The cardiovascular toxicity of polystyrene microplastics in rats: based on untargeted metabolomics analysis.

Background: Polystyrene microplastics (PS-MPs) exhibit multi-target, multi-dimensional, chronic, and low toxicity to the cardiovascular system. They enter the bloodstream through the gastrointestinal tract and respiratory system, altering blood parameters and conditions, inducing thrombotic diseases, and damaging myocardial tissue through the promotion of oxidative stress and inflammatory responses in myocardial cells. However, many of the links and mechanisms remain unclear. Methods: In this study, 48 wistar rats were randomly divided into four groups and exposed to different concentrations of PS-MPs: control group (0 mg/kg/d), low dose group (0.5 mg/kg/d), middle dose group (5 mg/kg/d) and high dose group (50 mg/kg/d), with 12 rats in each group. After 90 consecutive days of intragastric administration of PS-MPs, biochemical markers in myocardium, aorta and blood were detected, and HE staining was performed to observe the toxic effects of PS-mps on cardiovascular system. Furthermore, non-targeted metabolomics methods were used to analyze the effect of PS-MPs exposure on the metabolism of cardiovascular system in rats, and to explore its potential molecular mechanism. Results: The results revealed no pathological changes in the heart and aorta following PS-MPs exposure. However, the myocardial enzyme levels in the high dose PS-MPs group of rats showed a significant increase. Moreover, exposure to polystyrene microplastics caused a disorder in lipid metabolism in rats, and led to an increase in indicators of inflammation and oxidative stress in myocardial and aortic tissues, but resulted in a decrease in the level of IL-6. Untargeted metabolomics results showed that metabolites with antioxidant and anti-inflammatory effects, including equol and 4-hydroxybenzoic acid, were significantly upregulated. Conclusion: These results suggest that long-term exposure to high concentrations of PS-MPs may lead to abnormal lipid metabolism and cardiovascular system damage. The mechanism may be related to oxidative stress and inflammatory response. Exogenous antioxidants and changes in own metabolites may have a protective effect on the injury. Therefore, understanding the toxicological mechanism of PS-MPs not only helps to elucidate its pathogenesis, but also provides new ideas for the treatment of chronic diseases.

Water vapor assisted aramid nanofiber reinforcement for strong, tough and ionically conductive organohydrogels as high-performance strain sensors.

Conductive organohydrogels have gained increasing attention in wearable sensors, flexible batteries, and soft robots due to their exceptional environment adaptability and controllable conductivity. However, it is still difficult for conductive organohydrogels to achieve simultaneous improvement in mechanical and electrical properties. Here, we propose a novel "water vapor assisted aramid nanofiber (ANF) reinforcement" strategy to prepare robust and ionically conductive organohydrogels. Water vapor diffusion can induce the pre-gelation of the polymer solution and ensure the uniform dispersion of ANFs in organohydrogels. ANF reinforced organohydrogels have remarkable mechanical properties with a tensile strength, stretchability and toughness of up to 1.88 ± 0.04 MPa, 633 ± 30%, and 6.75 ± 0.38 MJ m-3, respectively. Furthermore, the organohydrogels exhibit great crack propagation resistance with the fracture energy and fatigue threshold as high as 3793 ± 167 J m-2 and ∼328 J m-2, respectively. As strain sensors, the conductive organohydrogel demonstrates a short response time of 112 ms, a large working strain and superior cycling stability (1200 cycles at 40% strain), enabling effective monitoring of a wide range of complex human motions. This study provides a new yet effective design strategy for high performance and multi-functional nanofiller reinforced organohydrogels.

Meat, vegetable, and fruit consumption among urban and rural elders aged 60+ years in regional China: a population-level nutritional study.

