Hospitalized patients with isolated distal deep vein thrombosis: anticoagulation therapy or not?

BACKGROUND: Isolated distal deep vein thrombosis (IDDVT), a disease frequently detected in hospitalized patients, can progress to proximal deep vein thrombosis (PDVT) and pulmonary embolism (PE). Here, we evaluated the effects of anticoagulation in hospitalized IDDVT patients. METHODS: We conducted a retrospective study in our hospital and enrolled hospitalized IDDVT patients diagnosed by compression ultrasonography (CUS) from January to December 2020. Participants were divided into anticoagulation (AC) and non-anticoagulation (non-AC) groups. After propensity score matching (PSM), multivariate Cox regression analyses were performed to assess whether anticoagulation was associated with PDVT/PE, and all-cause mortality. RESULTS: A total of 426 IDDVT inpatients with CUS follow-up were screened from 1502 distal DVT patients and finally enrolled. The median age was 67 years with 51.4% males and 15.5% cancer patients. The median follow-up was 11.6 months. There were 288 and 138 patients treated with or without anticoagulants, respectively. Patients in the non-AC group had less body mass index and more comorbidities. Patients in the AC group were treated with rivaroxaban or dabigatran (52.1%), low molecular weight heparin (42.7%), and warfarin (5.2%). The PSM generated 111 pairs of well-matched IDDVT patients with or without anticoagulation. The Kaplan-Meier analysis demonstrated that neither the incidence of PDVT/PE (5.4% vs. 2.7%, log-rank p = 0.313) nor all-cause mortality (27.9% vs. 18.9%, log-rank p = 0.098) was significant different between groups. Anticoagulation was not associated with PDVT/PE and all-cause mortality in the multivariable Cox regression analyses using the matched cohorts. The main risk factors for all-cause mortality were age, malignancy history, BMI, sepsis, heart failure, and white blood cell (WBC) count. CONCLUSIONS: In hospitalized IDDVT patients, the thrombosis extension rate to PDVT/PE was low. Anticoagulation did not reduce the incidence of thrombosis extension of IDDVT and was not associated with all-cause mortality.

Effects of Aggregate Types on the Stress-Strain Behavior of Fiber Reinforced Polymer (FRP)-Confined Lightweight Concrete.

The realization of reducing concrete self-weight is mainly to replace ordinary aggregates with lightweight aggregates; such replacement usually comes with some intrinsic disadvantages in concrete, such as high brittleness and lower mechanical properties. However, these shortages can be effectively remedied by external confinement such as fiber reinforced polymer (FRP) jacketing. To accurately predict the stress-strain behavior of lightweight concrete with lateral confinement, it is necessary to properly understand the coupling effects that are caused by diverse aggregates types and confinement level. In this study, FRP-confined lightweight concrete cylinder with varying aggregate types were tested under axial compression. Strain gauges and linear variable displacement transducers were used for monitoring the lateral and axial deformation of specimens during the tests. By sensing the strain and deformation data for the specimens under the tri-axial loads, the results showed that the lateral to axial strain relation is highly related to the aggregate types and confinement level. In addition, when compared with FRP-confined normal weight aggregate concrete, the efficiency of FRP confinement for lightweight concrete is gradually reduced with the increase of external pressure. Replace ordinary fine aggregate by its lightweight counterparts can be significantly improved the deformation capacity of FRP-confined lightweight concrete, meanwhile does not lead to the reduction of compressive strength. Plus, this paper modified a well-established stress-strain model for an FRP-confined lightweight concrete column, involving the effect of aggregate types. More accurate expressions pertaining to the deformation capacity and the stress-strain relation were proposed with reasonable accuracy.

Psychotherapies for prolonged grief disorder in adults: A systematic review and network meta-analysis.

BACKGROUND: Prolonged grief disorder (PGD), a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Psychotherapies are among the most recommended treatments for PGD, but which should be considered as first-line treatment needs to be clarified. The purpose of this systematic review and network meta-analysis was to synthesize the available evidence to compare five outcomes of different psychotherapies on PGD in adults and identify the optimal psychotherapy modality to inform clinical decision-making for the treatment of PGD. METHOD: A comprehensive search was conducted in 7 databases from inception until March 20th, 2023. In the frequentist framework, pairwise and network meta-analyses using random-effects models were performed for outcomes with 95 % confidence interval (CI). RESULTS: There were 2962 records found and 55 studies (1,0330 participants) assessing 11 different psychological interventions were included. Compared with the waiting list, behavioral therapy (SMD=-1.05; 95 %CI=-1.71, -0.38), third-wave cognitive behavior therapy (SMD=-1.00; 95 %CI =-1.41, -0.58), family therapy (SMD=-0.87; 95 %CI=-1.59, -0.16), psychodynamic therapy (SMD=-0.88; 95 %CI=-1.67, -0.10) and cognitive therapy (SMD=-0.84; 95 %CI=-1.57, -0.12) were statistically effective in reducing grief symptom. Only cognitive behavior therapy (OR =0.48; 95 %CI = 0.27, 0.85) was more acceptable than waiting list. In terms of secondary outcome, third-wave CBT can statistically significantly reduce depression (SMD= -0.60; 95 %CI =- 0.84, -0.36), PTSD (SMD=-0.99; 95 %CI =- 1.62, -0.36) and anxiety (SMD= -1.44; 95 %CI =-2.63, -0.25) respectively. CONCLUSIONS: Most psychological interventions are effective, but only cognitive behavior therapy has the highest acceptability. Third-wave CBT with higher efficacy rates may be more beneficial for reducing secondary outcomes. To provide more robust evidence, high-quality trials should be conducted in the future.

