Acute Pulmonary Thromboembolism Research Articles

A novel SERPINC1 c.119G>A (p.Cys40Tyr) mutation with variable clinical expression in an Indian family.

Hereditary antithrombin (AT) deficiency due to mutations in SERPINC1 is known to be the most severe form of thrombophilia. We report three members in a family with hereditary AT deficiency with a novel mutation in exon 2 of SERPINC1, that is c.119 G>A (p.Cys40Tyr). Two brothers presented with acute pulmonary thromboembolism (PTE) at 18 and 21 years of age, whereas their 58-year-old father did not have any thrombotic episode till date. The in-silico prediction of the variant was found to be highly damaging by PolyPhen-2, SIFT and MutationTaster. Clinical exome sequencing did not show any strong coinherited thrombophilia genes, except SERPINE1 -844 G>A variant in homozygous state in the two affected brothers as compared to the father who was heterozygous for this variant. The additive effect of SERPINE1 variant in the clinical expression in two siblings cannot be ruled out, in the absence of any other known environmental triggering factors.

Rescue of COVID-19 Patient Complicated by Spontaneous Pneumothorax and Acute Pulmonary Thromboembolism

Abstract Pulmonary thromboembolism is a common cardiovascular disease, with high morbidity and mortality rates in hospitalized patients. Because of clotting disorders and hypoxemia caused by COVID-19, critically ill patients are highly susceptible to thrombotic complications. A study published in the Journal of the American Medical Association in 2022 showed that the incidence of venous thromboembolism (VTE) in critically ill COVID-19 patients was approximately 10% to 35%, whereas the incidence of VTE in autopsy cases was as high as 60% (JAMA Intern Med 182:1063-1070). Clinicians need increased awareness of VTE in COVID-19 patients, to reduce the risk of deep vein thrombosis and pulmonary thromboembolism and to be alert to life-threatening complications.

Clinical Features and Risk Factors of 134 HA-PTE Patients

<i>Objective</i>: The objective of this study was to determine the clinical features and risk factors for hospital-associated pulmonary thromboembolism (HA-PTE) in Taizhou Hospital of Zhejiang Province. <i>Methods</i>: The clinical data of 513 pulmonary thromboembolism (PTE) patients who were admitted to Taizhou Hospital of Zhejiang Province in from January 1st, 2020, to December 31st, 2022, were retrospectively analyzed. The HA-PTE group and the community-associated PTE (CA-PTE) group were classified according to whether these disorders occurred during hospitalization or within a 90-day period of admission to the hospital (including inpatients with at least two days of hospitalization stay or a surgical procedure under or regional anesthesia). Differences in clinical features, risk factors and other indicators were also analyzed between the two groups. <i>Results</i>: A total of 513 patients with acute PTE were analyzed in the present study. Among them, 134 patients had HA-PTE, and 379 patients had CA-PTE. Patients in the HA-PTE group had less dyspnea or hemoptysis and more fever and chest pain. The all-cause mortality rate in the HA-PTE group was greater than that in the CA-PTE group, but it was not statistically significant. In comparison to community-acquired pulmonary thromboembolism (CA-PTE), long-term bed rest, active malignancy, lung infection, acute cerebral infarction, and fracture were observed as more prevalent risk factors in the hospital-acquired pulmonary thromboembolism (HA-PTE) group. Additionally, recent surgery (within one month post-operation) and central venous catheterization were identified as independent risk factors in the HA-PTE group. According to the subgroup analysis of the HA-PTE group, the all-cause mortality rate of patients who experienced HA-PTE in the hospital was lower than that of patients who experienced HA-PTE which in 90 days after admission (1.56% versus 2.85%, respectively); however, the difference was not statistically significant. <i>Conclusion</i>: More than half of the HA-PTE events were associated with recent hospitalization. HA-PTE and CA-PTE have different risk factors; when combined with different clinical symptoms, they have a higher incidence of HA-PTE occurring in the hospital. More attention should be given to inpatients to reduce the incidence of HA-PTE.

