关键词： Social democracy   Singapore   globalization   labour movements   class compromise   capitalism  

摘要： One of the key challenges that globalization poses to the project of social democracy is that, by allowing capital to move production anywhere that suits its interests, the ability of labor to organise in opposition to capital is threatened, as capital can simply move production to other places as soon as labor starts making uncomfortable demands. In this article, I argue that Singapore is best understood as a social democracy adapted to the conditions of globalization. As such, Singapore's form of social democracy looks very different from most traditional/Western social democracies. Nevertheless, I argue, Singapore's form of social democracy is based on the same underlying principle of class compromise as traditional social democracy, only applied to very different circumstances. To make this argument, I begin by outlining what I mean by the term "social democracy", and why we should care about whether Singapore fits that label. I then describe the nature of Singapore's class compromise, as well as its underlying social contract, which I argue has a distinctly corporate character - one that is based on getting the citizens to invest as shareholders in the state-as-a-corporation, rather than on accepting high taxes in exchange for a generous public sector in which goods and services are offered in a "de-commodified" form. Lastly, I address the question of why it makes sense to view Singapore as a social democracy, given that the country is not very "socialistic", nor very "democratic".

关键词： complete revascularization   culprit-only revascularization   older adults   PCI   STEMI  

摘要： Background: Randomized controlled trials (RCTs) of complete revascularization (CR) versus culprit-only revascularization (COR) in patients with ST-elevation myocardial infarction (STEMI) have shifted the recommendation for CR from class III to class I in the AHA/ACC/SCAI guidelines, but it remains unclear if the benefit of CR over COR extends to older adults, who have greater bleeding risk, comorbidity burden, and complexity of lesions. We performed a meta-analysis to place the results of the previous RCTs in the context of the recently published FIRE trial and the subgroup analysis of the COMPLETE trial in adults >= 75 years old. Methods;We searched the literature from inception to October 21, 2023. RCTs of CR versus COR in STEMI were selected if it reported results for older adults, defined as either age > 65 years or > 75 years. Integrated hazard ratios (HRs) were calculated using random effects models. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes were major bleeding and contrast-associated acute kidney injury (CA-AKI). Results: In this meta-analysis of 5 RCTs including 3513 older adults, CR was associated with a lower hazard of MACE than COR (HR 0.60, 95% CI 0.37-0.99, p = 0.047). Sensitivity analysis including trials that defined older adults as age > 65 years resulted in a lower hazard of MACE with CR versus COR, but not in trials that defined older adults as age > 75 years. There was no difference in the hazard of major bleeding or CA-AKI between CR and COR. Conclusions: In this largest meta-analysis to date investigating CR compared with COR in older adults with STEMI, CR was associated with reduced MACE without a concomitant increase in major bleeding or CA-AKI compared with COR. These results can help cardiologists and geriatricians involved in shared decision-making with patients and caregivers when contemplating whether to pursue CR in older adults.

关键词： Methicillin-resistant Staphylococcus aureus   (MRSA)   Methicillin-susceptible Staphylococcus   aureus (MSSA)   Bloodstream infection   Sequence type (ST)   Livestock-associated (LA) genotype   Japan  

摘要： Objectives: Staphylococcus aureus ( S. aureus ) is a major cause of bloodstream infections. The recent epidemiological features and antimicrobial resistance trend were analysed for methicillin-resistant and susceptible S. aureus (MRSA/MSSA) isolates from blood samples in people from northern Japan. Methods: The S. aureus isolates from blood culture were screened by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) and genotyped by the schemes of multilocus sequence typing (MLST), coa, agr, spa , and SCC mec types. Antimicrobial resistance genes and virulence factors were detected by multiplex/uniplex polymerase chain reaction (PCR). Antimicrobial susceptibility was examined using a broth microdilution test. Results: A total of 301 isolates (163 MRSA and 138 MSSA) were isolated from bloodstream infections in 2023 (from April to December). The MRSA isolates were classified into three groups, that is, clonal complexes (CC)1-SCC mec- IV (CC1-IV) (52%), CC5-II (36%), and CC8-IV (12%). The prevalence of CC1 was significantly higher than those in our previous studies (2017-2021). Four CC8-IVa isolates with PVL genes on DSa2usa were considered to be the USA30 0 clone (sequence type [ST]8/ spa -t008/ coa IIIa/ agr I) or its variants that were genotyped as those closely related to ST8/t008 or lacking arginine catabolic mobile element (ACME). In contrast, MSSA was genetically highly divergent and classified into 22 STs, with CC1 (ST1 and ST188) being the most common (25%). It was notable that 29 MSSA isolates (21%) were classified into livestock-associated (LA) genotypes, ST20, ST97, and CC398 (ST398 and ST291). Genetic characterization of the CC398 isolates suggested that these belong to human-adapted MSSA clones. Conclusions: The present study revealed the increasing trend of CC1 MRSA surpassing CC5, and the emergence of MSSA representing human-adapted CC398, and LA types ST97 and ST20 from bloodstream infections in people in Japan. (c) 2024 The Author(s

关键词： Homocysteine   Lipoprotein (a)   Myocardial infarction   Heart diseases   Acute coronary syndrome  

