II). The Fe2O3@LH hydrogel demonstrates a maximum Pb(II) adsorption capacity of 143.11 mg g-1, with Pb(II) removal mechanisms involving electrostatic adsorption, cation exchange, precipitation reactions, and the formation of coordination complexes, achieving a 22.3 % maximum removal efficiency in soil cultivation experiments. Additionally, the application of Fe2O3@LH markedly reduces the concentrations of cadmium (Cd) and arsenic (As) in the soil, meanwhile enhances the levels of total nitrogen (TN), soil organic matter (SOM), and cation exchange capacity (CEC) by 23.1 %, 10.6 %, and 16.9 %, respectively. Following 90 days of continuous application in the soil, the recovery rate of Fe2O3@LH remains above 75 %. The toxicity assay using zebrafish larvae indicates that Fe2O3@LH demonstrates good biosafety. This study demonstrates the considerable potential of Fe2O3@LH hydrogel for practical application in reducing Pb(II) levels in contaminated soil.

Shaping the general resilience of green infrastructure through integrating structures, functions, and connections.

Global climate change has necessitated the implementation of green infrastructure that is resilient in a manner of sustainable development. The current understanding of green infrastructure resilience is hindered by the divergence of generic properties and performance in adapting to uncertain disturbances. This study develops an operational methodology that integrates structural and functional properties of green infrastructure, and their connections to shape the general resilience. A further empirical study is conducted in the context of Shenzhen City, where the effectiveness of resilient connections is correlated with the distribution of waterlogging. We demonstrate that green infrastructure present different levels of resilience in terms of its structural composition and functional performance. The Shenzhen city shows a high capacity to maintain soil retention stability, but a feeble capacity regarding water yield and gross primary productivity. The resilient connections of green infrastructure are highly centralized, with a few pivotal nodes performing a high degree of connectivity. It shows that a total of 52.2% of resilient lines are identified as belonging to the fourth level but linking the majority of the nodes. Enhancing the general resilience of green infrastructure could facilitate its adaptation to specific disturbances such as waterlogging. When correlated the resilient connections of green infrastructure with the distribution of waterlogging, a distance of 1.6 km from the waterlogging points is significantly identified where the residuals of the entropy index display the lowest variance. As the distance increases, the composite entropy index initially decreases and then increases. We suggest that the alignment of generic properties and specified performance of green infrastructure is essential in the pursuit of sustainable development.

Nocardamine mitigates cellular dysfunction induced by oxidative stress in periodontal ligament stem cells.

BACKGROUND: The role of periodontal ligament stem cells (PDLSCs) in repairing periodontal destruction is crucial, but their functions can be impaired by excessive oxidative stress (OS). Nocardamine (NOCA), a cyclic siderophore, has been shown to possess anti-cancer and anti-bacterial properties. This study aimed to investigate the protective mechanisms of NOCA against OS-induced cellular dysfunction in PDLSCs. METHODS: The cytotoxicity of NOCA on PDLSCs was assessed using a CCK-8 assay. PDLSCs were then treated with hydrogen peroxide (H2O2) to induce OS. ROS levels, cell viability, and antioxidant factor expression were analyzed using relevant kits after treatment. Small molecule inhibitors U0126 and XAV-939 were employed to block ERK signaling and Wnt pathways respectively. Osteogenic differentiation was assessed using alkaline phosphatase (ALP) activity staining and Alizarin Red S (ARS) staining of mineralized nodules. Expression levels of osteogenic gene markers and ERK pathway were determined via real-time quantitative polymerase chain reaction (RT-qPCR) or western blot (WB) analysis. ß-catenin nuclear localization was examined by western blotting and confocal microscopy. RESULTS: NOCA exhibited no significant cytotoxicity at concentrations below 20 µM and effectively inhibited H2O2-induced OS in PDLSCs. NOCA also restored ALP activity, mineralized nodule formation, and the expression of osteogenic markers in H2O2-stimulated PDLSCs. Mechanistically, NOCA increased p-ERK level and promoted ß-catenin translocation into the nucleus; however, blocking ERK pathway disrupted the osteogenic protection provided by NOCA and impaired its ability to induce ß-catenin nuclear translocation under OS conditions in PDLSCs. CONCLUSIONS: NOCA protected PDLSCs against H2O2-induced OS and effectively restored impaired osteogenic differentiation in PDLSCs by modulating the ERK/Wnt signaling pathway.