The association between childhood adverse experiences and internet addiction: A meta-analysis.

Many studies have explored the association between adverse childhood experiences (ACEs) and Internet addiction (IA), yet the research findings on the association between them are inconclusive. We conducted a systematic search on 7 databases to identify the relevant studies published until January 2023, and analyzed the findings from 37 studies across 12 countries involving 45,364 participants aged 8 to 67 years (51 % women). Results indicated a positive correlation (r = 0.21) was found between ACE and IA around the world, which differed among continents. It was found that all ACE subtypes were significantly associated with IA (range r = 0.16 to 0.25). Meta-regression showed a stronger association among younger individuals without moderating effects of gender or publication year. In conclusion, this study sheds light on the significant association between ACEs and IA, emphasizing the need for targeted interventions and preventive measures. Future research could delve into specific interventions aimed at mitigating the impact of ACEs on IA, such as cognitive-behavioral therapies or metacognitive therapy interventions. Additionally, investigating cultural factors that may influence this association could provide valuable insights into tailored approaches for different populations. Understanding these dynamics is crucial for developing effective strategies to address IA and its underlying factors.

B-type natriuretic peptide levels at admission predict the prognosis of patients with infective endocarditis undergoing cardiac surgery.

Purpose: The objective of this study was to explore the relationship between elevated B-type natriuretic peptide (BNP) levels and the prognosis of patients with infective endocarditis (IE) undergoing cardiac surgery. Methods: In total, 162 IE patients with recorded BNP levels upon admission were included in the present study. The primary end point was all-cause mortality. Results: Multivariate Cox analysis revealed a significant association between log BNP and all-cause mortality. Kaplan-Meier analysis revealed a poorer prognosis for patients with BNP levels ≥ the 75th percentile. Furthermore, the linear trend test indicated a significant link between BNP quartiles and the primary end point within the models. Conclusion: Elevated BNP levels upon admission could predict all-cause mortality in IE patients undergoing cardiac surgery.

Infective endocarditis (IE) refers to an infection affecting the heart lining, heart valves or blood vessels. Despite advancements in medical and surgical interventions, the overall mortality rate remains high among IE patients after surgery. B-type natriuretic peptide (BNP) is a peptide released in response to increased stress on the ventricular and atrial walls and is commonly used as a biomarker for heart failure. This study was aimed to assess the potential of BNP in predicting all-cause mortality in IE patients. The results indicate that elevated BNP levels upon admission could predict a worse prognosis following endocarditis surgery. Additionally, elevated BNP levels upon admission were associated with an increased risk of death.

Does postcholecystectomy increase the risk of colorectal cancer?

With the increasing number of cholecystectomy and the high proportion of colorectal cancer in malignant tumors, the question of whether cholecystectomy is a risk factor for colorectal disease has been widely concerned. After reviewing the literature at home and abroad, the authors will summarize the research progress of the correlation between the occurrence of colorectal tumors after cholecystectomy, in order to provide help for the prevention and treatment of colorectal tumors.

Impact of coronary artery disease in patients with hypertrophic cardiomyopathy.

BACKGROUND: Atherosclerotic coronary artery disease (CAD) often occurs concurrently with hypertrophic cardiomyopathy (HCM). However, the influence of concomitant CAD has not been fully assessed in patients with HCM. METHODS: Invasive or computed tomography coronary angiography was performed in 461 patients with HCM at our hospital to determine the presence and severity of CAD from March 2010 to April 2022. The primary end points were all-cause, cardiovascular, and sudden cardiac deaths. The survival of HCM patients with severe CAD was compared with that of HCM patients without severe CAD. RESULTS: Of 461 patients with HCM, 235 had concomitant CAD. During the median (interquartile range) follow-up of 49 (31-80) months, 75 patients (16.3%) died. The 5-year survival estimates were 64.3%, 82.5%, and 86.0% for the severe, mild-to-moderate, and no-CAD groups, respectively (log-rank, p = 0.010). Regarding the absence of cardiovascular death, the 5-year survival estimates were 68.5% for patients with severe CAD, 86.4% for patients with mild-to-moderate CAD, and 90.2% for HCM patients with no CAD (log-rank, p = 0.001). In multivariate analyses, severe CAD was associated with all-cause and cardiovascular death after adjusting for age, left ventricular ejection fraction, hypertension, and atrial fibrillation. CONCLUSIONS: This study showed a worse prognosis among HCM patients with severe CAD than among HCM patients without severe CAD. Therefore, timely recognition of severe CAD in HCM patients and appropriate treatment are important.