Antithrombotic activity of Punica granatum, L (Pomegranate): Experimental investigation and exploration of its mechanism of action on primary and secondary hemostasis in vitro and ex vivo

Hemostasis is the physiological process that stops bleeding by forming a thrombus (or blood clot). However, the inappropriate formation of a thrombus can constitute a pathophysiological event involving the same steps as those of hemostasis. Despite some adverse effects, antithrombotic therapy remains an effective means in the prevention and treatment of thrombotic diseases. In this regard, scientific research aimed at discovering new remedies of natural origin is particularly active.This study aims to evaluate the antithrombotic activity of the aqueous extract of Punica granatum peels in vivo. To understand the mechanism of action of this activity, we will investigate primary and secondary hemostasis in vitro and ex vivo. Furthermore, we will examine its antioxidant activity, toxicity, and phytochemical composition to identify the molecules responsible for the observed effects.The antithrombotic activity is assessed in vivo using the acute pulmonary thromboembolism model in mouse. Thrombosis is induced by injecting the thrombogenic solution (epinephrine + collagen) into the lateral caudal vein. Platelet aggregation, both in vitro and ex vivo, is performed on washed platelets isolated by centrifugation from rat blood. The platelet suspension is pre-incubated with the extract for 1 min. Aggregation is triggered by adding the following agonists: ADP, thrombin, collagen, and arachidonic acid. The bleeding time is measured in the absence and presence of the extract following an apical section of the mouse tail. This time corresponds to the duration of flow between the first and last drops of blood. To evaluate plasma coagulation, activated partial thromboplastin time (aPTT) and prothrombin time (PT) were measured under conditions both with and without the extract, using appropriate reagents. Acute toxicity is conducted by administering a single oral dose of the extract to mice (5 and 10 g kg-1). Possible changes in animal behavior are observed for fifteen days. The identification of polyphenols and flavonoids is performed by High Performance Liquid Chromatography (HPLC).The results obtained show that P. granatum exerted a significant preventive antithrombotic action (80 % protection) in mice. Furthermore, the extract inhibited platelet aggregation induced in vitro by all agonists in a dose-dependent manner, prolonged bleeding time, and coagulation times in rats. The results of the ex vivo study in rats confirmed these effects. We also noted that the extract did not exhibit toxicity following administration, and HPLC analysis revealed a richness of polyphenols and flavonoids in the extract.P. granatum exhibited an interesting antithrombotic activity, which could be attributed to its antiplatelet and anticoagulant actions. The phytochemical compounds identified in this extract could, at least in part, be responsible for these effects. Therefore, the demonstrated activities of this plant on hemostasis could lead to the development of more effective remedies and represent a means of prevention against thrombotic events.

Validation of a Recently Developed Fluoroscopic Video Analysis Workstation (Radwisp™) for the Reliable Diagnosis of Acute Pulmonary Thromboembolism.

Objective Radwisp™ is a fluoroscopic video analysis workstation recently developed to evaluate pulmonary circulation, thereby obviating the need for contrast medium or breath-holding. This study validated Radwisp as a diagnostic tool for acute pulmonary embolism (APE) and evaluated its potential utility in patients with symptoms of suspected APE. Methods The study included 10 patients (mean age, 69±16 years old) who were admitted to our hospital for suspected APE based on symptoms and physical examination findings between January 2020 and April 2021. Contrast-enhanced computed tomography (CT) and cineradiography, based on standard radiographs for the creation of a Radwisp image, were performed on the same day. Of the 10 cases of suspected APE, 7 were definitively diagnosed by CT with APE, and 3 were definitively diagnosed as not having APE. Fifty physicians (25 cardiologists and 25 residents) were blinded to patient information and CT images and asked to diagnose the presence of APE based solely on the Radwisp images. Results A total of 250 diagnoses were made by cardiologists and 250 by residents. Among the cardiologists, the sensitivity and specificity of the Radwisp-based analysis were 91% and 48%, respectively, and the positive and negative predictive values were 80% and 69%, respectively. Among the residents, the sensitivity and specificity were 88% and 35%, respectively, and the positive and negative predictive values were 76% and 55%, respectively. Conclusion This study showed an initial validation of Radwisp for diagnosing APE, revealing a high sensitivity but not yet achieving a high specificity. Further studies with a larger number of cases are needed to thoroughly evaluate the diagnostic performance.

