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Abstract Since the first report on single-layer MoS2 based transistor, rapid progress has been achieved in two-dimensional (2D) material-based atomically thin electronics, providing an alternative approach to solve the bottleneck in silicon device miniaturization. In this scenario, reliable contact between the metal electrodes and the subnanometer-thick 2D materials becomes crucial in determining the device performance. Here, utilizing the quasi-van der Waals (vdW) epitaxy of metals on fluorophlogopite mica, we demonstrate an all-stacking method for the fabrication of 2D devices with high-quality vdW contacts by mechanically transferring pre-deposited metal electrodes. This technique is applicable for complex device integration with sizes up to the wafer scale and is also capable of tuning the electric characteristics of the interfacial junctions by transferring selective metals. Our results provide an efficient, scalable, and low-cost technique for 2D electronics, allowing high-density device integration as well as a handy tool for fundamental research in vdW materials.

ABSTRACTWith the rapid development of artificial intelligence, deep learning is considered a promising technique for intelligent fault diagnosis using large amounts of data in various industrial fields. Under such circumstances, imbalanced datasets in the real world will not only hinder the further development of classification models, but also degrade the performance of existing models. To overcome this limitation, this paper proposes a novel Mel-Frequency Cepstral Coefficent-based Generative Adversarial Network (MFCC-GAN) to augment the high-quality small class data. Specifically, the MFCC is first used to capture the time- and frequency-domain features of the real signals as a priori information, which is then fed into the generative model. The temporal structural features and energy features contained in a prior information can provide effective guidance for the process of the generative model to map the Gaussian distribution to the real-world distribution. Moreover, a contrastive loss is introduced to refine the discriminative features of the generated signals, aiming to improve the distinguishability among different health states. Experimental results show that the MFCC-GAN algorithm improves the quality and fidelity of the generated data compared to other state-of-the-art algorithms.

Abstract Introduction Chronic kidney disease-mineral and bone disorder (CKD-MBD) is characterized by bone abnormalities, vascular calcification, and some other complications. Although there are diagnostic criteria for CKD-MBD, in situations when conducting target feature examining are unavailable, there is a need to investigate and discover alternative biochemical criteria that are easy to obtain. Moreover, studying the correlations between the newly discovered biomarkers and the existing ones may provide insights into the underlying molecular mechanisms of CKD-MBD. Methods We collected a cohort of 116 individuals, consisting of three subtypes of CKD-MBD: calcium abnormality, phosphorus abnormality, and PTH abnormality. To identify the best biomarker panel for discrimination, we conducted six machine learning prediction methods and employed a sequential forward feature selection approach for each subtype. Additionally, we collected a separate prospective cohort of 114 samples to validate the discriminative power of the trained prediction models. Results Using machine learning under cross validation setting, the feature selection method selected a concise biomarker panel for each CKD-MBD subtype as well as for the general one. Using the consensus of these features, best area under ROC curve reached up to 0.95 for the training dataset and 0.74 for the perspective dataset, respectively. Discussion/Conclusion For the first time, we utilized machine learning methods to analyze biochemical criteria associated with CKD-MBD. Our aim was to identify alternative biomarkers that could serve not only as early detection indicators for CKD-MBD, but also as potential candidates for studying the underlying molecular mechanisms of the condition.

