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Pulmonary embolisms are frequently and prognostically in individuals infected by coronavirus disease 2019 (COVID-19); the incidence of pulmonary embolisms is varied across numerous studies. This study aimed to assess the pooled incidence of pulmonary embolic events and the prognostic value of such events in intensive care unit (ICU) admissions of patients with COVID-19. The Cochrane Library, PubMed, and EmBase were systematically searched for eligible studies published on or before October 20, 2021. The pooled incidence of pulmonary embolism was calculated using the random-effects model. Moreover, the prognostic value was assessed by measuring the sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Thirty-six studies involving 10,367 COVID-19 patients were selected for the final meta-analysis. The cumulative incidence of pulmonary embolism in patients with COVID-19 was 21% (95% confidence interval [95%CI]: 18-24%; P<0.001), and the incidence of pulmonary embolism in ICU and non-ICU patients was 26% (95%CI: 22-31%; P<0.001) and 17% (95%CI: 14-20%; P<0.001), respectively. The predictive role of pulmonary embolism in ICU admission was also assessed, and the sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.31 (95%CI: 0.21-0.42), 0.84 (95%CI: 0.75-0.90), 1.88 (95%CI: 1.45-2.45), 0.83 (95%CI: 0.75-0.91), 2.25 (95%CI: 1.64-3.08), and 0.61 (95%CI: 0.57-0.65), respectively. This study found that the incidence of pulmonary embolism was relatively high in COVID-19 patients, and the incidence of pulmonary embolism in ICU patients was higher than that in non-ICU patients.

This study evaluated the causal relationship between matrix metalloproteinases (MMPs) and pulmonary embolism using data from the genome-wide association study (GWAS) of pulmonary embolism from the UK Biobank and a GWAS dataset of MMPs based on 5,457 Icelanders aged 65 years and older. MR-Egger, MR-PRESSO, Cochran’s Q, and leave-one-out were used for sensitivity analysis. The Mendelian randomization (MR) analysis, based on the IVW analysis, indicated an elevated risk for pulmonary embolism in association with MMP19 (OR = 1.0009, 95%CI: 1-1.0017, P  = 0.041), consistent with the weighted median method results ( P  = 0.015). In addition, despite the negative result from the IVW method ( P  = 0.554), the weighted median analysis suggested a reduced risk for pulmonary embolism related to MMP12 (OR = 0.9992, 95%CI: 0.9984-1, P  = 0.038). No causal associations were found for the other MMPs (including MMP1, MMP2, MMP3, MMP7, MMP8, MMP9, MMP10, MMP13, MMP14, MMP16, MMP17, and MMP20) on pulmonary embolism (all P  > 0.05). The reverse MR analysis revealed no causal associations between pulmonary embolism as exposure and MMPs as outcomes. Sensitivity analyses confirmed the robustness of these findings. In conclusion, this MR analysis revealed the potential causal relationship between MMPs and pulmonary embolism, suggesting that measuring MMPs could help identify people at higher risk of pulmonary embolism, but further research is needed.

Adaptive cruise control (ACC) is recognized as an effective method to improve vehicle safety and reduce driver workload. This paper proposes a whole hierarchical multi-level state ACC system. According to the function of ACC system, the three-level state ACC system is designed and the conversion mechanism between different states is put forward. As for the complex car-following mode, considering the variable headway safety distance and the road adhesion coefficient, the expected safety distance model is established, using the distance error and the speed error as fuzzy input, based on the fuzzy control algorithm, the following mode is obtained; considering vehicle safety, tracking capability and ride comfort, the control objectives are formulated into the model predictive control algorithm. A dynamic weight strategy is proposed to solve time-varying multi-objective control problems, where the weight can be adjusted with respect to different following conditions. The simulation results demonstrate that the car following performance of ACC with the proposed dynamic weighted MPC can provide better performance than that using constant weight MPC, and the multi-level state ACC system can display the control mode more intuitively.