ST-Segment Alterations in the Electrocardiogram of Acute Pulmonary Thromboembolism: A Rabbit Model

In this study, we investigated the mechanism underlying electrocardiogram (ECG) alterations in a rabbit model of acute pulmonary thromboembolism (PTE). Twelve healthy adult New Zealand white rabbits were used, with eight in the experimental group (PTE group) and four in the control group. After developing the rabbit model of acute PTE, ECG and coronary angiography were performed. HE staining was conducted on the right and left ventricular tissues, and polymerase chain reaction (PCR) was used to determine brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-α), and Troponin I (TNI) mRNA expression in the myocardium. There were considerable changes in the ST segment of the ECG in the PTE group. Coronary angiography revealed the absence of spasm, stenosis, and occlusion. In the plasma of the PTE group, the levels of D-dimer, BNP, TNF-α, and TNI were significantly elevated, and these changes were statistically significant (P<0.05). PCR analysis of ventricular myocardial tissue indicated significantly higher levels of BNP, TNF-α, and TNI mRNA in the PTE group than in the control group. These differences were statistically significant (P<0.05). The ST-T variations on the ECG of rabbits with acute PTE correlate strongly with the temporary changes in right heart volume caused by acute PTE.

Evaluation of neutrophil gelatinase-associated lipocalin (NGAL), hypoxia-induced factor-1 alpha (HIF-1α) and apelin 13 levels as new potential biomarkers for pulmonary thromboembolism: A prospective clinical study

AimThe objective was to evaluate the serum levels of neutrophil gelatinase-associated lipocalin (NGAL), hypoxia-induced factor-1 alpha (HIF-1α), and apelin 13 in patients with acute pulmonary thromboembolism (PE) and to investigate their diagnostic and prognostic role in PE patients with different mortality risk groups. Material and methodsThis study was conducted in a tertiary referral center and included 124 subjects with 94 cases of PE and 30 cases of healthy control group. All subjects were 18 years of age or older. The diagnosis of PE was done with computed tomography angiography of the thorax. After the diagnosis of acute PE, the serum levels of neutrophil gelatinase-associated lipocalin (NGAL), hypoxia-induced factor-1 alpha (HIF-1α), and apelin 13 levels were measured with a commercial enzyme-linked immunosorbent assay (ELISA) kit. ResultsThe median and IQR (interquartile range) age of patients and control groups were 68 (56–76) and 61.5 (56–67) years, respectively. The majority of patients with PE had risk factors (97.88 %), and only two (2.12 %) had no known risk factors. HIF-1 alpha level was found to be higher in the patient group than in the control group (p = 0.03). At the same time, the HIF-1 alpha level was found to be higher in the high mortality risk group than in the control group, low mortality risk group and intermediate-low mortality risk group (p = 0.000, 0.011, 0.002, respectively). While there was no significant difference in NGAL level between the patient group and the control group, a significant difference was observed between the mortality groups. NGAL level was found to be higher in the high mortality risk group than the control group, low mortality risk group, and medium-low mortality risk group (p = 0.001, 0.000, 0.010, respectively). Apelin 13 levels did not differ significantly in all groups. ConclusionHIF-1 alpha is a promising biomarker in distinguishing between patients and control groups and in identifying those with high mortality risk in the patient group. At the same time, NGAL can be used as a successful biomarker in determining the group with high mortality risk in cases of PE.