摘要： Although electrocardiographic changes are used widespreadly to characterize patients presenting with myocardial infarction (MI), little is known about recent incidence rates, treatment, and outcomes of patients presenting for MI, which is also stratified by ST-segment elevation (STEMI). Homocysteine (Hcy) metabolism is essential in methionine availability, protein homeostasis, and DNA methylation. Therefore, it is necessary in post-genomic and epigenetic regulation mechanisms. As a result, impaired Hcy metabolism leading to high Hcy concentrations in blood plasma (hyperhomocysteinemia) is linked to the excessive free-radical production. The aim of this study is to evaluate the relationship between routinely-measured cardiac parameters, lipid profile, homocysteine and lipoprotein (a) levels in the diagnosis of STEMI. The study subjects comprised 100 patients diagnosed with STEMI and 100 healthy individuals. Homocysteine, lipoprotein (a), cardiac parameters and routine biochemical parameters were measured in serum obtained from blood samples taken from patients and healthy individuals. The study indicates that in the patient group, leukocyte (p< 0.01), neutrophil (p< 0.01), CRP (p< 0.01), total cholesterol (p< 0.01), LDL-cholesterol (p< 0, 01) levels were found to be higher. Lympho- cyte count, albumin (p< 0.05), uric acid (p< 0.01), and HDL-cholesterol (p<0.01) levels were found to be low. Again, CK (p<0.01), CK-MB (p<0.01), tro- ponin (p<0.01), homocysteine (p< 0.01), and lipo- protein (a) (p< 0.01) levels were found to be higher in the patient group than in the control group. As a result, it can be concluded that the relationship between routinely-measured cardiac parame- ters, lipid profile, Homocysteine and lipoprotein (a) levels may be important in the diagnosis of STEMI, and the results obtained will make a base for further studies in this field.

关键词： endoscopy   Mount St. Helen's sign   variceal hemorrhage   white nipple sign  

关键词： Menstrual cycle   Premenstrual syndrome   Affective symptoms   Biopsychosocial model   Psychotherapy   Menstrual cycle   Premenstrual syndrome   Affective symptoms   Biopsychosocial model   Psychotherapy  

摘要： Premenstrual dysphoric disorder (PMDD) is characterized by pronounced affective core symptoms as well as other psychological and physical symptoms that occur in the luteal phase, usually in the premenstrual week and subside after the onset of menstruation. The PMDD has been included in the International Classification of Diseases 11 (ICD-11) in the chapter on gynecological disorders with a cross-reference in the depressive disorders section. The differential diagnosis requires a distinction from other mental disorders and premenstrual symptom patterns. This article provides an overview of prevalence rates, comorbidities, etiopathogenetic factors, diagnostics and differential diagnosis and treatment options for PMDD.

关键词： Multivariate time series classification   Neural tree   Interpretability   Representations learning  

摘要： Multivariate time series classification is of great importance in practical applications and is a challenging task. However, deep neural network models such as Transformers exhibit high accuracy in multivariate time series classification but lack interpretability and fail to provide insights into the decision-making process. On the other hand, traditional approaches based on decision tree classifiers offer clear decision processes but relatively lower accuracy. Swin Transformer (ST) addresses these issues by leveraging self-attention mechanisms to capture both fine-grained local patterns and global patterns. It can also model multi-scale feature representation learning, thereby providing amore comprehensive representation of time series features. To tackle the aforementioned challenges, we propose ST-Tree with interpretability for multivariate time series classification. Specifically, the ST-Tree model combines ST as the backbone network with an additional neural tree model. This integration allows us to fully leverage the advantages of ST in learning time series context while providing interpretable decision processes through the neural tree. This enables researchers to gain clear insights into the model's decision-making process and extract meaningful interpretations. Through experimental evaluations on 10 UEA datasets, we demonstrate that the ST-Tree model improves accuracy in multivariate time series classification tasks and provides interpretability through visualizing the decision-making process across different datasets.

关键词： Carbapenem-resistant Klebsiella pneumoniae   ST11-KL64   Hypervirulent   Ceftazidime-avibactam  

摘要： Background: With the widespread clinical use of ceftazidime-avibactam (CZA), reports of resistance have increased continuously, posing immense threats to public health worldwide. In this study, we explored the underlying mechanisms leading to the development of CZA resistance in an ST11-KL64 hypervirulent Klebsiella pneumoniae CRE146 that harbored the bla KPC-228 gene. Methods: Twelve carbapenem-resistant Klebsiella pneumoniae (CRKP) strains were isolated from the same patient, including K. pneumoniae CRE146. Whole-genome sequencing (WGS), phylogenetic analysis, bla KPC gene cloning and pACYC-KPC construction assays were conducted to further explore the molecular mechanisms of CZA resistance. Quantitative siderophore production assay, string test, capsule quantification and Galleria mellonella in vivo infection model were applied to verify the level of pathogenicity of K. pneumoniae CRE146. Results: This strain carried key virulence factors, iutA-iucABCD operon and rmpA gene. Compared to the wild-type KPC-2 carbapenemase, the novel KPC-228 enzyme exhibited a deletion of four amino acids in the ohm-loop (del_167-170_ELNS). In addition, the emergence of CZA resistance appeared to be associated with drug exposure, and we observed the in vivo evolution of wild-type KPC-2 to KPC-228 and then the reversion to its original wild-type KPC-2. The bla KPC-228 gene was located within the double IS26 flanking the ISKpn6- bla KPC-228-IS Kpn27 core structure and carried on an IncFII/IncR-type plasmid. Notably, CRE146 exhibited high-level resistance to CZA (64/4 mg/L) but increased susceptibility to meropenem (1 mg/L) and imipenem (0.5 mg/L) respectively. PACYC-KPC plasmids were constructed and expressed in K. pneumoniae ATCC13883. Compared to K. pneumoniae ATCC13883 harboring bla KPC-2 , K. pneumoniae ATCC13883 harboring bla KPC-228 exhibited a high-level resistance to CZA (32/4 mg/L) and increased susceptibility to meropenem (1 mg/L) and imipenem (0.5 mg/L). Interestingly, K. pne