关键词： Cardiogenic shock   ST-elevation myocardial infarction   Mechanical circulatory support   Microaxial flow pump   DanGer Shock  

摘要： Aims The DanGer Shock (DGS) trial demonstrated that the routine use of a microaxial flow pump (mAFP) with standard care to treat STEMI-related cardiogenic shock (STEMI-CS) led to a lower risk of all-cause death at 180 days than standard care alone. We investigated the impact of patient eligibility for DGS in an all-comers cardiogenic shock registry of patients receiving a mAFP. Methods and results Prospective single-centre mAFP registry including 478 CS-patients with 225 patients having STEMI-CS. DGS-like was defined as STEMI-CS, lactate >= 2.5 mmol/L, left ventricular ejection fraction < 45%, no mechanical complications, and no comatose out-of-hospital cardiac arrest but in-hospital cardiac arrest with a maximum of 10 min to return of spontaneous circulation as a surrogate for medically witnessed cardiac arrest was included. The comparison group consisted of STEMI-CS patients who did not fulfil the aforementioned criteria (DGS-unlike). The primary outcome was 180-day mortality. Out of 225 STEMI-CS, 64 (28.4%) patients were considered DGS-like. Those patients were younger, had less often received CPR before mAFP implantation, and mAFP-support was longer. Comorbidities, baseline lactate, coronary artery disease characteristics/treatment, inotropes/vasopressors, and escalation to other mechanical circulatory support devices were not different. All-cause mortality at 180 days was significantly lower in the DGS-like compared to the DGS-unlike cohort (62.5% vs. 72.0%, P = 0.014) as was 30-day all-cause mortality (48.4% vs. 70.2%, P < 0.001). DGS-like remained an independent predictor of both 180-day (HR 0.57, 95% CI 0.39, 0.83) and 30-day mortality (HR 0.48, 95% CI 0.32, 0.72) in a multivariable analysis. Conclusions A DGS-like profile was associated with a lower 180-day mortality compared with a DGS-unlike profile in a STEMI-CS cohort treated by mAFP.

关键词： cardiomypathy   electrocardiogram   myocardial ischemia  

摘要： Recent studies demonstrate the relevance of apical ischemia in the pathophysiology of apical hypertrophic cardiomyopathy. This finding could explain why some patients may exhibit chest pain and dynamic ST-segment changes simulating an acute coronary syndrome. We present a paradigmatic case of apical hypertrophic cardiomyopathy with normal coronary arteries presenting with prolonged chest pain and ST-segment elevation myocardial infarction. © 2025 The Authors

关键词： vapochromic behavior   host-guest chemistry   inclusion complex   stereoregular polymer   C-60  

摘要： In multicomponent self-assembly, the chemical and compositional diversity of functional molecules governs the formation of complex architectures with distinct functionalities. However, the influence of composition in host-guest systems has rarely been explored. Therefore, this study investigates composition-driven structural modulation in the st-PMMA/C-60 complex system. Tuning the encapsulation ratio (E-ratio) of C-60 not only regulates the accumulation of C(60)s molecules within the st-PMMA supramolecular helices but also modulates the composition of the st-PMMA/C-60 helical bundles in the semicrystalline morphology. Variations in these hierarchical structures subsequently affect the vapochromism of the st-PMMA/C-60 complex. At low E-ratios, isolated C(60)s molecules within the st-PMMA helices do not trigger a vapochromic response to aromatic volatile organic compounds (VOCs). At a moderate E-ratio of 15 wt %, the st-PMMA/C-60 complex forms optimal hierarchical structures, allowing aromatic VOCs to efficiently intercalate into the st-PMMA/C-60 helices and perturb the pi-conjugation of C(60)s. However, at the maximum E-ratio, the st-PMMA/C-60 complex loses its vapochromic response since the fully occupied supramolecular helices no longer encapsulate aromatic VOCs. Furthermore, the application of electrospinning to fabricate complex fibers increases the surface area, thereby improving the vapochromic response. Thus, this study highlights that hierarchical structures and vapochromic performance can be modulated by tuning the composition of host-guest systems.

关键词： Revascularization   Coronary revascularization   Myocardial infarction   Medical risk factors   Coronary artery bypass grafting   Coronary angioplasty   Coronary heart disease   Metaanalysis  

摘要： Background Percutaneous coronary intervention (PCI) is a revolutionary breakthrough in saving many lives from myocardial infarction. However, little is known about the PCI strategy in multivessel disease (MVD) Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients. Should complete revascularization be achieved or culprit-only is sufficient, then when the appropriate time of multivessel revascularization is, whether it is staged or immediate. Limited evidence is available on this matter compared to ST-elevation myocardial infarction (STEMI), even though NSTE-ACS patients carry poorer long-term prognoses compared to STEMI. Methods A thorough search for appropriate studies was executed across PubMed, Embase, Medline, Science Direct, and Scopus databases until July 4th, 2023. The risk ratio (RR) underwent analysis through Review Manager 5.4. Results Twenty-six studies with 222,350 MVD NSTE-ACS patients were included. Culprit-only revascularization was significantly related to a higher risk of non-fatal MI (RR: 1.41, 95% CI: 1.04-1.91, p = 0.03, I2: 65%) and all-repeat revascularization (RR 1.86, 95% CI 1.07-3.25, p = 0.03). While multistage multivessel revascularization was related to significantly higher all-cause mortality (RR: 1.73;95% CI 1.43-2.10;p < 0.01;I2: 0%), TVR repeat (RR 1.38 95% CI 1.11-1.73, I2 = 18%, p = 0.004), and non-TVR repeat (RR 2.59;95% CI 1,56-4.30;p = 0.0002;I2: 70%). Conclusion Patients with MVD NSTE-ACS treated with multivessel revascularization showed more favorable results than culprit-only. One-stage multivessel revascularization resulted in fewer adverse events than multistage. Additionally, a comprehensive and methodical prospective investigation is required to validate the factors accountable for these outcomes.