Objective The concurrence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea syndrome (OSAS) is defined as overlap syndrome (OS), but investigations into predictors of OS in patients with COPD remain limited. Here, potential markers of OS in patients with COPD were investigated, and results of intubation were compared between patients with COPD only or OS. Methods This retrospective study included patients with COPD who were divided according to OS diagnosis: COPD only (COPD group) or OS (OS group). Results Among 206 patients with COPD, 120 were diagnosed with OS. Mean body mass index (BMI) was significantly higher in the OS versus COPD group (28.95 ± 2.96 versus 23.84 ± 4.06, respectively). Receiver operating characteristic curve analyses revealed that BMI was associated with OS (area under the curve, 0.835). The rate of invasive intubation within 48 h was lower in the OS versus COPD group (9.2% versus 20.9%, respectively), and the duration of noninvasive ventilation was longer in the OS versus COPD group. Conclusions BMI may be a predictor of OS in patients with COPD. The duration of noninvasive ventilation was longer in patients with OS than in patients with COPD alone.

Background Due to the latent onset of novel coronavirus disease 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies. This study aimed to identify the factors associated with increased COVID-19 severity and evaluate the current antiviral drugs, especially in severe patients. Methods This was a retrospective observational study performed at the No. 7 Hospital of Wuhan (Wuhan, China) with hospitalized patients confirmed with COVID-19 from January 11 to March 13, 2020. Multivariable logistic regression analysis was used to identify the associated factors of severe COVID. Treatments of antivirus drugs were collected and evaluated. Results Of the 550 patients, 292 (53.1%) were female and 277 (50.4%) were  >  60 years old. The most common symptom was fever ( n  = 372, 67.7%), followed by dry cough ( n  = 257, 46.7%), and dyspnea ( n  = 237, 43.1%), and fatigue ( n  = 224, 40.7%). Among the severe patients, 20.2% required invasive ventilator support and 18.0% required non-invasive ventilator. The identified risk factors for severe cases were: age ≥ 60 years (odds ratio (OR) =3.02, 95% confidence interval (CI): 1.13–8.08, P  = 0.028), D-dimer > 0.243 μg/ml (OR = 2.734, 95%CI: 1.012–7.387, P  = 0.047), and low oxygenation index (OR = 0.984, 95%CI: 0.980–0.989, P  < 0.001). In severe cases, the benefits (relief of clinical symptoms, clinical outcome, and discharge rate) of arbidol alone was 73.3%, which was better than ribavirin (7/17, 41.2%, P  = 0.029). Conclusions Age  >  60 years, D-dimer > 0.243 μg/ml, and lower oxygenation index were associated with severe COVID-19. Arbidol might provide more clinical benefits in treating patients with severe COVID-19 compared with ribavirin.

Metagenomic next-generation sequencing (mNGS) enables simultaneous sequencing of DNA fragments for comprehensive pathogen identification. Pneumonia in immunocompromised patients-characterized by atypical clinical manifestations and rapid progression-poses diagnostic challenges. Conventional microbiological testing (CMT), which relies on pathogen culture and serological assays, is limited by prolonged turnaround times and suboptimal detection rates. This study was performed to evaluate the clinical utility of mNGS through comparative analysis with CMT in detecting pathogens among immunocompromised patients with pneumonia. We conducted a retrospective cohort study of 146 immunocompromised patients with suspected pneumonia. The mNGS and CMT results were systematically analyzed. Pathogen detection rates and microbial spectrum concordance were visualized using pie and bar charts. Diagnostic performance was compared using McNemar's test and Kappa (κ) statistics for inter-method agreement. The sensitivity, specificity, accuracy, and area under the curve were calculated for pathogen-specific evaluations. mNGS demonstrated superior detection efficacy, identifying pathogens in 98 cases versus 50 by CMT, with 48 overlapping positives. The microbial spectrum showed substantial differences: mNGS detected 73 bacterial, 46 fungal, and 45 viral pathogens, whereas CMT identified 38 bacterial, 27 fungal, and 21 viral agents. mNGS outperformed CMT across all infection types, including single-pathogen infections (bacterial, fungal, or viral only) and mixed infections (bacterial + fungal, bacterial + viral, fungal + viral, or bacterial + fungal + viral). Bacterial and fungal detections showed low inter-method concordance, while viral detection exhibited moderate agreement (κ = 0.510, < 0.001). Notably, mNGS achieved significantly higher detection rates for and in intensive care unit (ICU)-admitted patients with severe pneumonia ( < 0.05). Clinical outcomes improved in 45 patients following mNGS-guided therapeutic adjustments. mNGS and CMT demonstrate complementary strengths in bacterial and fungal detection in immunocompromised patients with pneumonia. mNGS provides enhanced diagnostic accuracy for key pathogens such as and , particularly in severe and ICU-admitted cases. As a high-throughput diagnostic tool, mNGS may improve pathogen detection and clinical management in immunocompromised populations.