Unraveling the role of NLRP3 inflammasome in allergic inflammation: implications for novel therapies.

Allergic diseases like asthma, allergic rhinitis and dermatitis pose a significant global health burden, driving the search for novel therapies. The NLRP3 inflammasome, a key component of the innate immune system, is implicated in various inflammatory diseases. Upon exposure to allergens, NLRP3 undergoes a two-step activation process (priming and assembly) to form active inflammasomes. These inflammasomes trigger caspase-1 activation, leading to the cleavage of pro-inflammatory cytokines (IL-1ß and IL-18) and GSDMD. This process induces pyroptosis and amplifies inflammation. Recent studies in humans and mice strongly suggest a link between the NLRP3 inflammasome, IL-1ß, and IL-18, and the development of allergic diseases. However, further research is needed to fully understand NLRP3's specific mechanisms in allergies. This review aims to summarize the latest advances in NLRP3 activation and regulation. We will discuss small molecule drugs and natural products targeting NLRP3 as potential therapeutic strategies for allergic diseases.

Metadielectrics for high-temperature energy storage capacitors.

Dielectric capacitors are highly desired for electronic systems owing to their high-power density and ultrafast charge/discharge capability. However, the current dielectric capacitors suffer severely from the thermal instabilities, with sharp deterioration of energy storage performance at elevated temperatures. Here, guided by phase-field simulations, we conceived and fabricated the self-assembled metadielectric nanostructure with HfO2 as second-phase in BaHf0.17Ti0.83O3 relaxor ferroelectric matrix. The metadielectric structure can not only effectively increase breakdown strength, but also broaden the working temperature to 400 oC due to the enhanced relaxation behavior and substantially reduced conduction loss. The energy storage density of the metadielectric film capacitors can achieve to 85 joules per cubic centimeter with energy efficiency exceeding 81% in the temperature range from 25 °C to 400 °C. This work shows the fabrication of capacitors with potential applications in high-temperature electric power systems and provides a strategy for designing advanced electrostatic capacitors through a metadielectric strategy.

Self-separating core-shell spheres with a carboxymethyl chitosan/acrylic acid/Fe3O4 composite core for soil Cd removal.

Cadmium (Cd) removal from soil is crucial as Cd enters the food chain and affect food safety, thus impose severe threaten to human health. We developed PPC@PC-Fe, a dual-functional core-shell sphere for efficient soil Cd reduction. The shell (PPC) was composed of encapsulated citric acid (CA) in a polylactic acid (PLA) and polyethylene glycol (PEG) network, which endows a function of activating Cd; and the core (PC-Fe) consisted of a polyacrylic acid/carboxymethyl chitosan (PAA/CMC) hydrogel with Fe3O4 nanoparticles to adsorb adjacent activated Cd. Upon water contact, the shell dissolved, releasing CA to activate soil Cd. Simultaneously, the swellable PC-Fe core absorbed water and expanded in size, promoting the disintegration of PLA in the shell, which triggered the automatic separation of core from shell, enabling the exposed PC-Fe core to rapidly adsorb Cd. Furthermore, the PC-Fe core can be magnetically removed after adsorption of Cd. Soil culture tests showed that 2 % PPC@PC-Fe reduced soil Cd from 6.009 mg/kg to 4.834 mg/kg in 10 days, with the acid-soluble Cd being the predominantly target to be activated and remove. This study demonstrates an effective stepwise activation and adsorption mechanism by a single carrier, with simple magnetic collection minimizing secondary pollution. It offers an innovative approach to the remediation of cadmium-contaminated sites in the field.

Wet oxidation technology can significantly reduce both microplastics and nanoplastics.

For the resource recovery of biomass waste, it is a challenge to simultaneously remove micro-/nano-plastics pollution but preserve organic resources. Wet oxidation is a promising technology for valorization of organic wastes through thermal hydrolysis and oxidation. This might in turn result in the degradation of microplastics in the presence of oxygen and high temperatures. Based on this hypothesis, this study quantified both microplastics and nanoplastics in an industrial-scale wet oxidation reactor from a full-size coverage perspective. Wet oxidation significantly reduced the size and mass of individual microplastics, and decreased total mass concentration of microplastics and nanoplastics by 94.8 % to 98.6 %. This technology also reduced the micro- and nanoplastic shapes and polymer types, resulting in a complete removal of fibers, clusters, polypropylene (PP) and poly(methyl methacrylate) (PMMA). The present study confirms that wet oxidation technology is effective in removing microplastics and nanoplastics while recovering organic waste.