Lipid profile and mortality in patients with pulmonary thromboembolism; a systematic review and meta-analysis.

Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Considering the availability and accessibility of assessing the serum lipids, this study aims todefine the predictive value of lipid profile, as well as the history of lipid disorders, for the mortality of PTE patients. Clinical studies, in which the relation of lipid profile, including triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol, as well as history of imbalance of lipids, with mortality of PTE patients was reported, were included. Non-English articles, reviews, letters, editorials, and non-English papers were excluded. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science databases. Therisk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools and CMA 4 was utilized forthe quantitative synthesis. Out of 3,724 records, six studies were included inthis systematic review. Lipid profile is suggested as a prognostic marker for survival in patients with PTE so higher initial serum HDL, LDL, and total cholesterol levels were associated with lower mortality rates in PTE patients. In addition, dyslipidemia was found to be associated withmortality of PTE patients. Based on the quantitative synthesis, there was a greater serum level of HDL in thesurvival group (standardized mean difference:-0.98; 95 %CI:-1.22 to-0.75; p-value<0.01). Mortality is lower in PTE patients with greater serum lipid levels; therefore, the early prognosis of PTE maybe ascertained by measuring serum lipids within the first 24 h of admission.

The Role of Advanced Post-processing Techniques in Computed Tomography Pulmonary Angiography for the Accurate Diagnosis of Pulmonary Thromboembolism: A Retrospective Study.

Background Computed tomography pulmonary angiography (CTPA) isthe standard diagnostic tool for evaluating patients with suspected pulmonary thromboembolism (PTE) in many institutions. This condition, whether acute or chronic, results in both partial and complete intraluminal filling defects, which exhibit sharp interfaces with intravascular contrast material. Acute PTE that leads to complete arterial occlusion may cause the affected artery to appear enlarged. Chronic PTE often manifests as complete occlusive disease in vessels that are smaller than the adjacent patent vessels. CT imaging with iodinated contrast medium is crucial for many CT applications, including vascular CT angiography and CTPA. A comprehensive review of a case necessitates an integrated approach known as volume visualization, wherein the entire case is treated as a volume of information to be thoroughly reviewed. Advanced post-processing 3D CT techniques, such as maximum intensity projection (MIP), volume rendering (VR), and minimum intensity projection (MinIP) images, are essential for the detailed detection and assessment of the pulmonary vasculature. Materials and methods In this retrospective study, data from 50 patients with suspected PTE were analyzed over a six-month period from March 15 to August 30, 2023, at Saveetha Medical College and Hospital. Patients were selected based on previously recorded clinical symptoms and elevated D-dimer levels. CTPA images, acquired using multi-detector CT imaging with iodinated contrast, were reviewed. Various post-processing techniques were employed, including multiplanar reconstruction (MPR), MIP, MinIP, and VR. The aim of this study was to evaluate the effectiveness of CTPA combined with advanced post-processing techniques in improving early detection, reducing diagnostic time, and increasing accuracy through the detailed visualization of the pulmonary arterial vasculature. Results The study included patients aged from 10 years to70 years, with the highest prevalence of PTE in the 21-35-year age group (46%). Males constituted 56% of the cases. CTPA with advanced post-processing techniques revealed filling defects in 90% of patients, confirming PTE. MPR, MIP, MinIP, and VR effectively highlighted anatomical structures and thrombi, enhancing diagnostic accuracy. These techniques demonstrated high accuracy in identifying PTE, emphasizing their critical role in the early diagnosis and management of thromboembolic events. Conclusion The findings of the study revealed a relatively high incidence of PTE especially in the 21-35-year age group with a slight male predominance. Thesignificant majority of the patients (90%) had filling defects on their CTPA scan. CTPA, in conjunction with the use of post-processing techniques, the localization of thromboembolism sites, as well as the measurement of thrombus width and length, and the calculation of the percentage of blockage were achieved more easily. This facilitatedaccurate diagnosis, leading to improved patient outcomes.