The aim was to assess epidemiological characteristics of the most recent consumption patterns of meat, vegetable, and fruit among representative urban and rural residents aged 60+ years in regional China. In this cross-sectional survey conducted in mid-2018, participants aged 60+ years were randomly chosen from urban and rural communities in Nanjing municipality of China. Meat, vegetable, and fruit intake were assessed with a validated food frequency questionnaire. Multivariate logistic regression models were applied to compute odds ratio (OR) and 95 % confidence interval (CI) to investigate the association of socio-demographic characteristics with a likelihood of meeting intake recommendation. Among the 20 867 participants, 49⋅5 % were men and 45⋅0 % urban elders, and 6⋅5 % aged 80+ years. The mean values of consumption frequency of red meat, white meat, vegetable, and fruit were 2⋅99 ± 2⋅28, 1⋅37 ± 1⋅13, 5⋅24 ± 6⋅43, and 2⋅64 ± 2⋅91 times/week, respectively, among overall participants. Moreover, there were 14⋅9, 23⋅7, and 12⋅1 % of participants meeting intake recommendations of meat, vegetable, and fruit, separately, in this study. After adjustment for potential confounders, age, gender, residence area, and educational attainment each was associated with the likelihood of meeting intake recommendation of meat, vegetable, or fruit. The consumption frequency and proportion of participants meeting intake recommendations of meat, vegetable, or fruit were not high among elders in regional China. Socio-demographic characteristics were associated with intake recommendations of meat, vegetables, and fruit. It has public health implications that participants' socio-demographic attributes shall be considered for precision intervention on meat, vegetable, and fruit consumption in healthy eating campaigns among elders in China.

Effect of tixagevimab/cilgavimab for pre-exposure prophylaxis during the China Omicron outbreak.

OBJECTIVES: By the end of 2022, China had made a pivotal decision to optimize the COVID-19 policy. The dominant Omicron variant in China at that time was highly transmissible. In this study, we aimed to evaluate the real-world safety and efficacy of tixagevimab and cilgavimab against this background in China. METHODS: Participants were enrolled if they were over 12 years old and were planning to receive tixagevimab or cilgavimab. All participants received intramuscular administration of tixagevimab (150 mg) and cilgavimab (150 mg). Data were collected on demographics, underlying illness, prior infection, vaccination, adverse events, and COVID-19 outcomes (e.g., infection rate, hospitalization rate, and severe disease). RESULTS: During the study period, 168 (37.9%) of 443 who received tixagevimab/cilgavimab were diagnosed with SARS-CoV-2 infection. All infected patients had mild COVID-19. Two patients (0.5%) were hospitalized for COVID-19, but none of them were admitted to the ICU. None of the patients died during this study. 4 (0.9%) reported mild local adverse events, and no severe systemic adverse reactions were reported. CONCLUSION: Tixagevimab/cilgavimab may have protected high-risk populations against infection with the Omicron variant, hospitalization and severe disease during the China COVID-19 pandemic.

Association of socioeconomic status with metabolic syndrome and its components among adult population: a community-based cross-sectional study in Nanjing Municipality of China.

OBJECTIVES: To investigate the association of metabolic syndrome (MetS) and its components with socioeconomic status (SES) among general and gender-specific adult population in Nanjing municipality, China. DESIGN: Cross-sectional study. PARTICIPANTS: 13287 participants completed the survey. A participant: (1) must be a local registered resident, (2) aged 18+ years, (3) had no literal or physical/mental problems and (4) was not pregnant. STUDY MEASURES: MetS was the outcome variable, which was defined based on the diagnostic criteria released by the Chinese Diabetes Society. SES was the main explanatory measure, which was indicated with educational attainment and family average income (FAI), separately. RESULTS: The prevalence of MetS was 19.7% (95% CI=19.0% to 20.4%) among overall participants, and 24.6% (95% CI=23.5% to 25.6%) and 15.5% (95% CI=14.7% to 16.4%) for men and women, respectively. After controlling for potential confounders, participants with either college level (OR=0.51, 95% CI=0.43 to 0.60) or high school level education (OR=0.78, 95% CI=0.70 to 0.90) were at lower odds to experience MetS compared with those with primary education, while only those within upper FAI tertile were at significantly lower risk of MetS relative to their counterparts within lower FAI category (OR=0.85, 95% CI=0.76 to 0.97) among overall participants. Meanwhile, with respect to the five components of MetS, higher educational level predicted lower waist circumference (WC), triglycerides, systolic blood pressure (SBP) and diastolic blood pressure (DBP) and fasting glucose concentration among all participants. And higher FAI was associated with lower WC and SBP and DBP in women, and with lower SBP and DBP in men. CONCLUSIONS: Education and FAI each were inversely associated with MetS and its components at the present stage of economic development in Nanjing Municipality of China. It has important public health implications that the tailored prevention strategies for MetS should be put into consideration of the intervention of MetS components and subgroups of people with different SES.