A Solid Electrolyte RHE for Electrode Diagnosis of Proton Exchange Membrane Water Electrolyzers.

Reference electrode is the foundation of electrochemical study; thus, most electrode materials are tested in a three-electrode mode to acquire potential-dependent kinetics. However, it is difficult to directly use conventional reference electrodes to detect potential information in solid electrolyte devices due to their compact assembly structure. Therefore, the kinetic study of an electrochemical device faces challenges in precise identification of specific problems originating from the anode or cathode. Here, focusing on proton exchange membrane water electrolysis, we design a solid electrolyte reversible hydrogen electrode (SE-RHE), which can be used for electrode diagnosis under various operating conditions. Compared to the reference electrodes reported in the literature, which are mainly based on liquid electrolyte, the SE-RHE is highly sensitive and compatible, as well as easy to assemble. The potential deviation is less than ±0.5 mV, and the cell voltage derived from the electrode potential well reproduces the value that was directly measured with a deviation less than 0.2%. The reference electrode developed in this work enables the kinetic study of a specific electrode rather than the entire cell. For instance, an interesting observation is that the cathode shows distinct stability under stable and fluctuating operations. Differing from the high stability under stable operation, the cathode degrades significantly under fluctuating operations.

Melatonin attenuates scopolamine-induced cognitive dysfunction through SIRT1/IRE1α/XBP1 pathway.

BACKGROUND: The prevalence of dementia around the world is increasing, and these patients are more likely to have cognitive impairments, mood and anxiety disorders (depression, anxiety, and panic disorder), and attention deficit disorders over their lifetime. Previous studies have proven that melatonin could improve memory loss, but its specific mechanism is still confused. METHODS: In this study, we used in vivo and in vitro models to examine the neuroprotective effect of melatonin on scopolamine (SCOP)-induced cognitive dysfunction. The behavioral tests were performed. 18F-FDG PET imaging was used to assess the metabolism of the brain. Protein expressions were determined through kit detection, Western blot, and immunofluorescence. Nissl staining was conducted to reflect neurodegeneration. MTT assay and RNAi transfection were applied to perform the in vitro experiments. RESULTS: We found that melatonin could ameliorate SCOP-induced cognitive dysfunction and relieve anxious-like behaviors or HT22 cell damage. 18F-FDG PET-CT results showed that melatonin could improve cerebral glucose uptake in SCOP-treated mice. Melatonin restored the cholinergic function, increased the expressions of neurotrophic factors, and ameliorated oxidative stress in the brain of SCOP-treated mice. In addition, melatonin upregulated the expression of silent information regulator 1 (SIRT1), which further relieved endoplasmic reticulum (ER) stress by decreasing the expression of phosphorylate inositol-requiring enzyme (p-IRE1α) and its downstream, X-box binding protein 1 (XBP1). CONCLUSIONS: These results indicated that melatonin could ameliorate SCOP-induced cognitive dysfunction through the SIRT1/IRE1α/XBP1 pathway. SIRT1 might be the critical target of melatonin in the treatment of dementia.

Exact dispersion relation of the quantum Langmuir wave.

The normal modes, i.e., the eigensolutions to the dispersion relation equation, are the most fundamental properties of a plasma. The real part indicates the intrinsic oscillation frequency while the imaginary part the Landau damping rate. In most of the literature, the normal modes of quantum plasmas are obtained by means of small damping approximation, which is invalid for high-k modes. In this paper, we solve the exact dispersion relations via the analytical continuation scheme, and, due to the multi-value nature of the Fermi-Dirac distribution, reformation of the complex Riemann surface is required. It is found that the topological shape of the root locus in quantum plasmas is quite different from classical ones, in which both real and imaginary frequencies of high-k modes increase with k steeper than the typical linear behavior in classical plasmas. As a result, the time-evolving behavior of a high-k initial perturbation becomes ballistic-like in quantum plasmas.

The intelligent evaluation in ice and snow tourism based on LSTM network.