Establishing a risk prediction model for residual pulmonary vascular obstruction after regular anticoagulant therapy for non-high-risk pulmonary embolism.

The incidence of pulmonary embolism (PE) has been on the rise annually. Despite receiving regular sequential anticoagulation therapy, some patients with non-high-risk acute PE (APE) continue to experience residual pulmonary vascular obstruction (RPVO). This study sought to identify the risk factors for RPVO following 3 months of sequential anticoagulation therapy for non-high-risk PE. Machine learning techniques were utilized to construct a clinical prediction model for predicting the occurrence of RPVO. A total of 254 acute non-high-risk PE patients were included in this study, all of whom were admitted to the Third People's Hospital of Yunnan Province between 2020 and 2023. After 3 months of regular anticoagulant treatment, computed tomography pulmonary angiography (CTPA) were reviewed to identify the presence of RPVO. Patients were then categorized into either the thrombolysis group or the thrombosis residue group. Throughout the study period, 49 patients were excluded due to missing data, irregular treatment, or loss to follow-up. Clinical symptoms, physical signs, and laboratory results of 205 PE patients were recorded. Correlation and collinearity analyses were conducted on relevant risk factors, and significance tests were performed. Heat maps illustrating the relationships between influencing factors were generated. Predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate logistic regression analysis to create a predictive model. Internal validation of the model was also carried out. By searching the literature to understand all the clinical indicators that may affect the efficacy of anticoagulation therapy. A total of 205 patients with non-high-risk acute pulmonary thromboembolism were evaluated for various risk factors. Five independent factors were identified by multivariable analysis-age, chronic obstructive pulmonary disease (COPD), acratia, pulmonary systolic blood pressure (PASP), and major arterial embolism-and their P value, odds ratio (OR) and confidence interval (CI) were as follows: (P=0.012, OR =1.123; 95% CI: 1.026-1.23), (P=0.002, OR =13.30; 95% CI: 2.673-66.188), (P=0.001, OR =14.009; 95% CI: 2.782-70.547), (P=0.003, OR =1.061; 95% CI: 1.020-1.103) and (P<0.001, OR =18.128; 95% CI: 3.853-85.293), which may indicate a poor prognosis after standard anticoagulant therapy. A nomogram was constructed using these variables and internally validated. The receiver operating characteristic (ROC) curves of the model demonstrated strong predictive accuracy, with an area under the curve (AUC) of 0.94 (95% CI: 0.89-0.96) for the training set and 0.93 (95% CI: 0.88-0.95) for the validation set. Calibration curves were utilized to assess the practicality of the nomogram. A novel predictive model was developed based on a single-center retrospective study to identify patients with RPVO following anticoagulant therapy for acute non-high-risk PE. This model may aid in the early detection of patients, prompt adjustment of treatment, and ultimately lead to a decrease in adverse outcomes.

Clinical characteristics and anticoagulation patterns of patients with acute pulmonary thromboembolism and hemoptysis.

Hemoptysis is a frequently encountered manifestation in cases of acute pulmonary thromboembolism (PTE), significantly impacting clinical decision-making. Despite its clinical relevance, studies focusing on patients with acute PTE and hemoptysis are notably scarce. In this retrospective study, we examined data from hospitalized patients with acute PTE at Peking Union Medical College Hospital (PUMCH) between January 2012 and October 2020. Among the 896 patients analyzed, 105 (11.7%) presented with hemoptysis. Patients with hemoptysis were younger, had higher RRs, and frequently reported chest pain, predominantly showing a negative sPESI score. A significant association with autoimmune diseases was observed (39.0% vs. 16.1%; p < 0.001), along with higher occurrences of pulmonary infections (29.5%), lung cancer (21.0%), and chronic heart failure (16.2%). Hemoptysis in PTE is multifactorial; 51.4% of cases were PTE-related, with 85.2% experiencing mild hemoptysis. Among patients with disease-related hemoptysis (13.3%), 90.9% with massive hemoptysis had underlying diseases, predominantly lung cancer. In 35.2% of cases, the cause of hemoptysis remained undetermined, with vasculitis accounting for 29.7%. Anticoagulation strategies varied with the severity of hemoptysis; 82.9% with mild and only 27.3% with massive hemoptysis received therapeutic-dose anticoagulation. Multivariate analysis identified massive hemoptysis as the most significant determinant of anticoagulation decisions. Patients with massive hemoptysis had the poorest outcomes, with an in-hospital mortality rate of 36.4% and 72.7% receiving reduced or no anticoagulation.