Reliability-Based Design Analysis for FRP Reinforced Compression Yield Beams.

Fiber-reinforced polymers (FRPs) provide promising prospects for replacing steel bars in traditional reinforced concrete structures. However, the use of FRP as tension bars in concrete beams leads to insufficient ductility because of its elastic characteristics. A newly developed compression-yielding (CY) beam has successfully solved this issue. Instead of tensile reinforcement yield, the ductile deformation of a CY beam is realized by the compression yield of a CY block in the compressive region. Another important feature is that the CY block is also the fuse of the beam, where material damage to the beam is concentrated in the CY block region and can be easily replaced. As a load-bearing recoverable and ductile structure, it is necessary to conduct a reliability-based design analysis and recommend reduction factors for this new structure. In this study, the function for calculating the failure probability of CY beams is proposed, semi-probabilistic design recommendations are presented, and Monte Carlo simulation (MCS) is adopted as a reliability analysis method. This study discusses the influence of the possible characteristics of the critical variables on reliability and provides the reliability index with different reduction factors to guide the design of the CY beam. These analyses indicate that the reliability index can be improved from the material design of the CY block in greater strength fb, smaller depth, smaller coefficient of variation of fb, and yield modulus ratio ξ. This study also shows that compared with the design of FRP concrete beams, the ductile failure mode of the CY beams allows a lower safety factor to meet safety requirements, which significantly reduces construction costs and avoids over-designing the load-bearing capacity.

Effect of Aggregate Size on the Axial Compressive Behavior of FRP-Confined Coral Aggregate Concrete.

Using locally available raw materials for preparing concrete, such as coral reefs, seawater, and sea sand, is conducive to compensating for the shortage of construction materials used on remote islands. Jacketing fiber-reinforced polymer (FRP), as passive confinement, is a practical approach to enhance the strength, ductility, and durability of such coral aggregate concrete (CAC). Rational and economical CAC structural design requires understanding the interactions between the CAC fracture process and FRP confinement. The coral aggregate size is the critical parameter of their interaction since it affects the crack propagation of CAC and FRP confinement efficiency. This study conducted axial compression tests on FRP-confined CAC cylinders with varying coral aggregate sizes and FRP confinement levels. The test results indicate that the coral aggregate sizes affected the unconfined CAC strength. In addition, the dilation behavior of FRP-confined CAC varied with aggregate sizes, showing that CAC with smaller coral aggregate featured a more uniform hoop strain distribution and larger FRP rupture strain. These coupling effects are epitomized by the variation in the transition stress on the stress-strain curve, which makes the existing stress-strain models not applicable for FRP-confined CAC. A modified stress-strain model is subsequently proposed. Finally, the practical and environmental implications of the present study are discussed.

Fermented Dairy Food Intake and Risk of Colorectal Cancer: A Systematic Review and Meta-Analysis.

It was highly controversial whether fermented dairy foods protect against colorectal cancer (CRC) because of conflicting results from current human epidemiologic studies; we therefore conducted this meta-analysis based on the case-control and cohort studies to estimate the holistic analyses. Finally, a total of seven case-control studies and ten cohort studies comprising a total of >20,000 cases were incorporated in the quantitative synthesis. Specifically, statistical evidence of significantly decreasing CRC risk in case-control studies was found to be associated with cheese intake (OR = 0.89, 95% CI = 0.82-0.97). In a subgroup analysis, cheese intake was correlated with lower colon cancer (OR = 0.89, 95% CI = 0.79-1.00) and rectal cancer (OR = 0.86, 95% CI = 0.74-1.00) risk in case-control studies. Furthermore, we also found that the higher intake of yogurt may lower the risk of rectal cancer (OR = 0.75, 95% CI = 0.65-0.88) in cohort studies. The consumption of fermented dairy foods may be relevant to decrease CRC risk in this meta-analysis. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021269798, CRD42021269798.

Maintenance of recovered dilated cardiomyopathy patients with half-dose neurohumoral blockades (MED-CHARM): A protocol for an open-label, pilot, randomized trial.