In order to augment the efficacy of the intelligent evaluation model for assessing the suitability of ice and snow tourism, this study refines the model by incorporating the Long Short-Term Memory (LSTM) network within the framework of the Internet of Things (IoT). The investigation commences with an elucidation of the application of IoT technology in environmental detection. After this, an analysis is conducted on the structure of LSTM and its merits in the realm of time series prediction. Ultimately, a novel model for appraising the suitability of ice and snow tourism is formulated. The efficacy of this model is substantiated through empirical experiments. The results of these experiments reveal that the refined model exhibits exceptional performance across diverse climatic conditions, encompassing mild, cold, humid, and arid climates. In regions characterized by mild climates, the predictive accuracy of the refined model progressively ascends from 88% in the initial quarter to 94% in the fourth quarter, surpassing the capabilities of conventional models. Consistently robust performance is demonstrated by the refined model throughout each quarter. In terms of operational efficiency, comparative analysis indicates that the refined model attains a moderate level, manifesting a 30-33 s runtime and maintaining a Central Processing Unit (CPU) usage rate between 40 and 43%. This observation implies that the refined model adeptly balances precision against resource consumption. Consequently, this study holds significance as a scholarly reference for the integration of IoT and LSTM networks in the domain of tourism evaluation.

Metformin improves cognitive dysfunction through SIRT1/NLRP3 pathway-mediated neuroinflammation in db/db mice.

Diabetes mellitus (DM), an important public health problem, aggravates the global economic burden. Diabetic encephalopathy (DE) is a serious complication of DM in the central nervous system. Metformin has been proven to improve DE. However, the mechanism is still unclear. In this study, the db/db mice, a common model used for DE, were employed to explore and study the neuroprotective effect of metformin and related mechanisms. Behavioral tests indicated that metformin (100 or 200 mg/kg/day) could significantly improve the learning and memory abilities of db/db mice. The outcomes from the oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) demonstrate that metformin effectively modulates glucose and insulin signaling pathways in db/db mice. The results of body weight and blood lipid panel (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) show that metformin promotes the level of lipid metabolism in db/db mice. Furthermore, data from oxidative stress assays, which measured levels of malondialdehyde, superoxide dismutase, catalase, and glutathione peroxidase, suggest that metformin suppresses oxidative stress-induced brain damage in db/db mice. In addition, western blot, Nissl staining, and immunofluorescence results showed that metformin increased the expressions of nerve growth factor and postsynaptic density 95 and repaired neuronal structural damage. For the mechanism study, metformin activated SIRT1 and inhibited the expression of NLRP3 inflammasome (NLRP3, ASC, caspase-1, IL-1ß, and IL-18) and inflammatory cytokines (TNFα and IL-6). In conclusion, metformin could ameliorate cognitive dysfunction through the SIRT1/NLRP3 pathway, which might be a promising mechanism for DE treatment.

Efficacy and safety of direct oral anticoagulants for preventing venous thromboembolism in hospitalized cancer patients: a national multicenter retrospective cohort study.

Introduction: Studies on the use of direct oral anticoagulants (DOACs) for preventing venous thromboembolism (VTE) in hospitalized cancer patients are lacking. Therefore, we conducted a multicenter retrospective cohort study to evaluate the efficacy and safety of DOACs versus low-molecular-weight heparin (LMWH) for the primary prevention of VTE in hospitalized cancer patients. Methods: Clinical outcomes included thrombosis, VTE, other thrombosis, all bleeding, major bleeding, nonmajor bleeding, and all-cause death. A 1:1 cohort of rivaroxaban and LMWH patients was created by propensity score matching. Results: A total of 2,385 cancer patients were included in this study. During the 3-month follow-up period, 129 (5.4%) thrombosis events occurred, 63 (2.7%) of which were VTEs and 66 (2.8%) of which were other thrombosis events. All bleeding occurred in 163 (6.8%) patients, 68 (2.9%) had major bleeding, and 95 (4.0%) had nonmajor bleeding. All-cause deaths occurred in 113 (4.7%) patients. After adjusting for various confounders, the incidence of thrombosis and other thromboses was significantly lower in the rivaroxaban group than in the LMWH group [OR 0.543, 95% CI (0.343-0.859), p = 0.009; OR 0.461, 95% CI (0.241-0.883), p = 0.020]. There were no significant differences in incidence of VTE, total bleeding, major bleeding, nonmajor bleeding, or all-cause death. Conclusion: In oncology patients receiving thromboprophylaxis, rivaroxaban has a lower incidence of thrombosis and other thrombosis and a similar incidence of VTE as LMWH and does not increase the risk of bleeding. Rivaroxaban may be an attractive alternative to LMWH for preventing VTE in hospitalized cancer patients.