Protocolo del dolor abdominal en el paciente con patología cardiovascular

Abdominal pain is a frequent cause of consultation in emergency services. Anamnesis is fundamental, characteristics of abdominal pain usually allows to determine a suspect diagnosis, which is frequently confirmed with the ulterior study. This kind of patients can have cardiovascular causes of abdominal pain, that can be severe. Electrocardiogram and laboratory tests can be obtained in every patient in a quick way, and the first one is essential in the diagnosis of myocardial infarction. Laboratory tests can be useful in the diagnosis of acute mesenteric ischemia or pulmonary thromboembolism, in these diagnosis and in the case of suspiction of aortic aneurysm ruptura is very helpful asking for a computer tomography. But in case the patient has abnormal vital signs and an acute mesenteric ischemia or aortic aneurysm rupture is suspected, an urgent laparomy is indicated, it is diagnostic and it allows to treat the cause.

Chest non‑contrasted computed tomography in detecting acute pulmonary thromboembolism: A single‑center retrospective study.

The object of the study was to evaluate comprehensively the value of chest non-contrasted CT (NC-CT) in detecting acute pulmonary thromboembolism (APE). All patients were categorized into two groups: i) With APE; and ii) without APE based on clinical diagnosis. Using the clot distribution on computed tomography pulmonary angiography (CTPA), APE was divided into central and peripheral APE. Imaging features including hyperdense lumen sign and peripheral wedge-shaped opacity on chest NC-CT were evaluated. The attenuation value of peripheral wedge-shaped opacity on NC-CT was compared between patients with and without APE. Among the 273 patients, there were 110 patients with APE, 49 patients with central APE and 61 patients with peripheral APE and 163 patients without APE. The hyperdense lumen sign had a sensitivity of 30.0% and a specificity of 97.6% in detecting APE. The sensitivity and specificity of hyperdense lumen sign in detecting central APE were 57.1 and 97.6%, respectively, while the relevant percentages in detecting peripheral APE were 8.2 and 97.6%, respectively. The mean attenuation value of peripheral wedge-shaped opacity in patients with APE was significantly lower than that in patients without APE (P<0.001). Regarding the age-adjusted D-dimer, there was a decrease of eight D-dimer positive cases for patients >50 years old without APE, confirmed by CTPA. In conclusion, chest NC-CT cannot be used as an alternative modality for CTPA in diagnosing APE, however, the hyperdense lumen sign had high specificity in the diagnosis of central APE. Patients with this symptom and increased D-dimer may not require further CTPA. The lower attenuation value of peripheral wedge-shaped opacity on NC-CT suggested APE, and CTPA confirmation was required. The age-adjusted D-dimer had higher specificity in excluding APE.

Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants for Japanese Patients With Venous Thromboembolism - The Primary Results From the KUROSIO Study.

