摘要： Coronary collateral flow (CCF) is crucial for myocardial viability in patients with obstructive coronary artery disease, specifically ST-elevation myocardial infarction (STEMI). However, hypertension can contribute to vascular dysfunction and hinder the formation of CCF. Wide pulse pressure (WPP), defined as >= 65 mmHg, may better reflect impaired cardiovascular health compared to classic blood pressure indices. The effect of WPP on CCF remains unclear. Therefore, we aimed to evaluate the impact of WPP on CCF. This retrospective study included 1180 STEMI patients that underwent primary percutaneous coronary intervention (PCI) between 2021 and 2023 at a tertiary healthcare center. Patients were classified into good and poor CCF groups based on the Rentrop classification. Out of these patients, 272 (23.1%) had good CCF, while 908 (76.9%) had poor CCF. Two distinct models were constructed using multivariable logistic regression analysis to identify independent predictors of good CCF, including pulse pressure (Model 1) and WPP (Model 2). Covariates such as age, gender, diabetes mellitus, smoking, pre-infarction angina, Killip Class 3/4, multivessel disease, peak troponin, pre-thrombolysis in myocardial infarction (TIMI) flow 0, and previous PCI were added to both models. WPP was identified as an independent predictor that negatively influences good CCF (OR: 0.511, 95% CI: 0.334-0.783, p = 0.002). Moreover, diabetes, pre-infarction angina, Killip class III/IV, multivessel disease, and pre-TIMI flow 0 were also found to be independent predictors of CCF. WPP, derived from blood pressure measurements, has been associated with poor CCF in STEMI patients undergoing primary PCI and may serve as a predictor of poor CCF.

ISBN: (纸本)9787122461148

摘要： 《企业消防安全管理与隐患排查》共分为10章。第1章、第2章为企业消防管理基础理论，包括消防安全管理基本知识、消防安全系统工程方法；第3章到第9章为与企业消防相关的隐患排查，主要包括火灾风险行为隐患排查、工业建筑场所隐患排查、建筑消防设施隐患排查、消防设备用房隐患排查、消防重点部位隐患排查、火灾高危场所隐患排查、消防安全管理隐患排查，每一类隐患排查，都列举了隐患排查内容、依据标准、法律法规要求、隐患风险等级以及整改类型、整改方式、整改措施；第10章为重大火灾隐患判定方法，包括重大火灾隐患判定依据、重大火灾隐患判定程序、重大火灾隐患判定方法、重大火灾隐患判定要素、重大火灾隐患立案销案、重大火灾隐患判定应用举例。本书可供企业消防安全负责人、消防安全管理人员学习使用，也可供国家注册消防工程师、注册安全工程师、企业班组长参考，还可供安全科学与工程、消防工程、应急管理专业师生阅读。

关键词： C-peptide   HbA1c   no-reflow   ST-elevation myocardial infarction   primary percutaneous coronary intervention  

摘要： Currently, the gold standard treatment for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (pPCI), but even after successful pPCI, a perfusion disorder in the epicardial coronary arteries, termed no-reflow phenomenon (NR), can develop, resulting in short- and long-term adverse events. The present study assessed the relationship between NR and HbA1c/C-peptide ratio (HCR) in 1834 consecutive patients who underwent pPCI due to STEMI. Participants were divided into two groups according to NR status and the demographic, clinical and periprocedural characteristics of the groups were compared. NR developed in 352 (19.1%) of the patients in the study. While C-peptide levels were significantly lower in the NR group, HbA1c and HCR were significantly higher (P < .001, for all). In multivariable analysis, C-peptide, HbA1c, and HCR, were determined as independent predictors for NR (P < .05, for all). In Receiver Operating Characteristic (ROC) analysis, HCR predicted the NR with 80% specificity and 77% sensitivity. In STEMI patients, combining HbA1c and C-peptide in a single fraction has a predictive value for NR independent of diabetes. This ratio may contribute to risk stratification of STEMI patients.

关键词： Elastase   Immune evasion   Klebsiella pneumoniae   NETs   Neutrophils  

摘要： Klebsiella pneumoniae (Kp) strains of sequence type (ST) 258 producing K. pneumoniae-carbapenemase (KPC) are a major cause of hospital-associated outbreaks and the main contributors of carbapenemase spreading. Here, we deepen into the mechanisms behind the inhibition of neutrophil bactericidal functions mediated by a clinical isolate of Kp ST258 KPC, Kp from now on. We found that NETs formation induced by different stimuli (PMA, ionomycin, Staphylococcus aureus) was significantly reduced in the presence of Kp. We revealed that Kp affects actin polymerization which correlates with impaired mobilization of elastase from azurophilic granules to the nucleus and reduced elastase mobilization towards phagosomes that contain bacteria. In line with these results, Kp survived within neutrophils for 3 h post-challenge without compromising neutrophil viability. We also found that different Kp clinical isolates inhibited NETs formation and actin polymerization. These results describe a strategy of evasion used by Kp to subvert PMN-mediating both intra and extracellular mechanisms of killing, representing a clear advantage for the survival and spreading of this multidrug-resistant bacteria.