Background A large proportion of pulmonary embolism (PE) heritability remains unexplained, particularly among the East Asian (EAS) population. Our study aims to expand the genetic architecture of PE and reveal more genetic determinants in Han Chinese. Methods We conducted the first genome-wide association study (GWAS) of PE in Han Chinese, then performed the GWAS meta-analysis based on the discovery and replication stages. To validate the effect of the risk allele, qPCR and Western blotting experiments were used to investigate possible changes in gene expression. Mendelian randomization (MR) analysis was employed to implicate pathogenic mechanisms, and a polygenic risk score (PRS) for PE risk prediction was generated. Results After meta-analysis of the discovery dataset (622 cases, 8853 controls) and replication dataset (646 cases, 8810 controls), GWAS identified 3 independent loci associated with PE, including the reported loci FGG rs2066865 ( p -value = 3.81 × 10 −14 ), ABO rs582094 ( p -value = 1.16 × 10 −10 ) and newly reported locus FABP2 rs1799883 ( p -value = 7.59 × 10 −17 ). Previously reported 10 variants were successfully replicated in our cohort. Functional experiments confirmed that FABP2-A163G (rs1799883) promoted the transcription and protein expression of FABP2 . Meanwhile, MR analysis revealed that high LDL-C and TC levels were associated with an increased risk of PE. Individuals with the top 10% of PRS had over a fivefold increased risk for PE compared to the general population. Conclusions We identified FABP2 , related to the transport of long-chain fatty acids, contributing to the risk of PE and provided more evidence for the essential role of metabolic pathways in PE development.

The prevalence of venous thrombus embolism (VTE) in patients with chronic obstructive pulmonary disease (COPD) is higher than in patients without COPD. Owing to the similarity of clinical symptoms between PE and acute exacerbation COPD (AECOPD), PE is likely to be overlooked or underdiagnosed in patients with AECOPD. The aim of the study was to investigate the prevalence, risk factor, clinical characteristics, and prognostic impact of VTE in patients with AECOPD. This multicenter, prospective, cohort study was conducted in 11 research centers of China. Data on the baseline characteristics, VTE-related risk factors, clinical symptoms, laboratory examination results, computed tomography pulmonary angiography (CTPA) and lower limb venous ultrasound of AECOPD patients were collected. Patients were followed up for 1 year. A total of 1580 AECOPD patients were included in the study. The mean (SD) age was 70.4 (9.9) years and 195 (26%) patients were women. The prevalence of VTE was 24.5% (387/1580) and PE was 16.8% (266/1580). VTE patients were older; had higher BMI; and longer course of COPD than non-VTE patients. The history of VTE, cor pulmonale, less purulent sputum, increased respiratory rate, higher D-dimer, and higher NT-proBNP/BNP were independently associated with VTE in hospitalized patients with AECOPD. The mortality at 1-year was higher in patients with VTE than patients without VTE (12.9% vs 4.5%, p<0.01). There was no significant difference in the prognosis of patients with PE in segmental or subsegmental arteries and in main pulmonary arteries or lobar arteries (P>0.05). VTE is common in COPD patients and is associated with poor prognosis. Patients with PE at different locations had poorer prognosis than patients without PE. It is necessary to perform active screening strategy for VTE in AECOPD patients with risk factors.