Direct oral anticoagulants (DOACs) are recommended as the first-choice anticoagulation therapy in the acute phase of venous thromboembolism (VTE). However, there is limited real-world data for Japanese VTE patients. The KUROSIO study (UMIN000023747) was a prospective long-term observational study comprising 1,017 patients with concurrent acute symptomatic pulmonary thromboembolism and proximal deep vein thrombosis (DVT) or isolated calf DVT initially treated with DOACs. After excluding 24 patients, 993 (mean age, 66.3±15.1 years; 58.6% females) were analyzed. The incidences of recurrent symptomatic VTE and major bleeding for up to 52 weeks after diagnosis were 3.2% and 2.2%, respectively. Multivariate analyses revealed chemotherapy and anemia as significant risk factors associated with recurrent symptomatic VTE and major bleeding, respectively. The efficacy and safety of DOACs in Japanese patients with VTE were determined in this real-world observational study.

Federated-learning-based prognosis assessment model for acute pulmonary thromboembolism.

Acute pulmonary thromboembolism (PTE) is a common cardiovascular disease and recognizing low prognosis risk patients with PTE accurately is significant for clinical treatment. This study evaluated the value of federated learning (FL) technology in PTE prognosis risk assessment while ensuring the security of clinical data. A retrospective dataset consisted of PTE patients from 12 hospitals were collected, and 19 physical indicators of patients were included to train the FL-based prognosis assessment model to predict the 30-day death event. Firstly, multiple machine learning methods based on FL were compared to choose the superior model. And then performance of models trained on the independent (IID) and non-independent identical distributed(Non-IID) datasets was calculated and they were tested further on Real-world data. Besides, the optimal model was compared with pulmonary embolism severity index (PESI), simplified PESI (sPESI), Peking Union Medical College Hospital (PUMCH). The area under the receiver operating characteristic curve (AUC) of logistic regression(0.842) outperformed convolutional neural network (0.819) and multi layer perceptron (0.784). Under IID, AUC of model trained using FL(Fed) on the training, validation and test sets was 0.852 ± 0.002, 0.867 ± 0.012 and 0.829 ± 0.004. Under Real-world, AUC of Fed was 0.855 ± 0.005, 0.882 ± 0.003 and 0.835 ± 0.005. Under IID and Real-world, AUC of Fed surpassed centralization model(NonFed) (0.847 ± 0.001, 0.841 ± 0.001 and 0.811 ± 0.001). Under Non-IID, although AUC of Fed (0.846 ± 0.047) outperformed NonFed (0.841 ± 0.001) on validation set, it (0.821 ± 0.016 and 0.799 ± 0.031) slightly lagged behind NonFed (0.847 ± 0.001 and 0.811 ± 0.001) on the training and test sets. In practice, AUC of Fed (0.853, 0.884 and 0.842) outshone PESI (0.812, 0.789 and 0.791), sPESI (0.817, 0.770 and 0.786) and PUMCH(0.848, 0.814 and 0.832) on the training, validation and test sets. Additionally, Fed (0.842) exhibited higher AUC values across test sets compared to those trained directly on the clients (0.758, 0.801, 0.783, 0.741, 0.788). In this study, the FL based machine learning model demonstrated commendable efficacy on PTE prognostic risk prediction, rendering it well-suited for deployment in hospitals.

Avoidable Overuse of Computed Tomography Pulmonary Angiography (CTPA) in Patients with Suspected Acute Pulmonary Thromboembolism (PTE): The Role of Clinical Prediction Rules and D-Dimer Assay