Effect of statin treatment on mortality in elderly patients with type 2 diabetes mellitus patients: a retrospective cohort study.

BACKGROUND: The effects of statins on the reduction of mortality in individuals aged 75 years or older remain controversial. We conducted this study to investigate whether there is an association between statin therapy and mortality in patients with type 2 diabetes mellitus (T2DM) who are over the age of 75 years. METHODS: The present study used data from the Staged Diabetes Targeting Management Study, which began in 2005. A total of 518 T2DM patients older than 75 years were included. Cox regression analyses were used to evaluate the association between statins and specific causes of death in patients with T2DM. RESULTS: After a follow-up period of 6.09 years (interquartile range 3.94-8.81 years), 111 out of 518 patients died. The results of Cox regression analyses showed that there was no significant association between statin use and all-cause mortality (HR 0.75; 95% CI 0.47, 1.19) after adjustment for all potential confounders. Subgroup analysis indicated that statins had no association with the risk of all-cause mortality or deaths caused by ischemic cardiovascular diseases in T2DM patients with or without coronary heart disease. CONCLUSIONS: Our study found no significant association between all-cause mortality and statin use in T2DM patients over the age of 75 years. More evidence is needed to support the use of statins in the elderly T2DM patients.

The effects of brominated flame retardants (BFRs) on pro-atherosclerosis mechanisms.

Brominated flame-retardants (BFRs) are environmental endocrine disruptors, comprising several pollutants, which potentially affect the endocrine system and cause dysfunction and disease. Widespread BFR exposure may cause multisystem toxicity, including cardiovascular toxicity in some individuals. Studies have shown that BFRs not only increase heart rate, induce arrhythmia and cardiac hypertrophy, but also cause glycolipid metabolism disorders, vascular endothelial dysfunction, and inflammatory responses, all of which potentially induce pre-pathological changes in atherosclerosis. Experimental data indicated that BFRs disrupt gene expression or signaling pathways, which cause vascular endothelial dysfunction, lipid metabolism-related disease, inflammation, and possibly atherosclerosis. Considerable evidence now suggests that BFR exposure may be a pro-atherosclerotic risk factor. In this study, we reviewed putative BFR effects underpinning pro-atherosclerosis mechanisms, and focused on vascular endothelial cell dysfunction, abnormal lipid metabolism, pro-inflammatory cytokine production and foam cell formation. Consequently, we proposed a scientific basis for preventing atherosclerosis by BFRs and provided concepts for further research.

Nanofiber Composite Reinforced Organohydrogels for Multifunctional and Wearable Electronics.

Composite organohydrogels have been widely used in wearable electronics. However, it remains a great challenge to develop mechanically robust and multifunctional composite organohydrogels with good dispersion of nanofillers and strong interfacial interactions. Here, multifunctional nanofiber composite reinforced organohydrogels (NCROs) are prepared. The NCRO with a sandwich-like structure possesses excellent multi-level interfacial bonding. Simultaneously, the synergistic strengthening and toughening mechanism at three different length scales endow the NCRO with outstanding mechanical properties with a tensile strength (up to 7.38 ± 0.24 MPa), fracture strain (up to 941 ± 17%), toughness (up to 31.59 ± 1.53 MJ m-3) and fracture energy (up to 5.41 ± 0.63 kJ m-2). Moreover, the NCRO can be used for high performance electromagnetic interference shielding and strain sensing due to its high conductivity and excellent environmental tolerance such as anti-freezing performance. Remarkably, owing to the organohydrogel stabilized conductive network, the NCRO exhibits superior long-term sensing stability and durability compared to the nanofiber composite itself. This work provides new ideas for the design of high-strength, tough, stretchable, anti-freezing and conductive organohydrogels with potential applications in multifunctional and wearable electronics.

High quality AlN film assisted by graphene/sputtered AlN buffer layer for deep-ultraviolet-LED.

