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Background: Several risk scores have been developed to predict and analyze in-hospital mortality and short- and long-term outcomes of ST-elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI); these can classify patients as having a high or low risk of death or complications., Objective: To compare the prognostic precision of four risk scores for predicting in-hospital mortality in patients with STEMI treated with PPCI., Methods: We performed a retrospective cohort analysis of patients with STEMI who underwent PPCI between 2012 and 2019 ( N  = 1346). GRACE (Global Registry of Acute Cardiac Events), CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications), Zwolle, and TIMI (Thrombolysis in Myocardial Infarction) risk scores were calculated for each patient according to different variables. We evaluated the predictive accuracy of these scores for in-hospital mortality using the C statistic, which was obtained using logistic regression and receiver operating characteristic curves., Results: The GRACE, CADILLAC, Zwolle, and TIMI risk scores all had good predictive precision for in-hospital mortality, with C statistics ranging from 0.842 to 0.923. The GRACE and CADILLAC risk scores were found to be superior., Conclusions: All GRACE, CADILLAC, Zwolle, and TIMI risk scores showed a high predictive value for in-hospital mortality due to all causes in patients with STEMI treated with PPCI. The GRACE and CADILLAC risk scores revealed a better accuracy for predicting in-hospital mortality than the Zwolle and TIMI risk scores., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Chih-Hwa Wang et al.)

Emergency care is a critical area of medicine whose outcomes are influenced by the time, availability, and accuracy of contextual information. The success of critical or emergency care is determined by the quality and accuracy of the information received during the emergency call and the data collected during emergency transportation. The Internet of Things (IoT) consists of many smart devices and components that communicate via their connection to the Internet, which is used to collect data with sensors that obtain personal health parameters. In the past, most health measurement systems were based on a single dedicated orientation, and few systems had multiple devices on the same platform. In addition to traditional health measurement technologies, most such systems use centralized data transmission, which means that health measurement data have become the exclusive intellectual asset of the system developer. Therefore, this study develops an IoT-based message-broker system that is deployed and demonstrated for five health devices: blood oxygen, blood pressure, forehead temperature, body temperature, and body weight sensors. A central controller accessed by radio-frequency identification (RFID) collects clients' health profiles on the cloud platform. All collected data can be quickly shared, analyzed, and visualized, and the health devices can be changed, added to, and removed reliably when the requirements change. Additionally, following the message queuing telemetry transport (MQTT) protocol, all devices can communicate with each other and be integrated into a higher-level health measurement standard (such as blood pressure plus weight or body temperature plus blood oxygen). We implement a smart healthcare monitoring system (SHMS) and verify its reliability. We use MQTT to establish an open communication format that other organizations can follow to perform individual patient vital sign monitoring in potential applications. The robustness and flexibility of this research can be verified through the addition of other systems. Through this structure, more large-scale health detection devices can be integrated into the method proposed in this research in the future. Personal RFID or health insurance cards can be used for personal services or in medical institutions, and the data can easily be shared through the mechanism of this research. Such information sharing will enable the utilization of medical resources to be maximized., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Yung-Chung Tsao et al.)