Background: Computed tomography pulmonary angiography (CTPA) is an imaging technique widely used in the diagnosis of acute pulmonary thromboembolism (PTE). Despite its disadvantages and potential risks, the overuse of CTPA has been a growing concern over the past decades. Objectives: The objective of this study was to investigate the rate of avoidable overuse of CTPA in patients with suspected PTE and to identify factors contributing to this overuse. The study aimed to highlight the importance of proper training for physicians in using validated diagnostic algorithms to minimize the overuse of CTPA and improve patient outcomes. Methods: In a cross-sectional study conducted between April 2016 and March 2019 at Shariati Hospital at Tehran University of Medical Sciences (TUMS), 1058 patients underwent CTPA due to suspected PTE. Wells scores were calculated retrospectively for all patients. The study defined avoidable overuse of CTPA as an imaging request without prior D-dimer testing or ignoring a negative D-dimer result in patients with low clinical pre-test probability. Results: Two hundred and seventy-three patients were excluded from the study due to unavailable documentation or pregnancy. Among the included 785 patients, 139 (17.7%) revealed PTE on CTPA. Based on the Wells scores, 480 patients were identified as the “PTE-unlikely” group. In this group, 299 patients (62.3%) underwent CTPA directly despite recommendations to order a D-dimer test first. Of these patients, 281 (94%) cases showed negative results. Moreover, CTPA was performed inappropriately in 52 “PTE-unlikely” cases despite negative D-dimer serum levels, and only one patient was diagnosed with PTE. Conclusions: The study revealed that 44.7% of the CTPA requests for patients with suspected PTE were avoidable, indicating the need for better adherence to current diagnostic guidelines to reduce unnecessary radiologic investigations and improve patient care.

A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report

A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report

Performance of AI-powered chatbots in diagnosing acute pulmonary thromboembolism from given clinical vignettes

Performance of AI-powered chatbots in diagnosing acute pulmonary thromboembolism from given clinical vignettes

Sildenafil improves hemodynamic changes caused by acute pulmonary embolism by inhibiting Rho kinase activity.

This study examined the effects of sildenafil on acute pulmonary embolism (APE) using a rat model. Sprague-Dawley rats were randomly divided into the sham, pulmonary thromboembolism (PTE), and sildenafil groups. The sham and PTE groups received normal saline once daily via gavage for 14 consecutive days, whereas the sildenafil group received sildenafil (0.5 mg/kg/day) once daily via gavage for 14 consecutive days. Autologous emboli were prepared from blood samples collected from the left femoral artery of rats in each group on day 13, and autologous emboli were injected into the jugular vein cannula of rats in the PTE and sildenafil groups on day 14. Sham-treated rats received the same volume of saline. Right systolic ventricular pressure (RVSP) and mean pulmonary arterial pressure (MPAP) were used to assess pulmonary embolism, and western blotting and enzyme-linked immunosorbent assay were used to detect relevant markers. The Rho kinase signaling pathway was significantly activated in rats with APE, and sildenafil significantly inhibited this activation. Sildenafil protected against APE through inhibiting Rho kinase activity, thereby reducing pulmonary vasoconstriction and decreasing elevated pulmonary arterial pressure. These findings might provide new ideas for the clinical treatment of acute pulmonary thromboembolism.

Imaging of Patients Suspected of Having Pulmonary Thrombo-Embolic Disease; The Value of Chest X-Ray Combined with Perfusion Scan

Objective: To determine the value of a recent chest x-ray (done within 24 hours of the perfusion scan) combined with perfusion in diagnosing acute pulmonary thromboembolism in clinical settings. Methodology: Retrospective analysis of 155 consecutive patients clinically suspected with pulmonary thromboembolism between January 2017 and January 2019, who underwent a lung scintigraphy. Results: Most of the study participants (75.5%) were black Africans. The overall population studied had a mean age of 50.09 years (SD 16.78). A recent chest x-ray was found in 40.1% of the projected sample size of 386 patients. The sensitivity and specificity of the PISAPED 1 reader were 96% and 97%, respectively, with a NPV and PPV of 99% and 89%. The sensitivity and specificity of the PISAPED 2 reader were both 96%, with a NPV and PPV of 86%and 99%, respectively. The PIOPED II and the PISAPED 1 had an agreement of 88.39% (Kappa value of 0.7348) while the PIOPED II and the PISAPED 2 had an agreement of 88.39% (Kappa value of 0.7444). Conclusion: Chest x-ray in conjunction with perfusion scintigraphy is accurate and can be used where ventilation/perfusion scintigraphy cannot be done in the diagnosis of pulmonary embolism.