The advantages of van der Waals epitaxial nitrides have become a research hot topic. It is worth noting that graphene plays an important role in the research of epitaxial AlN epitaxial layer. In this work, we demonstrate a method to obtain high-quality and low-dislocation AlN epitaxial layer by combining graphene and sputtered AlN as the nucleation layer on the C-sapphire substrate via metal organic chemical vapor deposition, and successfully fabricated a 277 nm AlGaN-based deep ultraviolet light emitting diode (DUV-LED) based on the obtained AlN epitaxial layer. The presence of graphene promotes the stress release of AlN. Compared with the AlN epitaxial layer directly grown on graphene/sapphire substrate, the exist of sputtered AlN/graphene nucleation layer facilitates most of the threading dislocations in AlN can annihilate each other in the range of about 100 nm. Thus, as grown AlN epitaxial layer shows the decreasing of the screw dislocation from 2.31 × 109to 2.08 × 108cm-2significantly. We manufacture an DUV-LED with 277 nm emission wavelength by using high-quality AlN films, which shows that magnitude of the leakage current is only on the order of nanoamperes and the forward turn on voltage is 3.5 V at room temperature. This study provides a meaningful strategy to achieve high-quality AlN film and high-performance DUV-LED.

Solvent-Exchange-Assisted Wet Annealing: A New Strategy for Superstrong, Tough, Stretchable, and Anti-Fatigue Hydrogels.

Hydrogels are widely used in tissue engineering, soft robots, wearable electronics, etc. However, it remains a great challenge to develop hydrogels possessing simultaneously high strength, large stretchability, great fracture energy, and good fatigue threshold to suit different applications. Herein, a novel solvent-exchange-assisted wet-annealing strategy is proposed to prepare high performance poly(vinyl alcohol) hydrogels by extensively tuning the macromolecular chain movement and optimizing the polymer network. The reinforcing and toughening mechanisms are found to be "macromolecule crystallization and entanglement". These hydrogels have large tensile strengths up to 11.19 ± 0.27 MPa and extremely high fracture strains of 1879 ± 10%. In addition, the fracture energy and fatigue threshold can reach as high as 25.39 ± 6.64 kJ m-2 and ≈1233 J m-2 , respectively. These superb mechanical properties compare favorably to those of other tough hydrogels, organogels, and even natural tendons and synthetic rubbers. This work provides a new and effective method to fabricate superstrong, tough, stretchable, and anti-fatigue hydrogels with potential applications in artificial tendons and ligaments.

The joint association of physical activity and sedentary behavior with metabolic syndrome among urban men aged 60+ years in regional China.

Objectives: Metabolic syndrome (MetS) is a major public health issue worldwide, which is preventable through physical activity (PA) promotion and sedentary behavior (SB) reduction. However, the joint association of PA and SB with MetS was not well-investigated, particularly in elderly people. This study aimed to examine separate and joint associations of PA and SB with MetS among elderly urban men in China. Methods: In this cross-sectional study conducted in mid-2018, participants were urban men aged 60+ years randomly selected from in Nanjing of China. Exposure variables were PA and SB. The outcome variable was MetS. A participant was categorized as "having MetS" or "not having MetS" in the analysis. Independent variables were PA and SB, which were categorized as "sufficient PA or insufficient PA" and "shortened SB or prolonged SB", respectively. Mixed-effects logistics regression models were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the association of PA and SB with MetS. Results: Totally, 5,520 from 5,792 eligible participants were randomly recruited and their mean age was 68.9 (standard deviation: 16.9) years. The prevalence of MetS was 30.8% (95%CI = 29.6%, 32.0%) among urban men aged 60+ years in the study. After adjustment for potential confounders, subjects with sufficient PA were less likely (OR = 0.77, 95%CI = 0.67, 0.88) to experience MetS, independently of SB, relative to their counterparts with insufficient PA, while a lower odds (OR = 0.74; 95%CI = 0.61, 0.89) of experiencing MetS was examined for participants with shortened SB, also independently of PA, compared to those with prolonged SB in the study. Furthermore, compared to participants with insufficient PA and prolonged SB, those either within categories of insufficient PA and shortened SB (OR = 0.81; 95%CI = 0.65, 0.99), sufficient PA and prolonged SB (OR = 0.80; 95%CI = 0.70, 0.92), or sufficient PA and shortened SB (OR = 0.41; 95%CI = 0.26, 0.63) were at significantly lower risk to experience MetS, respectively. Conclusions: PA was negatively associated with MetS, and SB was positively linked to MetS, which were independent of each other. Moreover, sufficient PA and shortened SB might exert additively joint influence on MetS. This study has important implications that concurrent PA promotion and SB reduction shall be encouraged for people to optimize the effectiveness of MetS prevention.