Theabrownins (TBs) are the characteristic functional and quality components of dark teas such as Pu'er tea and Chin-brick tea. TBs are a class of water-soluble brown polymers with multi-molecular weight distribution produced by the oxidative polymerisation of tea polyphenols during the fermentation process of dark tea, both enzymatically and non-enzymatically. TBs have been extracted and purified from dark tea all the time, but the obtained TBs contain heterogeneous components such as polysaccharides and caffeine in the bound state, which are difficult to remove. The isolation and purification process was tedious and required the use of organic solvents, which made it difficult to industrialise TBs. In this study, epigallocatechin (EGC), epigallocatechin gallate (EGCG), epigallocatechin gallate (ECG), EGC/EGCG (mass ratio 1:1), EGCG/ECG (mass ratio 1:1), EGC/ECG (mass ratio 1:1) and EGC/EGCG/ECG (mass ratio 1:1:1) as substrates and catalyzed by polyphenol oxidase (PPO) and peroxidase (POD) in turn to produce TBs, named TBs-dE-1, TBs-dE-2, TBs-dE-3, TBs-dE-4, TBs-dE-5, TBs-dE-6 and TBs-dE-7. The physicochemical properties and the antibacterial activity and mechanism of TBs-dE-1–7 were investigated. Sensory and colour difference measurements showed that all seven tea browning samples showed varying degrees of brownish hue. Zeta potential in aqueous solutions at pH 3.0–9.0 indicated that TBs-dE-1–7 was negatively charged and the potential increased with increasing pH. The characteristic absorption peaks of TBs-dE-1–7 were observed at 208 and 274 nm by UV-visible (UV-vis) scanning spectroscopy. Fourier transform infrared (FT-IR) spectra indicated that they were phenolic compounds. TBs-dE-1–7 showed significant inhibition of Escherichia coli DH5α (E. coli DH5α). TBs-dE-3 showed the strongest inhibitory effect with minimum inhibitory concentration (MIC) of 1.25 mg mL–1 and MBC of 10 mg mL–1, followed by TBs-dE-5 and TBs-dE-6. These three TBs-dEs were selected to further investigate their inhibition mechanism. The TBs-dE was found to damage the extracellular membrane of E. coli DH5α, causing leakage of contents, and increase intracellular reactive oxygen content, resulting in abnormal cell metabolism due to oxidative stress. The results of the study provide a theoretical basis for the industrial preparation and product development of TBs.

Objective: This research was aimed to preliminarily explore the clinical roles and potential molecular mechanisms of MIR99AHG and its significant transcripts in breast cancer (BRCA). Methods: Public databases were utilized to analyze the expression and prognostic roles of MIR99AHG and its transcripts. Relationships between MIR99AHG expression and immune cells infiltration were analyzed in Xiantao platform. In addition, co-expressed genes and interacting proteins of MIR99AHG were predicted. CancerSEA analyzed its relationship with functional states. Next, CNV status, DNA methylation, interacting transcription factors (TFs) and ceRNA network were analyzed to explore its possible mechanisms. Then, RNA ISH and FISH assays were used to detect its expression and location in BRCA tissues and cell lines, respectively. Finally, qRT-PCR was utilized to investigate MIR99AHG expression in cell lines. Results: Compared with the corresponding normal tissues, MIR99AHG expression levels were lower in all BRCA subtypes, and luminal B's was the lowest one. And MIR99AHG expression was negatively related to the tumor stage. In addition, 4 transcripts (ENST00000619222.4, ENST00000418813.6, ENST00000602901.5 and ENST00000453910.5) of MIR99AHG showed significant differences in the expression. Databases also suggested that the high MIR99AHG expression levels indicated good prognosis, especially in patients without lymph node metastasis. Xiantao found that MIR99AHG was positively related to 17 immune cells and negatively linked with 2 immune cells. CancerSEA analysis showed no relationships between MIR99AHG and functional states. From GEPIA and BCIP databases, 19 co-expressed genes were highly related to these four significant transcripts of MIR99AHG. StarBase, RNAct and HDOCK showed that several tumor-associated proteins, including U2AF65, hnRNPC, AEBP2, CHIC1 and so on, might interact with MIR99AHG. Genetically, BRCA had a higher proportion of MIR99AHG CNV loss than CNV gain, and the high level of DNA methylation indicated a good prognosis. Furthermore, 19 TFs were predicted to combine with the promoter of MIR99AHG. Then, we screened out 10 miRNAs potentially interacting with the significant transcripts of MIR99AHG, and five were significantly increased in breast tumors compared to normal tissues, including miR-194–5p, miR-320 b and so on, which could combine 14 mRNAs. Through ISH and FISH assays, we verified that MIR99AHG was down-regulated in BRCA samples and cell lines in comparison to non-tumor tissues and mammary epithelial cell line (MCF10A), and MIR99AHG was located both in cytoplasm and nucleus. qRT-PCR assay also showed the lower expression of MIR99AHG in breast cancer cells than that in MCF10A. Conclusion: These results indicate that MIR99AHG can be a favorable prognostic indicator for BRCA. ENST00000619222.4, ENST00000418813.6, ENST00000602901.5 and ENST00000453910.5 are significant transcripts and their down-regulation may play crucial roles in the progression of BRCA.

