To address the limitations of the existing automatic electrocardiogram(ECG)diagnosis models in learning long-term dependencies,an automatic 12-lead long-term ECG signal diagnosis model which combines bidirectional selective state space model(bidirectional mamba,BiMamba)with residual multi-scale receptive field block(RMSF)is proposed:(1)designing a multi-scale receptive field module with residual connections to realize more extensive feature extraction and fusion;(2)introducing BiMamba block to enhance the model's temporal modeling capability by employing both forward and backward temporal processing;(3)using the classifier to process features from BiMamba for accomplishing multi-label ECG classification.Five major diagnostic categories from the PTB-XL dataset are extracted and subjected to 5-fold cross-validation experiments.The experimental results from the comparative study show that BiMamba-RMSF achieves an average accuracy of 89.42%,an average AUC of 0.9356,and an average F1 score of 72.85%,outperforming the other 4 automatic ECG diagnosis models.Additionally,ablation study further validates the effectiveness of BiMamba block.It is demonstrated that the proposed model has a high precision in the multi-label classification for 12-lead long-term ECG signals.

Objective To identify the cuproptosis genes associated with prognosis and immune microenvironment in lung cancer with the use of bioinformatics.Methods The lung cancer dataset used in this study was obtained from the TCGA database.The cuproptosis-related genes(CRGs)were obtained from the previously reported literature.The R software Deseq2 package was used to identify the differentially expressed genes(DEGs)in lung cancer.The intersection of DEGs and CRGs was taken to obtain the differentially expressed CRGs(DE-CRGs).COX analysis and R software rms package were used to identify DE-CRGs associated with the prognosis of lung cancer.Estimate and Cibersort algorithms were applied to identify the correlation of DE-CRGs with the immune microenvironment.Results Compared to the normal tissues,a total of 5,269 DEGs were present in lung cancer tissues in the TCGA database,and there were 11 shared genes between DEGs and CRGs.The 11 DE-CRGs mainly regulated the energy metabolism,carbon metabolism and amino acid metabolism.In the DE-CRGs,LIPT1 was an independent risk factor for lung cancer,and the column chart constructed with the clinical features(age,TNM staging,and residual tumor)predicted the survival of lung cancer patients in a manner similar to their actual outcomes.LIPT1 showed a positive correlation with the infiltration of M1 and M2 type macrophages,activated natural killer cells cells and CD8+T cells,and showed a significant negative correlation with M0 type macrophages,activated mast cells,neutrophils and Treg cells(P<0.05).Conclusion LIPT1 may serve as a prognostic and immune microenvironment-associated cuproptosis gene,which is a novel biomarker for lung cancer therapy.

OBJECTIVES: To design a deep learning model that balances model complexity and performance to enable its integration into wearable ECG monitoring devices for automated diagnosis of atrial fibrillation. METHODS: This study was performed based on data from 84 patients with atrial fibrillation, 25 patients with atrial fibrillation, and 18 subjects without obvious arrhythmia collected from the publicly available datasets LTAFDB, AFDB, and NSRDB, respectively. A lightweight attention network based on depthwise separable convolution and fusion of channel-spatial information, namely DSC-AttNet, was proposed. Depthwise separable convolution was introduced to replace standard convolution and reduce model parameters and computational complexity to realize high efficiency and light weight of the model. The multilayer hybrid attention mechanism was embedded to compute the attentional weights of the channels and spatial information at different scales to improve the feature expression ability of the model. Ten-fold cross-validation was performed on LTAFDB, and external independent testing was conducted on AFDB and NSRDB datasets. RESULTS: DSC-AttNet achieved a ten-fold average accuracy of 97.33% and a precision of 97.30% on the test set, both of which outperformed the other 4 comparison models as well as the 3 classical models. The accuracy of the model on the external test set reached 92.78%, better than those of the 3 classical models. The number of parameters of DSC-AttNet was 1.01M, and the computational volume was 27.19G, both smaller than the 3 classical models. CONCLUSIONS This proposed method has a smaller complexity, achieves better classification performance, and has a better generalization ability for atrial fibrillation classification.
Atrial Fibrillation/diagnosis* ; Humans ; Electrocardiography ; Deep Learning ; Wearable Electronic Devices ; Neural Networks, Computer