Flexible High-Stability Self-Variable-Voltage Monolithic Integrated System Achieved by High-Brightness LED for Information Transmission.

The emergence of visible light information transmission systems is profoundly affecting the future of the Internet of Things (IoT) technology. The complex sensing and driving circuits of the IoT have become the key factor to hinder signal conversion and processing. Herein, a high-performance self-variable-voltage light information transmission integrated system (SVV-LTS) is reported and its application potential in low-power, self-powered optical communication transmission systems is demonstrated. Diffusion-adsorption regulation growth method and laser induction technology are innovatively used to realize high-brightness light-emitting diode (LED) and flexible micro-supercapacitor (MSC) on graphene. Meanwhile, MSC realizes the dual functions of supplying power to the system, realizing pressure signal response, and converting pressure signals into electrical signals. Finally, the MSC as power, sensor and LED as signal transmitter are integrated into an SVV-LTS. The response time of SVV-LTS is 80 ms and the luminous wavelength fluctuation of the LED is stable at 1.2 nm. This study will provide a new approach to realize low-power optical communication transmission systems affecting the IoT technology.

Syncope as the initial presentation of pulmonary embolism in two patients with hepatocellular carcinoma: Two case reports and literature review.

RATIONALE: Pulmonary embolism (PE) has diverse clinical manifestations and syncope might be the first or only symptom of PE. Tumor disease usually presents with symptoms associated with the primary site, however, PE may be the first manifestation of occult tumors. PATIENT CONCERNS: Here, we report 2 patients admitted to our hospital because of syncope. One patient had a chronic hepatitis B history of more than 20 years and the other patient had chronic heavy drinking for many years. Neither patient had been diagnosed with neoplastic disease before admission. DIAGNOSES: Clinical examinations, including laboratory tests and imaging tests upon admission demonstrated PE resulting in syncope. Furthermore, malignant hepatocellular carcinoma (HCC), inferior vena cava, and right atrium tumor thrombus were diagnosed. INTERVENTIONS: Thrombolysis and anti-coagulation therapy were performed immediately after the diagnosis of PE. Twenty-seven HCC patients with PE in 27 articles from 1962 to 2020 in the PubMed database were reviewed. OUTCOMES: The improvement was achieved that no syncope recurred after treatment of PE. The oxygen partial pressure increased and the D-dimer level decreased. The clinical characteristics of 27 HCC patients with PE were summarized and analyzed. LESSONS: It is important for clinicians to be aware that occult carcinoma might be a reason for patients with PE presenting with syncope. If PE cannot be explained by common causes, such as our patient, and HCC should be highly suspected when inferior vena cava and right atrial mass are found on imaging tests.

Higher than recommend dosage of sublingual isosorbide dinitrate for treating angina pectoris: a case report and review of the literature.

Nitrates primarily cause arterial and venous vasodilation effects, which increases coronary artery blood supply, and decreases cardiac preload and afterload by enhancing nitric oxide (NO) levels. The dosage of nitrates used for angina pectoris widely differs among individuals, and therapeutic resistance and tolerance gradually occur. Increasing doses of nitrates are needed to abolish ischemia chest pain onset in patients with angina pectoris, and to obtain satisfactory therapeutic effects. Here, we report the case of a 37-year-old male who was hospitalized six times, from September 2013 to April 2018, with recurrent angina pectoris. Although the patient was implanted with stents, he still presented with chest pain associated with physical efforts. Diagnosis with acute myocardial infarction was based on his ST-segment changes on electrocardiogram (ECG), elevated troponin-T level and coronary angiography. After the stents were implanted, his chest pain had no relief. Following three times of coronary angiography revealed that distal and small branch vessels still had stenosis, but was not required to revascularization. Due to serious headache resulted from sublingual or oral nitroglycerin; he had to take sublingual isosorbide dinitrate, from 20 mg to 150 mg each time, to obtain rapid relief from angina pectoris without doctor's consent. Followed up to April 2019, the patient has continued to take 100-150 mg sublingual isosorbide dinitrate for angina pectoris onset triggered by physical efforts, and has obtained remarkable relief within a few minutes, without blood pressure decrease and other side effects. Higher than recommend dosage of sublingual isosorbide dinitrate might establish better efficacy for angina pectoris in rarely patient.