关键词： Systems thinking  

摘要： Today’s globalized economic system and the growing competition for human talent worldwide will test university graduates’ competencies to perform jobs that do not yet exist. Positioned as a catalyst for project-based entrepreneurial learning, Business Plan Competitions (BPCs) serve as a valuable learning experience that effectively prepares students for the interrelated systems of the 21st century, which are complementary and contradictory. The research objective was to evaluate key factors that enhance BPC participants’ competency utilization and overall success by exploring winners and non-winners’ cognitive abilities, personal traits, and occupational interests. Statistically significant results were found for Agreeableness, Conscientiousness, Emotional stability, and General learning ability, with higher averages observed among winners. Additionally, alongside General learning ability, Social interest emerged as predictors of performance in the BPC. Our study advances knowledge in entrepreneurial education research by applying systems thinking to foster its efficacy, with a competency development focus. The results can practically guide educators and policymakers in designing and implementing improved project-based entrepreneurial education programs. © 2025 by the authors.

ISBN: (纸本)9781009355278

摘要： This book seeks to critically review and evaluate the changes and consistencies in how warfare is interpreted and represented by academics, mass media outlets and political actors in the 21st century. The authors suggest that it is essential to understand the evolution and transformation of contemporary warfare's conceptualisation and practice in order to make sense of the current global geopolitical transformations that are in process, from a unipolar to multipolar global order. They therefore examine the various key actors in international relations from conceptual, theoretical and empirical perspectives through thematic chapters that demonstrate the increasingly central role played by intangible factors in the representation and management of contemporary armed conflict. The book stresses the need to reflect and rethink the potentially highly problematic trajectory of the global community within the framework of 21st century warfare's political and informational influence and effects.

关键词： Forecasting   Feature extraction   Kernel   Transformers   Spatiotemporal phenomena   Transmitters   Encoding   Convolution   Accuracy   Indexes   Radio environment maps (REMs)   spatiotemporal forecasting   fast Fourier transform   convolution neural networks (CNNs)  

摘要： Radio environment maps (REMs) forecasting is critical for wireless communication, yet existing methods have notable gaps, hindering efficient, reliable, and secure spectrum utilization. This letter introduces an innovative network, STCSFNet, that addresses these limitations, particularly their dependence on radiation source information and their failure to capture spatiotemporal dynamics. ST-CSFNet enhances REM forecasting accuracy through multiscale temporal analysis, capturing sequence dynamics across intervals, and by assessing spatial correlations, it accurately extracts spatial characteristics at various granularities. Specifically, it reduces MAE by 37.6%, RMSE by 29.5%, and increases R-2 by 6.3%, showcasing significant advancements in REM forecasting accuracy.

关键词： MRSA   Outbreak   Healthcare worker   Colonisation   Screening   Cardiac surgery  

摘要： Background: Patients undergoing cardiac surgery are identified as high risk for Staphylococcus aureus infection, including MRSA. An outbreak of MRSA was identified when two patients experienced MRSA infection concurrently in a cardiothoracic high dependency unit with uncommon detection of MRSA previously and an established screening programme. Methods: An outbreak control team was convened and interventions applied including refresher training in hand and environmental hygiene, review of practice with regard to aseptic access of medical devices and consideration of antibiotic use in the unit. MRSA isolates were referred to the Irish National MRSA Reference Laboratory where spa typing assigned all isolates to t1597 and whole genome sequencing assigned them to multilocus sequence type ST72-MRSA-IV. Recovery of this strain from only this unit in Ireland and infrequent reporting in Europe prompted staff MRSA screening with two staff members found to harbour the outbreak strain. Despite successful decolonisation, recolonisation and further transmission to patients occurred. Conclusions: In the clinical unit in which this outbreak occurred, the usual control measures to prevent spread of MRSA were in place. Recent Joint Healthcare Infection Society and Infection Prevention Society Guidance does not recommend routine staff screening for MRSA but does support its consideration in an outbreak of an unusual strain. In total, 9 patients and 2 staff were affected by this outbreak. There were 4 infections and 3 deaths. Sustained outbreak closure was necessary to protect certain national clinical programmes and was achievable only when colonised staff were no longer working in the unit. 2024 The Authors. 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： classification and regression tree model   fibrosis-4 index   mortality   ST-elevated myocardial infarction  

摘要： Background The fibrosis-4 (FIB4) index, a simple, noninvasive marker used for hepatic diseases, represents adverse outcomes. The aim of the present study was to evaluate whether the FIB4 index can predict adverse outcomes in patients with ST-elevation myocardial infarction (STEMI). Methods We investigated patients with STEMI who underwent primary percutaneous coronary intervention (PCI) and were alive at discharge. The cut-off FIB4 index at discharge was investigated using the survival classification and regression tree (CART) model to predict adverse outcomes. The primary outcome was all-cause mortality. Results Between January 2006 and December 2018, 1354 patients with STEMI (median age, 68 years;men, 76.1%) were investigated. The median value of the FIB4 index was 1.21 (0.84-1.78). The CART model divided the study population into low (FIB4 index <0.945;n = 435), intermediate (0.945 <= FIB4 index < 2.185;n = 692), and high (FIB4 index >= 2.185;n = 227) groups based on the significant predictive values for all-cause death. During a median follow-up period of 4.3 years, all-cause death occurred in 208 patients (15.4%). The Kaplan-Meier analysis showed a significant increase in mortality with higher FIB4 index values (log-rank, P < 0.001). The multivariate Cox regression model revealed that the FIB4 index was an independent risk predictor for all-cause death in patients with STEMI [low group as reference vs. intermediate group, hazard ratio: 1.975;95% confidence interval (CI): 1.166-3.346;P = 0.011 and vs. high group, hazard ratio: 4.633;95% CI: 2.549-8.418;P < 0.001]. Conclusions The FIB4 index was associated with the risk of all-cause mortality in patients with STEMI who underwent primary PCI.