关键词： Cardiac arrest   12-lead electrocardiogram   Out-of-hospital   Acute myocardial infarction   Resuscitation  

摘要： Introduction: A previous study found that following out-of-hospital cardiac arrest (OHCA), 67% of out-of-hospital 12-lead electrocardiograms (ECGs) diagnostic for ST-segment elevation myocardial infarction (STEMI) changed to non-STEMI on repeat emergency department (ED) ECG. Here we evaluated associations with resolution of STEMI on ED ECG. Methods: In this secondary analysis of a previous retrospective study, adults (>= 18 years) with return of spontaneous circulation (ROSC) following OHCA, at least 1 out-of-hospital and ED ECG and transport to the study hospital were entered. We analyzed variables suspected of influencing ischemic changes on ECG including arrest characteristics, treatment interventions, resuscitation duration, and out-of-hospital and ED ECG acquisition times. Results: Forty-nine of 176 patients entered had out-of-hospital ECGs diagnostic for STEMI, and 33/49 (67%) had resolved STEMI upon ED evaluation. Shorter resuscitation time (13 [interquartile range 5-18] vs 21 [14-28] minutes), p = 0.007), less epinephrine (3 [1-4] vs 5 [2-10] milligrams, p = 0.018), lower incidence of norepinephrine (5/33 (15%) vs 11/16 (69%), p <= 0.001), less time from ROSC to out-of-hospital ECG acquisition (5.5 [1-8] vs 8.5 [7-14] minutes, p = 0.044), and more time between out-of-hospital and ED ECG acquisition (34 [25-52] vs 21 [14-27] minutes, p = 0.001) were associated with resolution of out-of-hospital STEMI on ED evaluation. More defibrillations were associated with increased ischemia on ED ECG for patients with non-STEMI out-of-hospital ECGs. Conclusion: ROSC patients with STEMI on out-of-hospital ECG commonly resolve in the ED (67%). These identified associations may better inform clinical decision making. Post-ROSC out-of-hospital 12-lead ECGs should be repeated on arrival in the ED.

关键词： chest pain   clinical diagnostic score   emergency department   prehospital emergency care   ST elevation myocardial infarction  

摘要： Background: In resource-limited settings where prehospital electrocardiogram (ECG) is not available, prehospital recognition of ST-segment elevation myocardial infarction (STEMI) remains challenging. This study aimed to evaluate the accuracy of a structured prehospital questionnaire and develop a clinical diagnostic score for prehospital STEMI identification. Methods: We analyzed 324 adult patients with chest pain transported by ambulance in the Hong Kong West Cluster from 1 February 2018 to 12 August 2018. Participants' symptoms were systematically assessed by the ambulance crew using the standardized 5-item prehospital chest pain (PHCP) questionnaire, which produced a composite score, and its diagnostic performance was evaluated. Univariate analysis followed by multivariable backward logistic regression was conducted to identify independent predictors of STEMI. A clinical diagnostic score, named the MANS score, was consequently developed based on the regression coefficients of these predictors and its discriminatory performance was compared with the PHCP score. Results: The PHCP score demonstrated suboptimal performance, with an area under the receiver operating characteristic curve (AUROC) of 0.63 (95% confidence interval [CI] 0.47-0.79). The MANS score (male sex, aspirin use, and nausea or vomiting and sweating) was derived from three independent predictors: male sex (1 point), aspirin use (-2 points), and the cooccurrence of nausea or vomiting and sweating (1 point). The score ranges from -2 to 2, with a higher score indicating a higher risk of STEMI. The MANS score achieved an AUROC of 0.85 (95% CI 0.79-0.91). Conclusions: While the PHCP questionnaire exhibited suboptimal diagnostic performance, the MANS score may help to identify STEMI in the absence of prehospital ECG. Further external validation is necessary to evaluate its generalizability.

关键词： Diagnosis  

摘要： Acute myocardial infarction is a condition in which a part of the heart muscle cannot receive enough blood due to the narrowing and blockage of the vessels feeding the heart over time. Noticing this situation lately and failing to intervene immediately may cause death and some permanent damage to individuals. The ST-segment elevation MI (STEMI) is one of the most serious and fatal types of acute myocardial infarction which requires urgent diagnosis and intervention. Artificial intelligence-based applications used in health have become widespread, paving the way for early diagnosis and treatment. In modern medicine, it is vital that STEMI patients are identified and treated accurately and quickly. Determining the risk of death of patients in advance plays a major role in making clinical decisions. Traditional risk assessment methods are often time-consuming and subjective processes and rely on manual analysis of clinical data. In this respect, this study is expected to provide clinical decision support in the management of STEMI patients and contribute to improving the quality of healthcare services. In the proposed work, death risk analysis and in-hospital mortality risk prediction are carried out using some selected machine learning (ML) algorithms, such as SVM, RF, RT, k-NN, LMT, and MLP, that are proven to be effective in medical classification tasks. The conducted test results indicate that the proposed method outperforms similar studies in the literature, achieving a superior performance of over 99 % in all metrics, i.e., accuracy, recall, precision, sensitivity, F-score, and AUC. Moreover, the same competitive results have been obtained with even much fewer predictors. © 2025