AIM:To investigate the clinical effect of modified free conjunctival flap transplantation with limbal stem cells in the treatment of pterygium and its impact on tear film function.METHODS: A total of 60 pterygium patients admitted to our hospital from March 2017 to March 2021 were randomly divided into the control group and the observation group, with 30 cases in each group. The control group was treated with amniotic membrane transplantation, and the observation group was treated with modified free conjunctival flap transplantation with limbal stem cells. The treatment period of both groups was 21d. And then the clinical efficacy, operation duration, corneal wound repair time, xerophthalmia score, tear film rupture time value and basic tear secretion test value before and 1, 3mo after treatment, and the occurrence of adverse reactions were compared between the two groups.RESULTS: The total effective rate of clinical treatment in the observation group was higher than that of the control group(χ2=5.963, P=0.015), the operation duration in the observation group was longer than that for the control group(t=-2.643, P

Comprehensive Summary: Nitrenes, as neutral monovalent nitrogen‐centered molecular species, can insert into various bond or remove nitrogen atoms from amines. Nitrene assisted single‐atom skeletal editing, discovered decades ago, provides an efficient approach for the precise alteration of cyclic skeletons. In this review, we briefly summarize early studies on skeletal editing of cyclic frameworks involving nitrene species, and introduce several recent important advances systematically. [ABSTRACT FROM AUTHOR]

The incidence of colorectal cancer (CRC) among individuals younger than age 50 (early-onset CRC [EOCRC]) has substantially increased, and yet the etiology and molecular mechanisms underlying this alarming rise remain unclear. We compared tumor-associated T-cell repertoires between EOCRC and average-onset CRC (AOCRC) to uncover potentially unique immune microenvironment-related features by age of onset. Our discovery cohort included 242 patients who underwent surgical resection at Cleveland Clinic from 2000 to 2020. EOCRC was defined as younger than age 50 years at diagnosis (N = 126) and AOCRC as 60 years of age or older (N = 116). T-cell receptor (TCR) abundance and clonality were measured by immunosequencing of tumors. Logistic regression models were used to evaluate the associations between TCR repertoire features and age of onset, adjusting for sex, race, tumor location, and stage. Findings were replicated in 152 EOCRC and 1984 AOCRC cases from the Molecular Epidemiology of Colorectal Cancer Study. EOCRC tumors had significantly higher TCR diversity compared with AOCRC tumors in the discovery cohort (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.32 to 0.61, P  < .0001). This association was also observed in the replication cohort (OR = 0.74, 95% CI = 0.62 to 0.89, P  = .0013). No significant differences in TCR abundance were observed between EOCRC and AOCRC in either cohort. Higher TCR diversity, suggesting a more diverse intratumoral T-cell response, is more frequently observed in EOCRC than AOCRC. Further studies are warranted to investigate the role of T-cell diversity and the adaptive immune response more broadly in the etiology and outcomes of EOCRC. [ABSTRACT FROM AUTHOR]