High-Quality Transferred GaN-Based Light-Emitting Diodes through Oxygen-Assisted Plasma Patterning of Graphene.

Two-dimensional (2D) release layers are commonly used to realize flexible nitride films. Here, high-quality, large-area, and transferable nitride films can be precisely controlled grown on O2-plasma-assisted patterned graphene. The first-principles calculation indicates that the patterned graphene introduced by O2 plasma changes the original wettability of sapphire and the growth behavior of Al atoms is related with layer number of graphene, which is consistent with experimental results. The as-fabricated violet GaN-based light-emitting diodes (LEDs) show high stability and high light output power (LOP). This work provides a general rule for the growth of high-quality and transferable III-nitride films on graphene from the atomic scale and provide actual demonstration in LED. The advantages of the proposed new growth method can supply new ways for electronic and optoelectronic flexible devices of group III nitride semiconductors.

Association Between D-Dimer Level and In-Hospital Death of Pulmonary Embolism Patients.

To investigate whether D-dimer level could predict pulmonary embolism (PE) severity and in-hospital death, a total of 272 patients with PE were divided into a survival group (n = 249) and a death group (n = 23). Comparisons of patient characteristics between the 2 groups were performed using Mann-Whitney U test. Significant variables in univariate analysis were entered into multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of D-dimer level alone or together with the simplified Pulmonary Embolism Severity Index (sPESI) for in-hospital death. Results showed that patients in the death group were significantly more likely to have hypotension (P = 0.008), tachycardia (P = 0.000), elevated D-dimer level (P = 0.003), and a higher sPESI (P = 0.002) than those in the survival group. Multivariable logistic regression analysis showed that D-dimer level was an independent predictor of in-hospital death (OR = 1.07; 95% CI, 1.003-1.143; P = 0.041). ROC curve analysis showed that when D-dimer level was 3.175 ng/ml, predicted death sensitivity and specificity were 0.913 and 0.357, respectively; and when combined with sPESI, specificity (0.838) and area under the curve (0.740) were increased. Thus, D-dimer level is associated with in-hospital death due to PE; and the combination with sPESI can improve the prediction level.

Combination of D-dimer and simplified pulmonary embolism severity index to improve prediction of hospital death in patients with acute pulmonary embolism.

OBJECTIVE: To investigate whether the combination of D-dimer and simplified pulmonary embolism severity index (sPESI) could improve prediction of in-hospital death from pulmonary embolism (PE). METHODS: Patients with PE (n = 272) were divided into a surviving group (n = 249) and an in-hospital death group (n = 23). RESULTS: Compared with surviving patients, patients who died in hospital had significantly higher rates of hypotension and tachycardia, reduced SaO2 levels, elevated D-dimer and troponin T levels, higher sPESI scores, and were more likely to be classified as high risk. Elevated D-dimer levels and high sPESI scores were significantly associated with in-hospital death. Using thresholds for D-dimer and sPESI of 3.175 ng/mL and 1.5, respectively, the specificity for prediction of in-hospital death was 0.357 and 0.414, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.665 and 0.668, respectively. When D-dimer and sPESI were considered together, the specificity for prediction of in-hospital death increased to 0.838 and the AUC increased to 0.74. CONCLUSIONS: D-dimer and sPESI were associated with in-hospital death from PE. Considering D-dimer levels together with sPESI can significantly improve the specificity of predicting in-hospital death for patients with PE.

Rivaroxaban treatment for young patients with pulmonary embolism (Review).

