Early risk stratification is critical to clinical management of acute pulmonary embolism (APE). We aimed to evaluate the relationships among thrombus localization, thrombus burden, and inflammatory indices in patients with APE, and to assess the prognostic value of these parameters. This retrospective, single-center study included adult patients with computed tomography pulmonary angiography (CTPA)-confirmed APE. Patients with active infection, hematologic or active solid organ malignancy, or immunosuppressive therapy were excluded. The cohort comprised 821 patients. Thrombus localization was assessed by CTPA and classified as central or peripheral. Thrombus burden was quantified using the Qanadli score. The Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI) were calculated from hematologic parameters at admission. Clinical, laboratory, and echocardiographic data were analyzed to assess 28-day mortality. In patients with central thrombus location, the Qanadli score, right heart overload findings, pulmonary artery pressure, troponin, and B-type natriuretic peptide (pro-BNP) levels were significantly higher (p < 0.05). However, no significant relationship was found between thrombus localization and 28-day mortality, and the Qanadli score was also not associated with mortality (p > 0.05). SII, SIRI, and AISI values were significantly higher among patients who died (p < 0.05). In multivariate analyses, age, pro-BNP, C-reactive protein (CRP), red cell distribution width (RDW), and SII were identified as independent predictors of mortality (p < 0.05). In the receiver operating characteristics (ROC) analysis, SII showed the highest discriminatory power for predicting mortality (AUC = 0.748; p < 0.001). In APE, although thrombus burden and localization may correlate with clinical severity, mortality appears to be primarily driven by systemic inflammation. SII can serve as a practical, complementary biomarker for early risk stratification.

Deep vein thrombosis (DVT) is a frequent and often silent complication in intensive care unit (ICU) patients, markedly increasing the risk of pulmonary embolism and death. However, comprehensive quantitative evidence on ICU-DVT incidence and associated risk factors remains scarce. To synthesize global data on the epidemiology of ICU-DVT and identify independent risk factors, providing a basis for evidence-based, risk-stratified prevention. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science to July 2024 for observational studies reporting ICU-DVT incidence and risk factors. Pooled odds ratios (ORs) were calculated using random-effects models (PROSPERO ID: CRD42024583844). A total of 186 studies were included, involving 203,880 ICU patients. The overall incidence of DVT was 10.4% (95% CI 8.9%-12.0%). The incidence was significantly higher in COVID-19 patients than in non-COVID-19 patients (12.4% vs. 8.4%, p < 0.01). Medical ICUs had the highest incidence (16.3%), followed by trauma ICUs (11.6%), general ICUs (10.1%), neuro ICUs (8.6%), and surgical ICUs (7.9%). The incidence varied by region (Asia 12.5%, Europe 11.8%; America 9.3%, Oceania 9.1%). Systematic screening significantly improved DVT detection rates compared with clinically suspected diagnosis (14.6% vs. 7.9%). Meta-analysis revealed that central venous catheterization, a history of DVT, use of vasoactive agents, mechanical ventilation, prolonged ICU stay, and malignancy were associated with increased DVT odds. ICU-DVT affects approximately 1 in 10 patients and is associated with distinct modifiable and non-modifiable risk factors. The influence of diagnostic strategies on DVT incidence underscores the necessity for standardized screening in the ICU. Future prospective, large-scale studies are warranted to validate causal relationships and enable the development of risk prediction tools for precision prevention.

Deep vein thrombosis (DVT) is a form of venous thromboembolism, occurring in approximately 1.6 out of every 1000 people annually. Social media platforms have become influential tools for disseminating health information.This study aimed to comprehensively evaluate the content, quality, and reliability of DVT-related videos on TikTok, Bilibili, and YouTube. A comprehensive search was conducted on Bilibili, TikTok (Douyin), and YouTube using three keywords - "", "Deep vein thrombosis", and "DVT" - across all platforms.Two reviewers independently assessed video characteristics, categorized content (definition, etiologies and causations, symptoms, treatment, prevention, and complications), and evaluated quality using validated tools [Global Quality Scale(GQS), The Journal of the American Medical Association (JAMA), and modified DISCERN (mDISCERN) scores]. Analyzing 300 DVT-related videos revealed distinct content distribution patterns across platforms. On TikTok, prevention (24%), etiologies and causations (23%), and symptoms (21%) predominated; on Bilibili, treatment (30%), prevention (29%), and complications (16%) were most common; while on YouTube, treatment (25%), symptoms (24%), and etiologies and causations (18%) were prioritized. Quality assessment showed moderate overall scores: median GQS of 4 (Q1-Q3: 3-4) for TikTok and YouTube, compared to 3 (Q1-Q3: 3-4) for Bilibili (p = 0.02).TikTok videos had significantly higher modified DISCERN scores (4, Q1-Q3: 3-4) compared to Bilibili (3, Q1-Q3: 3-4) and YouTube (3, Q1-Q3: 2-3) (p < 0.0001). TikTok and Bilibili videos had higher JAMA scores (2, Q1-Q3: 2-2) than YouTube (2, Q1-Q3: 1-2) (p < 0.0001). Although DVT-related videos on social media offer valuable information on prevention and treatment, content on diagnosis and epidemiology is lacking.Videos created by medical professionals showed higher quality across all assessment metrics.Efforts should focus on improving the comprehensiveness and reliability of health information on social media platforms to enhance public awareness of DVT.