OBJECTIVE To investigate a suspected hospital-acquired infection cluster of Enterococcus faecium(Efm)in a neonatal intensive care unit(NICU)of the First Medical Center of Chinese PLA General Hospital,identify the source of infection and transmission routes,and provide a reference for precise prevention and control of hospital-acquired infections.METHODS Epidemiological investigations and environmental microbiological sam-pling were conducted for two neonates with Efm bloodstream infections in the NICU in Jul.2024 to detect Efm in the ward environment.Whole-genome average nucleotide identity(ANI)and multilocus sequence typing(MLST)were used to analyze the homology,drug resistance,and virulence factors of Efm isolates from patients and envi-ronments.Targeted intervention measures were proposed.RESULTS Two cases of Efm bloodstream infection were detected.A total of 37 environmental specimens were collected,and 2 were cultured Efm(the wipe dispenser o-pening and incubator handle of the patients).The drug susceptibility testing results of 2 environmental specimens were consistent with those of the two patient specimens.Genomic analysis confirmed high homology(ANI＞99.99％)among the four Efm isolates.After implementing a series of measures including centralized isolation,strict hand hygiene,thorough environmental cleaning and disinfection,strict disinfection and management of inva-sive devices,enhanced grouping of medical staff for diagnosis and treatment,the incident was effectively con-trolled.CONCLUSIONS This incident can be determined as cluster of hospital-acquired infection with Enterococcus faecium in the neonatal intensive care unit.The wet wipes are the source or transmission medium of contamina-tion.Inadequate disinfection of items and the environment,and insufficient hand hygiene of medical staff are the main reasons for this infection outbreak.Early identification of abnormal cluster of infection,investigation of the source of infection and transmission routes and timely implementation of targeted measures are the keys for preventing infection outbreaks.

OBJECTIVE To investigate a suspected hospital-acquired infection cluster of Enterococcus faecium(Efm)in a neonatal intensive care unit(NICU)of the First Medical Center of Chinese PLA General Hospital,identify the source of infection and transmission routes,and provide a reference for precise prevention and control of hospital-acquired infections.METHODS Epidemiological investigations and environmental microbiological sam-pling were conducted for two neonates with Efm bloodstream infections in the NICU in Jul.2024 to detect Efm in the ward environment.Whole-genome average nucleotide identity(ANI)and multilocus sequence typing(MLST)were used to analyze the homology,drug resistance,and virulence factors of Efm isolates from patients and envi-ronments.Targeted intervention measures were proposed.RESULTS Two cases of Efm bloodstream infection were detected.A total of 37 environmental specimens were collected,and 2 were cultured Efm(the wipe dispenser o-pening and incubator handle of the patients).The drug susceptibility testing results of 2 environmental specimens were consistent with those of the two patient specimens.Genomic analysis confirmed high homology(ANI＞99.99％)among the four Efm isolates.After implementing a series of measures including centralized isolation,strict hand hygiene,thorough environmental cleaning and disinfection,strict disinfection and management of inva-sive devices,enhanced grouping of medical staff for diagnosis and treatment,the incident was effectively con-trolled.CONCLUSIONS This incident can be determined as cluster of hospital-acquired infection with Enterococcus faecium in the neonatal intensive care unit.The wet wipes are the source or transmission medium of contamina-tion.Inadequate disinfection of items and the environment,and insufficient hand hygiene of medical staff are the main reasons for this infection outbreak.Early identification of abnormal cluster of infection,investigation of the source of infection and transmission routes and timely implementation of targeted measures are the keys for preventing infection outbreaks.