Pulmonary embolism (PE) is a serious, life-threatening condition that affects young populations (>18 and <50 years old, according to most literature reviews) with improved recognition of its clinical manifestations and the widespread use of sensitive imaging techniques, PE is increasingly diagnosed in younger patients. At present, there is limited understanding of the clinical features and adequate anticoagulant treatment options for this population. Most studies to date have yet to demonstrate significant differences in PE pathophysiology or symptoms between young and elderly patients. Although the overall incidence of PE is lower in young populations compared with elderly patients, important risk factors also apply for young patients. Hereditary thrombophilia is common and is a major cause of PE in younger patients. Immobilization, trauma, obesity, smoking and infection are also becoming increasingly frequent in young patients with PE. Among female patients, oral contraceptive use, pregnancy and postpartum status are predominant risk factors underlying PE. Rivaroxaban is a direct oral anticoagulant with a rapid onset of action that is associated with less drug-drug interactions compared with other therapies. Because the drug is administered at fixed doses with no requirement for routine coagulation monitoring, it is becoming an attractive option for anticoagulation treatment in young patients with PE. Therefore, the present literature review focuses on the clinical characteristics of PE and rivaroxaban therapy in younger patients.

Identification of foam cell biomarkers by microarray analysis.

BACKGROUND: Lipid infiltration and inflammatory response run through the occurrence of atherosclerosis. Differentiation into macrophages and foam cell formation are the key steps of AS. Aim of this study was that the differential gene expression between foam cells and macrophages was analyzed to search the key links of foam cell generation, so as to explore the pathogenesis of atherosclerosis and provide targets for the early screening and prevention of coronary artery disease (CAD). METHODS: The gene expression profiles of GSE9874 were downloaded from Gene Expression Omnibus (https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE9874) on GPL96 [HG-U133A] Affymetrix Human Genome U133. A total of 22,383 genes were analyzed for differentially expression genes (DEGs) by Bayes package. GO enrichment analysis and KEGG pathway analysis for DEGs were performed using KOBAS 3.0 software (Peking University, Beijing, China). STRING software (STRING 10.0; European Molecular Biology Laboratory, Heidelberg, Germany) was used to analyze the protein-protein interaction (PPI) of DEGs. RESULTS: A total of 167 DEGs between macrophages and foam cells were identified. Compared with macrophages, 102 genes were significantly upregulated and 65 genes were significantly downregulated (P < 0.01, fold-change > 1) in foam cells. DEGs were mainly enrich in 'sterol biosynthetic and metabolic process', 'cholesterol metabolic and biosynthetic process' by GO enrichment analysis. The results of KEGG pathway analysis showed all differential genes are involved in biological processes through 143 KEGG pathways. A PPI network of the DEGs was constructed and 10 outstanding genes of the PPI network was identified by using Cytoscape, which include HMGCR, SREBF2, LDLR, HMGCS1, FDFT1, LPL, DHCR24, SQLE, ABCA1 and FDPS. CONCLUSION: Lipid metabolism related genes and molecular pathways were the key to the transformation of macrophages into foam cells. Therefore, lipid metabolism disorder is the key to turn macrophages into foam cells, which plays a major role in CAD.

Current status of rivaroxaban in elderly patients with pulmonary embolism (Review).

Acute pulmonary embolism (PE) occurs with a high incidence rate in elderly patients, demonstrating complex clinical manifestations, as well as a difficult anticoagulant treatment strategy. Currently, there is limited understanding of the selection criteria for anticoagulant treatment in elderly patients with PE. In fact, the vitamin K antagonist warfarin, a commonly prescribed anticoagulant, has multiple disadvantages, including a narrow therapeutic range, unpredictable pharmacokinetics, multiple food and drug interactions and genetic polymorphisms resulting in poor response to this therapy; therefore, routine laboratory monitoring is required. Most elderly patients with PE fail to adhere to the treatment regimen or even discontinue it, and clinicians are equally hesitant to initiate oral anticoagulants in elderly patients with PE. This leads to a dilemma regarding the use of anticoagulation therapies and a worse prognosis for the patients. Rivaroxaban, a direct Xa factor inhibitor, has demonstrated considerable practical and clinical advantages, exhibits fast-start action pharmacokinetic and pharmacodynamic characteristics, and has an enhanced predictable anticoagulant effect with fewer drug-drug interactions. Based on randomized controlled trials and real-world clinical practice, rivaroxaban has also been recognized as a safe and effective anticoagulant, and these advantages have improved the therapeutic compliance of elderly patients with PE. Thus, this review focused on the current status of rivaroxaban treatment for elderly patients with PE, and described its significance in changing the current anticoagulation treatment regimens for patients. It is expected that rivaroxaban will become a good choice for the treatment of PE in elderly patients.