[INLINE:1] Spinal muscular atrophy (SMA) is a rare hereditary neuromuscular disease with a high lethality rate in infants. Variants in the homologous genes survival of motor neuron (SMN)1 and SMN2 have been reported to be SMA pathogenic factors. Previous studies showed that a high inclusion rate of SMN2 exon 7 increased SMN expression, which in turn reduced the severity of SMA. The inclusion rate of SMN2 exon 7 was higher in neural tissues than in non-neural tissues. Neuro-oncological ventral antigen (NOVA) is a splicing factor that is specifically and highly expressed in neurons. It plays a key role in nervous system development and in the induction of nervous system diseases. However, it remains unclear whether this splicing factor affects SMA. In this study, we analyzed the inclusion of SMN2 exon 7 in different tissues in a mouse model of SMA (genotype smn–/–SMN22tg/0) and littermate controls (genotype smn+/–SMN22tg/0). We found that inclusion level of SMN2 exon 7 was high in the brain and spinal cord tissue, and that NOVA1 was also highly expressed in nervous system tissues. In addition, SMN2 exon 7 and NOVA1 were expressed synchronously in the central nervous system. We further investigated the effects of NOVA1 on disease and found that the number of neurons in the anterior horn of spinal cord decreased in the mouse model of SMA during postnatal days 1–7, and that NOVA1 expression levels in motor neurons decreased simultaneously as spinal muscular atrophy developed. We also found that in vitro expression of NOVA1 increased the inclusion of SMN2 exon 7 and expression of the SMN2 protein in the U87MG cell line, whereas the opposite was observed when NOVA1 was knocked down. Finally, point mutation and RNA pull-down showed that the UCAC motif in SMN2 exon 7 plays a critical role in NOVA1 binding and promoting the inclusion of exon 7. Moreover, CA was more essential for the inclusion of exon 7 than the order of Y residues in the motif. Collectively, these findings indicate that NOVA1 interacts with the UCAC motif in exon 7 of SMN2, thereby enhancing inclusion of exon 7 in SMN2, which in turn increases expression of the SMN protein.

Background: X-inactive specific transcript (XIST), it has been found, is abnormal expression in various neoplasms. This work aims to explore its potential molecular mechanisms and prognostic roles in types of malignancies. Methods: This research comprehensively investigated XIST transcription across cancers from Oncomine, TIMER 2.0 and GEPIA2. Correlations of XIST expression with prognosis, miRNAs, interacting protens, immune infiltrates, checkpoint markers, mutations of tumor-associated genes and promoter methylation were also analyzed by public databases. In addition, 98 BRCA samples were collected to investigate XIST expression and evaluate its clinicopathological value. Results: In public databases, compared to normal tissues, XIST was lower in BRCA, CESC, COAD and so on, but increased in KIRC and PRAD. Databases also showed that XIST was a good indicator of prognosis in BRCA, COAD and so on, but a bad one in KIRC, KIRP and so on. From starBase, we found 29 proteins interacting with XIST, and identified 4 miRNAs which might be sponged by XIST in cancers. Furthermore, XIST was linked with immune infiltration, especially T cell CD4+, and was related to over 20 immune checkpoint markers. Moreover, several tumor-associated gene mutations and promoter methylation were negatively related to its expression. In addition, IHC showed that XIST in BRCA was obviously lower in comparison of normal tissues and was negatively related to lymph node invasion and TNM stage. Conclusion: In summary, abnormal expression of XIST influenced prognosis, miRNAs and immune infiltration across cancers, especially BRCA.

ObjectiveThe purpose of this study was to observe the relationship between physical performance and mild cognitive impairment (MCI) in the presence or absence of type 2 diabetes in elderly hemodialysis patients.MethodsIn this multicenter cross-sectional study, 396 clinically stable and aged ≥60 years hemodialysis patients (255 men; mean age: 68.3 ± 5.9 years) were included from seven dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were utilized to assess MCI. The performance-based assessments consisted of three physical tests, grip strength (GS), Timed Up and Go Test (TUGT), and 4-m walking test, which respectively represent muscle strength, mobility, and walking speed (WS). Logistic regression and multivariate linear regression were used for analysis.ResultsHemodialysis patients with diabetes had a high prevalence of MCI (20.6%). The odds ratio (OR) of MCI for the interacted items [(TUGT) * (diabetes) and (WS) * (diabetes)] was significant (p 0.05). Further analysis showed that TUGT was negatively associated with attention and calculation and language. WS was positively associated with recall and language in diabetic hemodialysis patients.ConclusionsPhysical performance was associated with MCI in diabetic hemodialysis patients rather than the non-diabetes group. Whether increasing mobility or WS can positively influence MCI in individuals with type 2 diabetes requires further study.