关键词： Klebsiella pneumoniae   ST65   Serotype K2   blaNDM-1   Drug resistance   Virulence plasmid  

摘要： PurposeThis study aimed to assess the resistance phenotype, virulence phenotype, and genetic characteristics of a blaNDM-1 and blaSHV-12 co-harboring ST65 K2 Klebsiella pneumoniae (KP114), which was isolated from General hospital of Ningxia Medical *** susceptibility test was determined by Vitek 2 Compact system. Multilocus Sequence typing (MLST), antimicrobial resistance and virulence genes were examined by PCR and Sanger sequencing. The virulence of KP114 was evaluated through string test, macrophage phagocytosis assay, serum resistance assay, and mouse infection model. Whole-genome sequencing was performed for further analysis of genetic *** presence of the blaNDM-1 and blaSHV-12 genes in KP114 confered resistance to multi-antibiotics. The hypervirulence of KP114 was demonstrated through various in vitro experiments and in vivo mouse infection model. KP114 was found to harbor two distinct plasmids: a drug-resistant plasmid (pKP114-NDM), classified as the IncX3 type, which contained various transfer elements including type IV coupling protein (T4CP) and type IV secretion system (T4SS), and a virulence plasmid (pKP114-vir) that exhibited a high sequence similarity with pLVPK. The results of the conjugation experiment showed that resistance and virulence traits were successfully transferred from KP114 to Escherichia coli EC600 and *** reported a Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) strain of ST65 K2 serotype carrying the blaNDM-1 and blaSHV-12, which exhibited hypervirulence and drug resistance with potential for transmission. This finding allows improved clinical surveillance and control of this clone, thereby holding considerable value for clinical treatment.

关键词： STEMI   Inflammation   Microvascular damage   Randomized clinical trial  

摘要： Background Microvascular injury in patients with ST-segment elevation myocardial infarction (STEMI) occurs in up to 50%, yet no therapeutic target exists. Inflammation contributes directly to myocardial damage in STEMI and may also cause deleteriously effects on the microcirculation. The aim of this prespecified sub-study was to determine the effect of prehospital pulse-dose glucocorticoid on the microcirculation determined by index of microvascular resistance (IMR) and its relation to *** PULSE-MI trial was a 1:1 randomized, blinded, placebo-controlled clinical trial in patients with STEMI transferred for primary percutaneous coronary intervention (PCI) investigating the cardioprotective effects of prehospital pulse-dose glucocorticoid (methylprednisolone 250 mg) compared with placebo. In this prespecified sub-study, we investigated microvascular function as IMR by thermodilution after primary PCI and inflammation defined by C-reactive protein (CRP) at 24 hours after onset of STEMI. Results Of 530 patients included in the PULSE-MI trial, 295 (56%) were assessed with coronary physiology of whom 142 (48%) were treated with glucocorticoid and 153 (52%) with placebo. Baseline characteristics were overall well-balanced in both groups. The median IMR in the glucocorticoid group was 23 (interquartile range (IQR), 11-38) and 18 (IQR, 11-42) in the placebo group (p=0.49). CRP upon arrival did not differ between treatment groups (p=0.81), but CRP at 24 hours was significantly lower in the glucocorticoid group compared to placebo (p<0.001). Conclusions Prehospital glucocorticoid did not impact IMR assessed immediately after primary PCI, albeit this compound, demonstrated significant anti-inflammatory effects as determined by CRP levels at 24 hours. Trial registration http://***;Unique Identifier: NCT05462730.

关键词： Geographic scene/VGE   graph convolutional network (GCN)   spatial-temporal knowledge representation   time-series forecasting  

摘要： Current forecasting methods for complex geographic scenes often fail to adequately account for both intrinsic factors and external environmental variables, which limits their predictive accuracy. This study proposes Scene-GCN, a Graph Convolutional Network (GCN)-based model that utilizes a spatio-temporal knowledge graph (ST-KG) to integrate static and dynamic environmental factors with the scene's spatio-temporal characteristics to predict trends. First, variations at each monitoring target point are abstracted as geo-processes, and instantaneous monitoring values are represented as geographic states, forming a coupled "process-state" ST-KG model tailored for monitoring networks in complex geographic scenes. Environmental knowledge, both dynamic and static, is then embedded within the nodes of the ST-KG, capturing historical and real-time contextual influences through feature computation. Next, a temporal graph convolutional network (T-GCN) cell is developed to quantify the relationships between spatio-temporal features, environmental knowledge, and target predictions. Experimental evaluation on a real-world time-series dataset for monitoring surface deformation in a tailings dam shows that our method outperforms baseline models. Ablation studies further show that the integration of the ST-KG enhances forecasting performance, reducing root mean square error (RMSE) by 49.2% compared to a T-GCN model without ST-KG. Additionally, leveraging a graph neural network framework improves the model's interpretability over traditional time-series forecasting methods.