Hypoxic pulmonary hypertension (HPH) lacks effective treatments. The research is designed to examine the effectiveness of Notoginsenoside R1 (NGR1) in addressing HPH and to explore its molecular mechanisms. Under hypoxic conditions, we created a rat model of HPH and treated the animals with NGR1. We assessed the therapeutic effects of NGR1 on HPH through hemodynamic measurements and pulmonary artery vascular remodeling. We employed transcriptomic analysis to evaluate gene expression changes in HPH rats. We conducted untargeted metabolomics to examine how NGR1 influences the metabolic profile of HPH rats. NGR1 treatment significantly improved hemodynamic parameters and ameliorated pulmonary artery vascular remodeling in HPH rats. Transcriptomic analysis identified Pck1 as the most significantly altered gene. NGR1 intervention significantly improved the expression of vascular remodeling‐related proteins. NGR1 reversed the expression of glycolysis‐related genes. NGR1 reduced the levels of glycolysis‐related metabolites. Further analysis revealed that NGR1 treatment decreased PFKL, HK2, and LDHA protein expression and lowered lactate levels in lung tissue. Our findings demonstrate that NGR1 effectively alleviates the pathological features of HPH in rats. NGR1 inhibits hypoxia‐induced glycolysis‐mediated pulmonary artery remodeling, mitigates vascular endothelial damage, and suppresses the abnormal proliferation of smooth muscle cells and fibroblasts.

Background Pre‐Omicron studies identified chronic obstructive pulmonary disease (COPD) as a significant risk factor for adverse COVID‐19 outcomes. Given Omicron's altered pathogenicity and widespread population‐level immunity, the association between COPD and COVID‐19 outcomes warrants reassessment in light of the variant's distinct clinical profile. We evaluated whether COPD remained a risk factor for poor clinical outcomes among hospitalized patients with SARS‐CoV‐2 infection during Omicron predominance. Methods We conducted a two‐center retrospective cohort study of 1176 adults hospitalized with confirmed Omicron infection between January 2022 and December 2023 in Northern China. Patients were stratified by pre‐existing COPD status. To address confounding by treatment selection, inverse probability weighting (IPW) was applied based on the likelihood of receiving inhaled corticosteroids. Multivariable logistic regression models, adjusted for comorbidities, disease severity (as measured by the PSI), inflammatory markers (CRP, D‐dimer, NLR, LDH), and treatment regimens, were used to evaluate the associations between COPD and in‐hospital outcomes. Results Among 1176 patients (337 COPD; 839 non‐COPD), COPD patients had significantly lower PSI scores and lower levels of systemic inflammation despite a higher prevalence of respiratory comorbidities. In unadjusted models, COPD was associated with reduced odds of mortality (OR 0.52), respiratory failure (OR 0.24), and ventilatory support. However, after IPW adjustment, these associations were no longer statistically significant (mortality: adjusted OR 0.90, 95% CI 0.22–3.74, p = 0.887). Conclusions COPD was not independently associated with increased risk of mortality, respiratory failure, or ventilatory support in hospitalized Omicron‐infected patients after rigorous adjustment for confounding. These findings suggest a shifting risk profile for COPD during Omicron predominance, likely influenced by variant tropism, treatment effects, and altered inflammatory responses. Future prospective studies are warranted to validate these findings and explore the mechanisms underlying this observed shift. In contrast to findings from previous COVID‐19 Delta waves, COPD was not independently associated with increased risk of adverse outcomes in patients hospitalized with Omicron variant infection. These findings suggest a significant shift in risk profiles during the Omicron wave, potentially reflecting the variant's altered pathogenicity, evolving treatment approaches, and vaccination impacts.