Prevalence and clinical predictors of vasodepressor syncope during head up tilt test.

INTRODUCTION: The aim of our study was to evaluate the prevalence and clinical predictors of vasodepressor (VD) response during head-up tilt test (HUTT) in patients with history of syncope admitted to a tertiary referral syncope unit. MATERIAL AND METHODS: We retrospectively evaluated all consecutive patients who underwent HUTT for suspected or established reflex syncope at our institution from March 1st, 2017, to June 1st, 2023. VD response was defined when syncope occurred during hypotension along with no or slight (< 10% bpm) decrease of heart rate. Univariate and multivariate analyses were performed to test the association of VD response to HUTT with a set of clinical covariates. RESULTS: 1780 patients (40 ± 19.9 years; 49.3% male) were included; among them, 1132 (63 %) showed a positive response to HUTT and 124 (7.0%) had a VD response. The prevalence of VD response showed a peak after 69 years (11.52% vs 6.18%; P = 0.0016), mainly driven by male patients (13.7% vs 4.9%; P < 0.0001). At multivariate analysis, age (OR: 1.15; P = 0.0026) was independently associated to HUTT-induced VD syncope; in contrast, smoking (OR: 0.33: P = 0.0009) and non-classical presentation of syncope (OR: 0.55; P = 0.0029) inversely correlated with VD syncope. CONCLUSIONS: VD response represents the less frequent responses among those induced by HUTT, accounting up to 7% of overall responses. A gender and age-related distribution has been shown. Advanced age was the only independent predictor of VD syncope; conversely, smoking and non-classical presentation of syncope reduced the probability of VD response to HUTT.

Anti-Inflammatory and Anticancer Effects of Anticoagulant Therapy in Patients with Malignancy.

Optimizing the anticoagulation therapy is of pivotal importance in patients with a malignant tumor, as venous thromboembolism (VTE) has become the second-leading cause of death in this population. Cancer can highly increase the risk of thrombosis and bleeding. Consequently, the management of cancer-associated VTE is complex. In recent years, translational research has intensified, and several studies have highlighted the role of inflammatory cytokines in cancer growth and progression. Simultaneously, the pleiotropic effects of anticoagulants currently recommended for VTE have emerged. In this review, we describe the anti-inflammatory and anticancer effects of both direct oral anticoagulants (DOACs) and low-molecular-weight heparins (LWMHs).

Shear Strength Prediction Model for RC Exterior Joints Using Gene Expression Programming.

Predictive models were developed to effectively estimate the RC exterior joint's shear strength using gene expression programming (GEP). Two separate models are proposed for the exterior joints: the first with shear reinforcement and the second without shear reinforcement. Experimental results of the relevant input parameters using 253 tests were extracted from the literature to carry out a knowledge analysis of GEP. The database was further divided into two portions: 152 exterior joint experiments with joint transverse reinforcements and 101 unreinforced joint specimens. Moreover, the effects of different material and geometric factors (usually ignored in the available models) were incorporated into the proposed models. These factors are beam and column geometries, concrete and steel material properties, longitudinal and shear reinforcements, and column axial loads. Statistical analysis and comparisons with previously proposed analytical and empirical models indicate a high degree of accuracy of the proposed models, rendering them ideal for practical application.

Predicting the Response of RC Beam from a Drop-Weight Using Gene Expression Programming.

For structures and load-bearing beams under extreme impact loading, the prediction of the transmitted peak impact force is the most challenging task. Available numerical and soft computing-based methods for finding peak impact force are not very accurate. Therefore, a simple and user-friendly predictive model is constructed from a database containing 126 impact force experiments of the simply supported RC beams. The proposed model is developed using gene expression programming (GEP) that includes the effect of the impact velocity and the impactor weight. Also identified are other influencing factors that have been overlooked in the existing soft computing models, such as concrete compressive strength, the shear span to depth ratio, and the tensile reinforcement quantity and strength. This allows the proposed model to overcome several inconsistencies and difficulties residing in the existing models. A statistical study has been conducted to examine the adequacy of the proposed model compared to existing models. Additionally, a numerical confirmation of the empirical model of the peak impact force is obtained by reference to 3D finite element simulation in ABAQUS. Finally, the proposed model is employed to predict the dynamic shear force and bending moment diagrams, thus rendering it ideal for practical application.

Flexure and shear response of an impulsively loaded rigid-plastic beam by enhanced linear complementarity approach.

The linear complementarity approach has been utilized as a systematic and unified numerical process for determining the response of a rigid-plastic structure subjected to impulsive loading. However, the popular Lemke Algorithm for solving linear complementarity problems (LCP) encounters numerical instability issues whilst tracing the response of structures under extreme dynamic loading. This paper presents an efficient LCP approach with an enhanced initiation subroutine for resolving the numerical difficulties of the solver. The numerical response of the impulsively loaded structures is affected by the initial velocity profile, which if not found correctly can undermine the overall response. In the current study, the initial velocity profile is determined by a Linear Programming (LP) subroutine minimizing the energy function. An example of a uniform impulsively loaded simply supported beam is adduced to show the validity and accuracy of the proposed approach. The beam is approximated with bending hinges having infinite resistance to shear. Comparison of the numerical results to the available closed-form solution confirms the excellent performance of the approach. However, a subsequent investigation into a beam having the same support conditions and the applied loading, but with bending and shear deformation, results in numerical instability despite optimizing the initial velocity profile. Thus a more generic description of kinetics and kinematics is proposed that can further enhance the numerical efficiency of the LCP formulation. The ensuing numerical results are compared with the available close form solution to assess the accuracy and efficiency of the developed approach.

Improved Shear Strength Prediction Model of Steel Fiber Reinforced Concrete Beams by Adopting Gene Expression Programming.

In this study, an artificial intelligence tool called gene expression programming (GEP) has been successfully applied to develop an empirical model that can predict the shear strength of steel fiber reinforced concrete beams. The proposed genetic model incorporates all the influencing parameters such as the geometric properties of the beam, the concrete compressive strength, the shear span-to-depth ratio, and the mechanical and material properties of steel fiber. Existing empirical models ignore the tensile strength of steel fibers, which exercise a strong influence on the crack propagation of concrete matrix, thereby affecting the beam shear strength. To overcome this limitation, an improved and robust empirical model is proposed herein that incorporates the fiber tensile strength along with the other influencing factors. For this purpose, an extensive experimental database subjected to four-point loading is constructed comprising results of 488 tests drawn from the literature. The data are divided based on different shapes (hooked or straight fiber) and the tensile strength of steel fiber. The empirical model is developed using this experimental database and statistically compared with previously established empirical equations. This comparison indicates that the proposed model shows significant improvement in predicting the shear strength of steel fiber reinforced concrete beams, thus substantiating the important role of fiber tensile strength.