Objective:To investigate the mechanism of inhibition of inflammation in osteoarthritis by Tougu Xiaotong capsule(TXC)via regulating Ras-Raf-MEK1/2-ERK1/2 signaling pathways.Methods:The chondrocytes from 4-week-old SD male rats obtained by the mechanical typeⅡcollagenase digestion method were cultured in vitro and identified by typeⅡcollagen immunohistochemical staining. Isolated chondrocytes of passage two were divided into blank group, model group(treatment with 10 ng/mL of LPS for 8 h), inhibitor group(treatment with 10 ng/mL of U0126 for 30 min followed by 10 ng/mL of LPS for additional 8 h)and TXC group(treatment with 10 ng/mL of LPS plus 300 μg/mL of TXC for 8 h).Western blot was carried out to detect the expression of Ras, Raf, p-ERK1/2, MEK1/2, MMP-3 and MMP-13.qPCR was used to detect the mRNAs expression of MEK1/2, ERK1/2, MMP-3 and MMP-13, as well as the expression of miR-27b, miR-34a and miR-146a.Results:1)The cytoplasm of isolated cells(P2)from the cartilage of knee joint of 4-week-old SD male rats was stained brown by typeⅡcollagen immunohistochemical staining as compared with the negative control cells, which indicated that the extracted cells were chondrocytes.2)The expression of Ras, Raf, MEK1/2, MMP-3, MMP-13 in the model group was significantly higher than that in the blank group, respectively(PPP>0.05);the expression of Ras, Raf, p-ERK1/2, MEK1/2, MMP-3, MMP-13 in both the inhibitor group and the TXC group was lower than that in the model group, respectively(PPP>0.05).3)The mRNA expression of MEK1/2, ERK1/2, MMP-3 and MMP-13 in the model group was significantly higher than that in the blank group, respectively(PPPPPPPPP

Abstract Many sensors like digital fault indicators (DFIs) have been applied and promoted in distribution systems. The sensors can provide a technical mean for single‐line‐to‐ground (SLG) fault section location, but there are still some feature extraction and fault diagnosis problems. A novel SLG fault section location method utilizing auto‐encoder (AE) and fuzzy C‐means (FCM) clustering is presented in this work. Taking advantage of abundant information provided by DFIs, striking features can be extracted by the AE network, which is different from the artificially designed features that rely on prior knowledge. Compared with the learning‐based methods requiring massive training data, the proposed method only requires the data from one SLG fault. By applying the AE network to the zero‐sequence current measured by DFIs, the SLG fault section location's striking features could be obtained. Through feature classification by FCM clustering without setting threshold, the positional relationship between each detection node and the fault point would be distinguished to locate the fault section. Considering the abnormal communication of DFIs, the experiment proves that the proposed method can work effectively under various fault conditions.

Abstract Background Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity. Methods One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications. Results Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups. Conclusions Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

Abstract Background A novel systemic immune-inflammation index (SII), based on the neutrophils, lymphocytes and platelet counts, is associated with the prognosis of several cancers. The present study evaluates the prognostic significance of SII in non-metastatic renal cell carcinoma (RCC). Method The present study retrospectively reviewed the medical record of patients with non-metastatic RCC who underwent nephrectomy between 2010 and 2013. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cut-off value. In addition, the propensity score matching (PSM) was performed with a matching ratio of 1:1. Univariate and multivariate Cox proportional hazards models were used to identify the prognostic factors. The results were reported by hazard ratio (HR) with 95% confidence interval (95% CI). Results A total of 646 patients were included in the final analysis. High SII group (> 529) was significantly associated with older age (P = 0.014), larger tumor (P