To address the limitations of the existing automatic electrocardiogram(ECG)diagnosis models in learning long-term dependencies,an automatic 12-lead long-term ECG signal diagnosis model which combines bidirectional selective state space model(bidirectional mamba,BiMamba)with residual multi-scale receptive field block(RMSF)is proposed:(1)designing a multi-scale receptive field module with residual connections to realize more extensive feature extraction and fusion;(2)introducing BiMamba block to enhance the model's temporal modeling capability by employing both forward and backward temporal processing;(3)using the classifier to process features from BiMamba for accomplishing multi-label ECG classification.Five major diagnostic categories from the PTB-XL dataset are extracted and subjected to 5-fold cross-validation experiments.The experimental results from the comparative study show that BiMamba-RMSF achieves an average accuracy of 89.42%,an average AUC of 0.9356,and an average F1 score of 72.85%,outperforming the other 4 automatic ECG diagnosis models.Additionally,ablation study further validates the effectiveness of BiMamba block.It is demonstrated that the proposed model has a high precision in the multi-label classification for 12-lead long-term ECG signals.

OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

BackgroundThe comorbidity rate of bipolar disorder and borderline personality disorder （BPD） is high， and the cognitive impairment of comorbidity patients is more serious. ObjectiveTo explore the difference of cognitive function between bipolar disorder patients with BPD or not， so as to provide references for clinical diagnosis and treatment. MethodsUsing simple random sampling， 60 patients with bipolar disorder comorbidity BPD treated in the First Hospital of Hebei Medical University from April 2021 to April 2022 were selected as the research group， including 33 patients with bipolar depression and 27 patients with bipolar mania. At the same time， 60 patients with bipolar disorder were randomly selected as the control group， including 35 patients with bipolar depression and 25 patients with bipolar mania. The cognitive function of patients was evaluated by the Chinese version of Repeatable Battery for the Assessment of Neuropsychological Status （RBANS） and the Stroop Color Word Test. ResultsThe immediate memory， visual span， speech function and total score of RBANS in the comorbid group were lower than those in the non-comorbid group， and the differences were statistically significant （t=-2.356， -2.138， -3.306， -2.729， P<0.05 or 0.01）. The single word time， single color time， double word time and double color time in Stroop Color Word Test in comorbid group were longer than those in non-comorbid group， and the differences were statistically significant （t=4.808， 3.341， 5.249， 5.167， P<0.01）. The immediate memory， visual span， speech function and total score in RBANS of bipolar depression patients with comorbid BPD were lower than those of bipolar depression patients without comorbid BPD （t=-2.446， -2.407， -2.231， -2.078， P<0.05）， and the time of single word， single color， double word and double color in Stroop Color Word Test were longer than those of non-comorbid BPD patients （t=-3.652， 3.035， 4.406， 5.016， P<0.01）. The speech function and total score of RBANS in bipolar manic patients in comorbid group were higher than those in non-comorbid group （t=-2.777， -2.347， P<0.05 or 0.01）， and the time of single word， single color， double word and double color in Stroop Color Word Test were longer than those in non-comorbid group （t=3.600， 2.658， 2.943， 4.337， P<0.05 or 0.01）. ConclusionThe cognitive impairment of bipolar disorder patients comorbid with BPD is more severe than that of patients without comorbid with BPD. ［Funded by Medical Science Research Project of Hebei Province in 2022 （number， 20221407）］

ObjectiveTo observe the early and mid-term clinical effect of occupational therapy on patients after total knee arthroplasty (TKA) during perioperative period. MethodsFrom July to August, 2018, 100 patients who underwent the first TKA in the First Affiliated Hospital of USTC were divided into control group (n = 50) and observation group (n = 50) according to the treatment plan. Both groups received routine preoperative rehabilitation education, surgical treatment and postoperative physical therapy, in addition, the observation group received perioperative occupational therapy. They were assessed with modified Barthel Index (MBI) and Instrumental Activities of Daily Living (IADL) before operation; one, two and three days after operation; on the day of discharge; one month, three months and six months after operation. ResultsOne day, two days, one month, three months and six months after operation, the scores of MBI were higher in the observation group than in the control group (t > 2.113, P < 0.05). One month, three months after operation, the scores of IADL were significantly higher in the observation group than in the control group (t > 5.125, P < 0.001). The postoperative hospitalization time was significantly shorter (t = -5.356, P < 0.001), and the total treatment cost was lower (t = -2.455, P < 0.05) in the observation group than in the control group. ConclusionOccupational therapy could effectively improve the early and mid-term activities of daily living of TKA patients and help them return to normal life earlier.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.