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Abstract Background Pulmonary embolisms (PEs) exhibit clinical features similar to those of acute coronary syndrome (ACS), including electrocardiographic abnormalities and elevated troponin levels, which frequently lead to misdiagnoses in emergency situations. Case presentation Here, we report a case of PE coinciding with chronic coronary syndrome in which the patient’s condition was obscured by symptoms mimicking ACS. A 68-year-old female with syncope presented to the hospital. Upon admission, she was found to have elevated troponin levels and an electrocardiogram showing ST-segment changes across multiple leads, which initially led to a diagnosis of ACS. Emergency coronary arteriography revealed occlusion of the posterior branches of the left ventricle of the right coronary artery, but based on the complexity of the intervention, the occlusion was considered chronic rather than acute. On the 3rd day after admission, the patient experienced recurrent chest tightness and shortness of breath, which was confirmed as acute PE by emergency computed tomography pulmonary angiography. Following standardized anticoagulation treatment, the patient improved and was subsequently discharged. Conclusions This case report highlights the importance of recognizing the nonspecific features of PE. Clinicians should be vigilant when identifying other clinical features that are difficult to explain accompanying the expected disease, and it is necessary to carefully identify the causes to prevent missed diagnoses or misdiagnoses.

Introduction: Malnutrition is strongly associated with heart failure (HF); however, the causal link remains unclear. We used Mendelian randomization (MR) to infer causal associations between different nutritional assessment phenotypes and HF and to analyze whether these associations were mediated by common HF risk factors. Methods: Two-sample bidirectional MR was used to infer causal associations between nutritional assessment phenotypes and HF. Mutual influences between different nutritional assessment phenotypes and potential correlations were estimated using multivariate MR methods. Two-step MR was used to quantify the mediating effects of common HF risk factors on the causal associations. Results: Three phenotypes were positively associated with the development of HF: waist circumference (WC) (odds ratio [OR] = 1.74; 95% confidence interval [CI], 1.60–1.90; P = 3.95 × 10−39), body mass index (BMI) (OR = 1.70; 95%CI, 1.60–1.80; P = 1.35 × 10−73), and whole body fat mass (WBFM) (OR = 1.54; 95%CI, 1.44–1.65; P = 4.82 × 10−37). Multivariate MR indicated that WBFM remained positively associated with HF after conditioning on BMI and WC (OR = 2.05; 95%CI, 1.27–3.31; P = 0.003). Three phenotypes were negatively correlated with the development of HF: usual walking pace (UWP) (OR = 0.40; 95%CI, 0.27–0.60; P = 8.41 × 10−6), educational attainment (EA) (OR = 0.73; 95%CI, 0.67–0.79; P = 2.27 × 10−13), and total cholesterol (TC) (OR = 0.90; 95%CI, 0.84–0.96; P = 4.22 × 10−3). There was a bidirectional causality between HF and UWP (Effect estimate = −0.03; 95%CI, −0.05 to −0.01; P = 1.95 × 10−3). Mediation analysis showed that common risk factors for HF (hypertension, coronary artery disease, cardiomyopathy, and valvular heart disease) mediated these causal associations (all P

Introduction: Heart Failure (HF) is a key area of research in human medicine, and traditional Chinese medicine (TCM) is an important branch of this field. This study aimed to use bibliometric methods to sort out the trajectory of TCM research on HF in this century (2000–2022) from a high dimension and to analyze its characteristics, hotspots and frontiers. Methods: In this study, the search formula “TS=((''traditional Chinese medicine'') OR (''Chinese medicine'')) AND TS=(''heart failure'')'' was used to find relevant studies included in the Web of Science Core Collection from 2000 to 2022. Targeted literature records were analyzed and mapped using CiteSpace and VOSviewer. Results: The authors and collaborators of this study were still in the formation process, but several well-known scholars were included: YONG WANG, WEI WANG, etc. The main research institutions in this research area were Beijing Univ Chinese Med, China Acad Chinese Med Sc, etc. The main country of study was China. Current research hotspots and frontiers were Qili Qiangxin capsules, extracts (Tanshinone ⅡA, Panax ginseng, etc.), cardiac hypertrophy, ventricular remodeling, oxidative stress, signaling pathways, network pharmacology, etc. Influential journals that publish papers in this field were the Journal of Ethnopharmacology, Scientific Reports, Biomedicine & Pharmacotherapy, etc. The top 3 co-cited journals were Circulation, J ethnopharmacol, and J am coll cardiol. Conclusions: We analyzed valuable details in TCM research on HF in the 21st century, which may help researchers identify potential collaborators and partner institutions, hotspots, and frontiers in the field.

Metro travelers’ travel experience is highly influenced by fellow passengers’ misbehaviors such as eating or littering in the carriage and sound blaster, which are common in the metro carriage. Although operators have implemented various regulations to reduce misbehavior, little theoretical research has investigated such behavior motivators to provide targeted guidelines for specific passenger segments. To this end, this study explores how demographic and perceived social norms of university students affect their misbehaviors, i.e., eating in the carriage, public display of affection, sound blaster, cross-legged sitting, leaning against the pole, and littering, in the metro carriage of Shanghai, China. With the structural equation model, it is revealed that both injunctive and descriptive norms impose significant impacts on passengers’ inappropriate behaviors, with the effect of the former generally to a greater degree. Gender heterogeneity in passenger misbehavior is also observed, where males significantly perform better in eating in the carriage and cross-legged sitting. These findings may decode the underlying motivation of passenger misbehaviors and provide guidelines for effective intervention with targeted policy design and implementation.