Dilated cardiomyopathy (DCM) has brought great damage to the patients' health and social economy. The number of patients with recovered dilated cardiomyopathy (recDCM) has increased over the years as treatment progresses. However, there is a lack of relevant evidence to support the clinical management of patients with recDCM, thereby, the recommendations in guidelines remains sparse. Accordingly, the exploration of recDCM is important to improve patient prognosis and reduce societal burden. This is an open-label, randomized controlled, prospective study that will compare the safety and efficacy of original dose and halved dose of neurohumoral blockades for patients with recDCM. Methods: An open-label, randomized controlled, prospective study will be conducted among eligible patients with recDCM. During the pilot study phase, we will recruit 50 patients. The primary endpoint is hospitalization for heart failure or heart failure relapse within 12 months. Secondary endpoint is major adverse cardiovascular events, including cardiovascular mortality, myocardial infarction, stroke, sustained atrial tachycardia, or ventricular tachycardia. The results will be analyzed using intention-to-treatment analysis. Discussion: The study will provide important evidence of whether it is safe and effective to halve the dosage of neurohumoral blockades in recDCM patients. Trial registration number: ChiCTR2100054051 (www.chictr.org.cn).

Identification of Critical Genes and Signaling Pathways in Human Monocytes Following High-Intensity Exercise.

BACKGROUND: Monocytes are critical components, not only for innate immunity, but also for the activation of the adaptive immune system. Many studies in animals and humans have demonstrated that monocytes may be closely associated with chronic inflammatory diseases and be proved to be pivotal in the association between high-intensity exercise and anti-inflammation response. However, the underlying molecular mechanisms driving this are barely understood. The present study aimed to screen for potential hub genes and candidate signaling pathways associated with the effects of high-intensity exercise on human monocytes through bioinformatics analysis. MATERIALS AND METHODS: The GSE51835 gene expression dataset was downloaded from the Gene Expression Omnibus database. The dataset consists of 12 monocyte samples from two groups of pre-exercise and post-exercise individuals. Identifying differentially expressed genes (DEGs) with R software, and functional annotation and pathway analyses were then performed with related web databases. Subsequently, a protein-protein interaction (PPI) network which discovers key functional protein and a transcription factors-DEGs network which predicts upstream regulators were constructed. RESULTS: A total of 146 differentially expressed genes were identified, including 95 upregulated and 51 downregulated genes. Gene Ontology analysis indicated that in the biological process functional group, these DEGs were mainly involved in cellular response to hydrogen peroxide, response to unfolded protein, negative regulation of cell proliferation, cellular response to laminar fluid shear stress, and positive regulation of protein metabolic process. The top five enrichment pathways in a Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were the FoxO signaling pathway, protein processing in the endoplasmic reticulum, influenza A, the ErbB signaling pathway, and the MAPK signaling pathway. TNF, DUSP1, ATF3, CXCR4, NR4A1, BHLHE40, CDKN1B, SOCS3, TNFAIP3, and MCL1 were the top 10 potential hub genes. The most important modules obtained in the PPI network were performed KEGG pathway analysis, which showed that these genes were mainly involved in the MAPK signaling pathway, the IL-17 signaling pathway, the TNF signaling pathway, osteoclast differentiation, and apoptosis. A transcription factor (TF) target network illustrated that FOXJ2 was a critical regulatory factor. CONCLUSIONS: This study identified the essential genes and pathways associated with exercise and monocytes. Among these, four essential genes (TNF, DUSP1, CXCR4, and NR4A1) and the FoxO signaling pathway play vital roles in the immune function of monocytes. High-intensity exercise may improve the resistance of chronic inflammatory diseases by regulating the expression of these genes.

Flexural Fatigue Properties of Ultra-High Performance Engineered Cementitious Composites (UHP-ECC) Reinforced by Polymer Fibers.

In recent years, the application of engineered cementitious composites (ECCs) in structures subjected to cyclic fatigue loading, such as highway bridges, has gained widespread attention. However, most existing ECCs do not have sufficient strength and ductility, which limits their applications, especially in highway bridge structures under high-stress. In this work, an ultra-high performance engineered cementitious composite (UHP-ECC) was configured, which had a compressive strength of approximately 120 MPa, a tensile strength of up to 12 MPa, and a tensile strain capacity of more than 8%. This paper presents a study of the fatigue performance of UHP-ECC at four different fatigue stress levels through the four-point bending test. The mid-span deflection of the specimen was monitored along with the crack opening displacement (COD) of the pure bending section at the bottom of the specimen, and the crack width. In addition, the dissipated energy was calculated at various stress levels. The progressive formation of cracks under static loading was monitored using the digital image correlation (DIC) technique. The fibers at the fractured surface of the specimens were observed and analyzed by environmental scanning electron microscopy, and the morphology of the fibers was obtained at different fatigue stress levels. Eventually, the fatigue life under different stress levels was obtained, and the relationship between the fatigue life and the stress level was established.