Abstract Background Without targets, triple negative breast cancer (TNBC) has the worst prognosis in all subtypes of breast cancer (BC). Recently, eukaryotic translation initiation factor 3 m (eIF3m) has been declared to be involved in the malignant progression of various neoplasms. The aim of this study is to explore biological functions of eIF3m in TNBC. Methods Multiple databases, including Oncomine, KM-plotter and so on, were performed to analyze prognosis and function of eIF3m in TNBC. After transfection of eIF3m-shRNA lentivirus, CCK-8, colony formation assay, cell cycle analysis, wound healing assay, transwell assays, mitochondrial membrane potential assay and cell apoptosis analysis were performed to explore the roles of eIF3m in TNBC cell bio-behaviors. In addition, western blotting was conducted to analyze the potential molecular mechanisms of eIF3m. Results In multiple databases, up-regulated eIF3m had lower overall survival, relapse-free survival and post progression survival in BC. EIF3m expression in TNBC was obviously higher than in non-TNBC or normal breast tissues. Its expression in TNBC was positively related to differentiation, lymph node invasion and distant metastasis. After knockdown of eIF3m, cell proliferation, migration, invasion and levels of mitochondrial membrane potential of MDA-MB-231 and MDA-MB-436 were all significantly suppressed, while apoptosis rates of them were obviously increased. In addition, eIF3m could regulate cell-cycle, epithelial–mesenchymal transition and apoptosis-related proteins. Combined with public databases and RT-qPCR, 14 genes were identified to be modulated by eIF3m in the development of TNBC. Conclusions eIF3m is an unfavorable indicator of TNBC, and plays a vital role in the process of TNBC tumorigenesis.

Abstract Background Recently, the De Ritis (AST/ALT) ratio has been considered as a prognostic biomarker for various malignancies. We conducted this systematic review and meta-analysis to explore the prognostic value of preoperative De Ritis ratio in patients after surgery for urothelial carcinoma. Methods We searched the online database Embase, PubMed and Cochrane Library up to October 2019. The hazard ratio (HR) and 95% confidence interval (CI) were extracted from the studies. Results A total of 8 studies incorporating 3949 patients were included in the quantitative synthesis. We observed that elevated preoperative De Ritis ratio is associated with inferior OS (HR = 1.97; 95% CI 1.70–2.28; P

Compressive sensing based matching pursuit algorithm can estimate the channel state information of communication system with shorter pilot sequences. It has the advantages of lower computational complexity and less number of pilots. However, the estimation accuracy is relatively low. Assigning different weights to the estimated channel according to the estimation error can improve the estimation performance under low Signal Noise Ratio (SNR) conditions. Nevertheless, it will reduce the estimation accuracy under high SNR conditions. To address this issue, an improved weighted matching pursuit algorithm is proposed. The information of weight value is obtained by training the channel data. Adjusting the weight values adaptively with the iterations can further improve the estimation accuracy. The simulation results show that the proposed algorithm can improve the estimation performance under both low and high SNR conditions.

ObjectivesThere are conflicting data concerning the prognostic significance of syncope in acute pulmonary embolism (PE). This study aimed to investigate the impact of syncope on clinical outcomes of acute PE, and determine the clinical phenotypes of PE patients with syncope and their correlation with prognosis.MethodsIn the ongoing, national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES) enrolling consecutive patients with acute PE, patients with and without syncope were investigated. Principal component analysis (PCA) was performed using nine variables relevant to syncope and PE, including age, sex, body mass index, history of cardiovascular disease, recent surgery or trauma, malignancy, pulse, systolic blood pressure, and respiratory rate. Patient classification was performed using cluster analysis based on the PCA-transformed data. The clinical presentation, disease severity and outcomes were compared among the phenotypes.ResultsIn 7,438 patients with acute PE, 777 (10.4%) had syncope, with younger age, more females and higher body mass index. Patients with syncope had higher frequency of precordial pain, palpitation, and elevated cardiac biomarkers, as well as higher D-Dimer level. In the syncope group, more patients had right ventricular/left ventricular ratio > 0.9 in ultrasonic cardiogram and these patients had higher estimated pulmonary arterial systolic pressure compared with patients without syncope. As the initial antithrombotic treatment, more patients with syncope received systemic thrombolysis. Despite a higher prevalence of hemodynamic instability (OR 7.626, 95% CI 2.960–19.644, P < 0.001), syncope did not increase in-hospital death. Principal component analysis revealed that four independent components accounted for 60.3% of variance. PE patients with syncope were classified into four phenotypes, in which patients with high pulse and respiratory rate had markedly higher all-cause mortality during admission.ConclusionSyncope was associated with hemodynamic instability and more application of thrombolysis, without increasing in-hospital deaths. Different clinical phenotypes existed in PE patients with syncope, which might be caused by various mechanisms and thus correlated with clinical outcomes.