In haemophilia, recurrent joint bleeding often results in joint destruction, which in turn leads to reduced physical activity (PA) and decreased quality of life (QOL). While maintaining high PA levels is important in the care of people with haemophilia (PwH), it remains unclear whether PwH without joint disease can maintain adequate activity levels. This descriptive cross-sectional study sought to compare moderate-to-vigorous physical activity (MVPA) levels among 19 PwH with haemophilic arthropathy (HA), 12 PwH without HA, and 15 non-PwH. A total of 46 males wore a triaxial accelerometer (wGT3X-BT, ActiGraph) during daily activities for seven consecutive days. A bout of MVPA was defined as at least 10 consecutive minutes of moderate-intensity or higher activity. MVPA was expressed as the percentage of the total wear time spent in MVPA, and the total number of MVPA bouts was also recorded. Both PwH groups demonstrated significantly lower MVPA percentages and fewer MVPA bouts than the controls (p < 0.01). No MVPA bouts were recorded among 52.6% of PwH with HA versus 25% of PwH without HA. No significant differences were observed in sedentary or light activity between the PwH groups. PA levels were significantly reduced in PwH, regardless of joint status, suggesting that factors beyond joint damage, such as fear of bleeding or behavioural avoidance, may play a role. These findings highlight the need for individualized, evidence-based interventions to safely promote physical activity and improve long-term health outcomes in PwH.

Real-world evidence on transition from standard-dose FVIII to Emicizumab prophylaxis in young children with hemophilia A remains limited, particularly in developing countries. We performed a single-center, retrospective, self-controlled study in boys with severe hemophilia A without inhibitors. Outcomes during 12 months of standard-dose factor VIII (FVIII) prophylaxis were compared with outcomes during 12 months after transition to Emicizumab prophylaxis (in this real-world cohort, most patients received reduced-dose maintenance regimens). Annualized bleeding rates (overall, treated, joint, and spontaneous) and zero-bleeding proportions were assessed. Direct annual prophylaxis drug costs were calculated using locally applicable drug prices and converted to USD. Thirty-one boys were included with a median age of 4.5 years. During FVIII prophylaxis, the median FVIII dose was 32.3 IU/kg/infusion with a median 3.1 infusions/week; median trough FVIII was 3.9 IU/dL. After transition, mean Emicizumab exposure was 4.2mg/kg/month (range 3.0-6.0) with a mean dosing interval of 14 days. Overall ABR decreased from 2.48 to 0.32, treated ABR from 1.64 to 0.29, joint ABR from 0.83 to 0.13, and spontaneous ABR from 0.26 to 0 (all P < 0.05). The proportion of patients with zero bleeds increased from 35% to 81% (P < 0.001), and zero treated bleeds from 52% to 69% (P < 0.05). Mean annual prophylaxis drug costs were lower with Emicizumab than with FVIII (34,417 vs. 47,168 USD; P < 0.001). In this selected pediatric cohort of children who transitioned from standard-dose FVIII to Emicizumab and remained on treatment for at least 12 months, lower observed bleeding rates and lower direct prophylaxis drug costs were seen during the Emicizumab period. These findings should be interpreted descriptively because the retrospective design and eligibility criteria introduced substantial selection bias. Not applicable.

Acquired dysfibrinogenemia is a rare and often underrecognized coagulation disorder characterized by impaired fibrinogen function rather than absolute deficiency. In plasma cell dyscrasias, including multiple myeloma, monoclonal gammopathy of undetermined significance, and monoclonal gammopathy of clinical significance, monoclonal immunoglobulins or light chains may interfere with fibrin polymerization, resulting in discordant fibrinogen assay results and diagnostic challenges. A middle-aged woman exhibited persistently prolonged thrombin time (TT) and markedly reduced fibrinogen by the Clauss method, while PT-derived fibrinogen remained relatively preserved, yielding a stable elevated PT-derived/Clauss ratio (~ 4.0-4.7) suggestive of qualitative fibrinogen dysfunction. These abnormalities were detected more than three years before the diagnosis of λ light-chain multiple myeloma (MM), in the absence of CRAB features. Following anti-myeloma therapy, TT and fibrinogen parameters normalized in parallel with hematologic response. This case illustrates that acquired dysfibrinogenemia with discordant fibrinogen assays may serve as an early laboratory clue to an underlying plasma cell dyscrasia and may precede overt multiple myeloma in some patients. Similar coagulation abnormalities may also occur in MGUS or MGCS and should not be interpreted as specific predictors of progression, but rather as potential manifestations of paraprotein-related hemostatic dysfunction.