Ambulance response time is a prognostic factor for out-of-hospital cardiac arrest (OHCA), but the impact of ambulance response time under different situations remains unclear. We evaluated the threshold of ambulance response time for predicting survival to hospital discharge for patients with OHCA. A retrospective observational analysis was conducted using the emergency medical service (EMS) database (January 2015 to December 2019). Prehospital factors, underlying diseases, and OHCA outcomes were assessed. Receiver operating characteristic (ROC) curve analysis with Youden Index was performed to calculate optimal cut-off values for ambulance response time that predicted survival to hospital discharge. In all, 6742 cases of adult OHCA were analyzed. After adjustment for confounding factors, age (odds ratio [OR] = 0.983, 95% confidence interval [CI]: 0.975-0.992, p < 0.001), witness (OR = 3.022, 95% CI: 2.014-4.534, p < 0.001), public location (OR = 2.797, 95% CI: 2.062-3.793, p < 0.001), bystander cardiopulmonary resuscitation (CPR, OR = 1.363, 95% CI: 1.009-1.841, p =0.044), EMT-paramedic response (EMT-P, OR = 1.713, 95% CI: 1.282-2.290, p < 0.001), and prehospital defibrillation using an automated external defibrillator ([AED] OR = 3.984, 95% CI: 2.920-5.435, p < 0.001) were statistically and significantly associated with survival to hospital discharge. The cut-off value was 6.2 min. If the location of OHCA was a public place or bystander CPR was provided, the threshold was prolonged to 7.2 min and 6.3 min, respectively. In the absence of a witness, EMT-P, or AED, the threshold was reduced to 4.2, 5, and 5 min, respectively. The adjusted OR of EMS response time for survival to hospital discharge was 1.217 (per minute shorter, CI: 1.140-1299, p < 0.001) and 1.992 (<6.2 min, 95% CI: 1.496-2.653, p < 0.001). The optimal response time threshold for survival to hospital discharge was 6.2 min. In the case of OHCA in public areas or with bystander CPR, the threshold was prolonged, and without witness, the optimal response time threshold was shortened., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Ling Hsuan Huang et al.)

Objective: By analyzing closed criminal malpractice claims involving resident physicians, we aimed to clarify the characteristics of litigations and examine the litigious errors leading to guilty verdicts., Design: A retrospective descriptive study. Setting/Study Participants . The verdicts pertaining to physicians recorded on the national database of the Taiwan justice system were reviewed. Main Outcome Measures . The characteristics of litigations were documented. Negligence and guilty verdicts were further analyzed to identify litigious errors., Results: Between January 1, 2000, and December 31, 2014, from a total of 436 closed criminal malpractice cases, 40 included resident physicians. Five (12.5%) cases received guilty verdicts with mean imprisonment sentences of 5.4 ± 4.1 months. An average of 77.2 months was required for the final adjudication, and surgery residents were involved most frequently (38.9%). Attending physicians were codefendants in 82.5% of cases and were declared guilty in 60% of them. Sepsis (37.5%) was the most common disease in the 40 cases examined, followed by operation/procedure complications (25%). Performance errors (70%) were more than twice as common than diagnostic errors (30%), but the percentage of guilty verdicts in performance error cases was much lower (7.1% vs. 25%). Four negligence cases received nonguilty verdicts, which were mostly due to lack of causation., Conclusion: Closed criminal malpractice cases involving residents took on average 6.22 years to conclude. Performance errors accounted for 70% of cases, with treatment of sepsis and operation/procedure complications predominant. To reduce medicolegal risk, residents should learn experiences from analyzing malpractice cases to avoid similar litigious pitfalls., Competing Interests: The authors declare no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Kuan-Han Wu et al.)

Aim. IgA nephropathy (IgAN) is the most common form of glomerulonephritis. Recent genome-wide association study (GWAS) suggested that DEFA locus (which encodes α-defensins) may play a key role in IgAN. Methods. The levels of α-defensins in 169 IgAN patients and 83 healthy controls were tested by ELISA. Results. We observed that α-defensins human neutrophil peptides 1-3 (HNP1-3) in IgAN patients were elevated compared with healthy controls. The mean levels of α-defensins of 83 healthy controls and 169 IgAN patients were 50 ng/mL and 78.42 ng/mL. When the results were adjusted to the mean levels of α-defensins of IgAN patients, the percentage of individuals with high levels of α-defensins increased in IgAN patients (22.5%) compared to healthy controls (9.6%) (p = 0.013). The elevation of α-defensins in IgAN patients was independent of renal function or neutrophil count, which were major sources of α-defensins in circulation. More importantly, negative correlation was observed between galactose-deficient IgA1and α-defensins. Conclusion. As α-defensin is a lectin-like peptide, we speculated that it might be involved in IgA galactose deficiency. The data implied that patients with IgAN had higher plasma α-defensins levels and high α-defensins correlated with IgA galactose deficiency, further suggesting a pathogenic role of α-defensins in IgAN.