Aim To analyze the risk factor of the cardiac rupture(CR)in patients with acute ST-segment eleva-tion myocardial infarction(STEMI).Based on this,the nomogram model of acute STEMI patients with CR was estab-lished.Methods Through Ningxia Medical University General Hospital's big data research platform and hospital in-formation system retrieval,5 412 patients with acute STEMI from January 2015 to December 2019 were continuously includ-ed in the study,of which 91 patients with CR were included as CR group;5 321 patients non-combined with CR were in-cluded as non-CR group.LASSO regression,univariate and multivariate Logistic regression were used to analyze the risk factors of CR in patients with acute STEMI,and the CR nomogram predictive model was established.The nomogram mod-el was validated and evaluated by using receiver operating characteristic(ROC)curve,Hosmer-Lemeshow test and clinical decision curve analysis(DCA).Results LASSO regression results showed that age,female,hypertension history,first medical contact time,shock index,Killip grade,white blood cell count,d-dimer,lactic acid,anterior myocardial in-farction,β-blocker administration within 24 hours,angiotensin converting enzyme inhibitor/angiotensin receptor antagonist(ACEI/ARB)administration within 24 hours,emergency percutaneous coronary intervention(PCI)were 13 risk factors of CR(P＜0.05).The screened 13 risk factors were analyzed by univariate and multivariate Logistic regression,the results suggested that age,Killip grade,first medical contact time,white blood cell count,not undergoing emergency PCI and not taking ACEI/ARB drugs within 24 hours were the risk factors of CR in patients with acute STEMI.The acute STEMI with CR nomogram model was established according to the above 6 risk variables.The area under the ROC curve before and after the internal verification of the nomogram model was 0.946(95％CI:0.927～0.961),0.947(95％CI:0.927～0.959),and the sensitivity was 0.957 and 0.904,respectively,the specificity was 0.858 and 0.876,respectively,which indicated that the model had good discrimination degree.The Hosmer-Lemeshow test showed that the deviation between the predicted value and the observed value was not statistically significant(x2=12.70,P=0.122),indicating that the no-mogram model had a good calibration.The DCA curve indicated that the predictive probability threshold of the model was from 0.00 to 0.40,and the clinical net benefit was the highest,indicating that the model had good clinical efficacy.Conclusion The nomogram model established in this study has better distinction,calibration and clinical effectiveness.It can effectively predict the probability of acute STEMI with CR,and provide some help for clinical diagnosis and treat-ment,so as to reduce the incidence of CR.

Objective:To construct medical students' employment quality evaluation index system based on analytic hierarchy process (AHP), for providing basis to scientific and objective evaluation of medical students' employment quality.Methods:Two rounds of consultation with 21 experts were conducted to construct medical students' employment quality index and evaluation standard by Delphi method, and the weight of each index and evaluation standard determined by AHP. Excel 2007 and SPSS 21.0 were used to analyze the results of expert consultation. The enumeration data were expressed as frequency and percentage. The mean and coefficient of variation were used to describe the importance scores of experts on indicators at all levels. The positive coefficient, authority coefficient and coordination degree of experts were calculated, and the Kendall coordination coefficient ( W) test was carried out. Yaahp 6.0 is used to analyze the pairwise comparison matrix in the analytic hierarchy process to calculate the weight of the indicator. Results:The authority of expert consultation was ranged from 0.77 to 0.94, and the positive coefficient of experts was 100.00%. The evaluation system of medical students' employment quality was determined, which involved 3 first-class indexes, 9 second-class indexes and 35 third-class indexes, and the weight coefficients of each index were calculated by AHP.Conclusion:The evaluation index system of medical students' employment quality is reasonable, which can be used to provide reference standard for medical students' employment quality evaluation, and has certain application value.

OBJECTIVES: Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model. METHODS: The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention. RESULTS: The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful. CONCLUSIONS Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.
Humans ; COVID-19 ; Sleep Initiation and Maintenance Disorders ; Crisis Intervention ; Psychosocial Intervention ; SARS-CoV-2 ; Mental Health ; Depression/epidemiology* ; Health Personnel/psychology* ; Anxiety/etiology*

This article gives a review on domestic and foreign researches on the non-drug intervention for patients with perimenopausal depression published from 2012 to 2022， so as to provide a reference for clinical treatment and nursing. Currently， pharmacotherapy is the mainstay of treatment for perimenopausal depression， while many existing problems remain to be solved such as the variation in treatment effect and the difficulty in maintaining emotional stability. however，high safety and relatively low cost are the characteristics of non-drug intervention， so this article expounds on the non-drug intervention measures for perimenopausal depression， such as music therapy， dietary therapy， exercise therapy， acupuncture therapy and repetitive transcranial magnetic stimulation （rTMS）.