摘要： Objectives Staphylococcus aureus is an important zoonotic pathogen that has often been seen in animals through the prism of the MRSA clonal complex (CC) 398 in pigs and in-contact humans. The goal of this study was first to assess the prevalence of MRSA, and second to look for MSSA CC398 in cats, dogs and horses in *** Clinical S. aureus isolates (n = 479) were collected from 186 cats, 143 dogs and 150 horses during 2022-2023 all over the French territory. Antibiograms were performed on all isolates. MRSA and MSSA CC398 isolates were subject to WGS. Core genome (cg) MLST-based and SNP-based phylogenetic analyses were performed using published methodologies, and characterization of the isolates was performed using publicly available *** Sixty-six MRSA isolates were identified in 14 cats (7.5%), 9 dogs (6.3%) and 43 horses (28.7%). The epidemiology of MRSA in cats and dogs remained stable since a previous study in 2015, with the presence of both CC398 and human-associated clones. In horses, in contrast, an important increase in MRSA (from 10% to 28.7%) was observed, potentially attributable to the emergence of the ST612 clones. In parallel, CC398 MSSA, a clone usually described as animal-independent, was found in 24.2% of the cat *** Our study, which is leading the way to a genomic surveillance of S. aureus in France, revealed the emergence of both MRSA ST612 in horses and MSSA CC398 in cats. These clones should be closely monitored to avoid their zoonotic spread and to understand their dynamics of transmission between humans and animals.

关键词： Spatial-temporal data   Deep learning   Multi-layer perceptron   Gated mechanisms   Traffic prediction  

摘要： The field of traffic forecasting has been the subject of considerable attention as a critical component in alleviating traffic congestion and improving urban services. Given the regular patterns of human activities, it is evident that traffic flow is inherently periodic. However, most of existing studies restrict themselves to recent historical observations and typically yield structurally and computationally complex models, which greatly limits the forecasting accuracy and hinders the application of models in realistic situations. To this end, this paper proposes a concise framework named Spatial-Temporal Gated Multi-Layer Perceptron (ST-GMLP), aiming to enhance the forecasting performance by leveraging the temporal patterns of different scales with a simple and effective structure. Nevertheless, due to the incorporation of more historical features, the presence of distribution shifts between periods further restricts the forecasting accuracy. To address the above issue, ST-GMLP employs a parallel structure of learning the interdependencies of traffic flow in both spatial node and temporal directions, and then establishes the interactions between time and space to effectively mitigate the adverse effects due to temporal distribution shifts. Owing to the utilization of MLP with gated mechanisms (GMLP) for modeling the spatial-temporal interdependencies, ST-GMLP has significant advantages in terms of training efficiency and resources occupation. Extensive experimental findings indicate that ST-GMLP exhibits superior performance in comparison to state-of-the-art methods.

关键词： Staphylococcus haemolyticus   Emergence   Outbreak   NICU   Whole genome sequencing   Cross-transmission   Hands   Incubators  

摘要： Purpose: Since 2021, several reports of Staphylococcus haemolyticus outbreaks in neonatal intensive care units (NICUs) have been reported in France. The aim of this study was to understand how S. haemolyticus became established in the NICUs of two facilities which share the care of newborns. Methods: All positive S. haemolyticus clinical samples isolated between 2020 and 2023 and medical records were analysed. Phenotypic analyses consisted of typing using the quantitative antibiogram method and microbiological investigations using whole genome sequencing. Environmental samples and samples from the hands of healthcare workers (HCWs) were collected, with the same analyses undertaken if S. haemolyticus was identified. Observational studies of the hygiene practices of HCWs were also performed. Results: One hundred and sixteen neonates were positive for S. haemolyticus, of whom 44 (38%) were infected. The ST29 strain was highly predominant, and distinct clonal populations were identified. Transfers of newborns between the two centres, followed by crosstransmissions, could explain the dissemination of one population. Twenty-one environmental samples revealed the presence of the clones involved in neonates. One clonal population was also found on the hands of 15% of the HCWs sampled. Misconceptions about alcoholbased hand rub were observed, and daily disinfection of NICU equipment was not optimal. Conclusion: Preliminary reports point to cross-transmission within and between the NICUs, either directly via the hands of HCWs or indirectly via contaminated environments, especially incubators. The ST29 lineage is identified in most NICUs, with the capacity to adapt locally and cause outbreaks. 2025 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://***/licenses/by/4.0/).

关键词： myocardial infarction   CABG   cardiac  

摘要： Background The optimal timing of surgical revascularization after ST-elevation myocardial infarction (STEMI) is controversial, with some suggesting higher mortality rates in patients undergoing early surgery. The aim of the study is to determine the effect of the timing of surgical revascularization on 30-day mortality and long-term outcomes in these patients. Methods Retrospective single-center analysis of patients with STEMI undergoing coronary artery bypass grafting (CABG) between January 2008 and December 2019 at our institution. The cohort was split into three groups based on time from symptom onset until surgical revascularization (Group 1: <12 hours, Group 2: 12-72 hours, Group 3: >72 hours). Statistical analyses were performed with and without patients in cardiogenic shock. Primary outcomes were 30-day mortality and 10-year survival. Results During the study period, 437 consecutive patients underwent surgical revascularization in the setting of STEMI. The mean age was 67.0 years, 96 (22.0%) patients were female, and 281 (64.3%) patients underwent off-pump CABG. The overall 30-day mortality including patients with cardiogenic shock was 12.8%. The 30-day mortality was 16.1, 13.9, and 9.3% in Groups 1, 2, and 3 (p = 0.31), whereas 10-year survival was 48.5, 57.3, and 54.9% (log-rank: p = 0.40). After exclusion of patients in cardiogenic shock, there was no difference between the three groups in 30-day and 10-year mortality. Timing of surgery had no influence on early- and long-term survival. Conclusion In patients with STEMI, early surgical revascularization achieved similar early- and long-term survival rates compared with a delayed surgical revascularization strategy. Hence, when indicated, an early CABG strategy has no disadvantages in comparison to a delayed strategy.