OBJECTIVE: To explore the genetic etiology of recurrent hydatidiform mole (RHM) and provide accurate guidance for reproduction. METHODS: Peripheral venous blood samples of the probands with RHM and members from 5 unrelated pedigrees were collected. Genomic DNA was extracted by using routine method, and whole exome sequencing was carried out to detect variants of RHM-associated genes including NLRP7 and KHDC3L. Sanger sequencing and real-time quantitative PCR (RT-qPCR) were used to validate the candidate variants and delineate their parental origin. RESULTS: Homozygous or compound heterozygous variants of the NLRP7 gene were identified in four patients from three pedigrees, which included a homozygous deletion of exon 1 to 4 of NLRP7 in patient P1 and her elder sister, compound heterozygous variants of NLRP7 c.939delG (p.Q314Sfs*6) pat and c.1533delG (p.N512Tfs*4) mat in patient P2, and compound heterozygous variants of NLRP7 c.2389_2390delTC (p.A798Qfs*6) pat and c.2165A>G (p.D722G) mat in patient P4. All variants were interpreted as pathogenic or likely pathogenic according to the American College of Medical and Genomics (ACMG) guidelines. Among these, NLRP7 exons 1 to 4 deletion, c.939delG (p.Q314Sfs*6), c.1533delG (p.N512Tfs*4) and c.2389_2390delTC (p.A798Qfs*6) were unreported previously. CONCLUSION Variants of the NLRP7 gene probably underlay autosomal recessive RHM in the three pedigrees, and definitive molecular diagnosis is beneficial for accurate genetic counseling. Above finding has also enriched the spectrum of the NLRP7 variants underlying RHM.
Adaptor Proteins, Signal Transducing/genetics* ; Aged ; China ; Female ; Homozygote ; Humans ; Hydatidiform Mole/pathology* ; Mutation ; Pedigree ; Pregnancy ; Sequence Deletion

Objective:This study aims to analyze the characteristics and basic principles of emergency surgery risks and anesthesia care of medical support at the landing site for China’s taikonauts of the Shenzhou-12, and to summarize China’s experience in medical support at the landing site for manned spaceflight, and ensure supports in special environments such as an emergency return of manned spaceflight.Methods:This study was carried out through literature research on relevant reports on the emergency surgery risks and aids of domestic and foreign astronauts at the landing sites, and summaries of the experience in medical support for taikonauts of spacecrafts from Shenzhou-5 to Shenzhou-11 at the landing sites. At the same time, according to the characteristics of Shenzhou-12 such as the long on-orbit time, the adjustment in the landing area, the optimization of the mission mode, and new search and rescue power, a series of organization, pre-arranged planning, equipment allocation, and effective anesthesia treatment plan were proposed and inspected in practice.Results:Based on the original anesthesia care plan of medical support, the first-aid carrier was adjusted and modified, the first-aid procedure was optimized, a new generation of supraglottic airway opening tool, video laryngoscope, portable ultrasound, and other devices were added, and the anesthesia care plan at the landing site for manned spaceflight was formulated to provide strong support for the medical care of taikonauts that had stayed in the outer space for a long time.Conclusions:Upon the targeted improvement and process optimization, the anesthesia care plan of medical support for taikonauts of Shenzhen-12 in the landing area fully meets the anesthesia requirement of medical support in special environments such as the emergency return of the taikonauts that have stayed in the outer space for a long time under the new orbital altitude.

Objective:To explore the characteristics and nursing measures of medical rescue support in space station.Methods:According to the characteristics of medical rescue support task of manned space mission, practical nursing schemes and corresponding nursing measures were formulated from the aspects of personnel selection, personnel training, material preparation, process formulation, training exercise and epidemic prevention.Results:The "Shenzhou-12" mission includes the whole launch phase, operation phase and return phase. There are many tasks that cover a long time. The contents of medical rescue support include personnel's physical and mental quality, technical ability, environmental equipment, the possible injuries of astronauts, and the normalization of COVID-19's task guarantee. In view of this content, a practical nursing scheme was formulated to enable nurses to quickly master and skillfully cooperate with the treatment, win more time for the treatment and improve the overall rescue level.Conclusions:Various process plans have been integrated and optimized for medical rescue support of space mission. The equipment carried is advanced, and can be used in various complex environments and complex working conditions. The rescue support personnel have also done their best, kept improving and solidified the state. We should constantly sum up experience, explore and study new problems, and make new achievements in medical rescue support for space missions.

To analyze how the handover were effected by the conditions of manned spaceflight medical support mission through the practice of medical equipment and drugs in Shenzhou-12 and Shenzhou-13 manned spaceflight medical rescue support missions, this article discussed the preparation, organization and implementation in the handover of medical equipment and drugs in the changing of medical rescue teams, summarized the notices in the work of handover, and provided experience for the smooth handover of different manned spaceflight medical rescue teams in the future.

Objective To explore the effect of failure mode and effect analysis (FMEA)in the safety management of digestive endoscopic specimens. Methods From April to November 2016, the specimens by biopsy from the patients in the department of gastrointestinal endoscopy were assigned as the control group, where conventional sample management was used and those from December 2016 to July 2017 were all included in the intervention group, where FMEA was used to find the failure mode and improvement plan was worked out. The FMEA team was set up to discuss and determine the high risk factors leading to the safety management defects in the digestive endoscopy center and calculate the risk priority number (RPN). According to the potential risk factors, we optimized and implemented continuous improvement of the specimen safety management process. Results After the implementation of FMEA,the RPNs in the top 6 failure modes were less than 125,the risk coefficient value dropped from 126~175 to 0~40.The specimen error rate after the implementation of FMEA was statistically significantly lower than that before the implementation (P<0.001). Conclusion The FMEA reduces the incidence of specimen failure and improves the quality of the management of digestive endoscopy.