Objective: To analyze factors impacting mental health status of medical students based on ecological systems theory, so as to provide reference for the mental health promotion system for medical students. Methods: In June 2024, 1 760 medical school students randomly selected from 19 different kinds of medical colleges in eastern China by stratified cluster were surveyed using questionnaires and expert interviews. Descriptive statistics, cross analysis, hierarchical linear regression analysis, structural equation models were used for data analysis. Results: Medical school students had higher satisfaction with the school (65.85%) and a great sense of perceived social support (57.16%). Furthermore, 91.14% of the students had normal interpersonal relationships. However, 44.89% reported that their mental health was impacted by high level of depression. The hierarchical linear regression analysis showed that the mental health outcomes of the medical students were positively predicted by higher perceived social support scores ( β =-11.40), institutional satisfaction ( β =-4.85 ), and lower help seeking stigma scores ( β =9.31) ( P <0.05). The structural equation modeling showed that the status of both perceived social support and self help seeking stigma had significant impacts on depression severity ( β =-0.32, -0.53) and interpersonal relationship sensitivity ( β =-0.31, 0.58) among medical students ( P <0.01).Through expert interviews, collaborations between the school and the tripartite organization (families, universities and society) was of growing importance. Conclusions Perceived social support and self stigma have a significant impact on the mental health status of medical students. The problem of self stigma of medical students should be paid attention to. Therefore, families, universities and society should work together to improve the mental health of medical students.

OBJECTIVE To evaluate the safety of fondaparinux in pregnancy and provide reference for its rational clinical application. METHODS A search was conducted in databases including CNKI， Wanfang， PubMed， Embase， and Elsevier （the search time was from the construction of the database to December 17， 2024） to collect case report literature on fondaparinux use during pregnancy. Patient demographic information， fondaparinux use during pregnancy， concomitant medications， clinical manifestations， and treatment details were extracted for descriptive statistical analysis. RESULTS A total of 17 case reports regarding the use of fondaparinux during pregnancy were collected， involving 42 patients from 11 countries and 47 pregnancy records. Among these， 20 cases involved the use of fondaparinux for the prevention of pregnancy-related venous thromboembolism （VTE）， while 27 cases were fondaparinux treatment due to related conditions. A total of 29 occurrences of the patients were treated with fondaparinux due to a （family） history of VTE. Nine occurrences of complicated pregnancies were reported， and 35 patients had records of comorbidities or relevant medical histories. The adverse events that occurred during pregnancy with the use of fondaparinux include postpartum hemorrhage （7 cases） and excessive anticoagulation caused by inappropriate dosage （1 case）. Among the 7 cases of postpartum hemorrhage， 3 cases had a blood loss of no less than 1 000 mL （including 2 cases with uterine atony）， 3 cases had a drug discontinuation time of ≤12 h. CONCLUSIONS Based on the existing literature， the safety of fondaparinux during pregnancy is generally manageable， with the main adverse event being postpartum hemorrhage. The dosage， interval between discontinuation，comorbidities/medical history， and concomitant medications of fondaparinux may be the main causes of its adverse events.

Patients with gastric cancer are at high risk for venous thromboembolism(VTE)and bleeding,and patients who develop VTE are often associated with poor outcomes,making it clinically challenging to identify and manage the risk of thrombosis in patients with gastric cancer.Risk factors for VTE in gastric cancer patients include age,obesity,surgery,chemotherapy,etc.It is essential to identify high-risk patients and adopt aggressive prevention strategies.The main strategy to prevent and treat VTE is the use of anticoagulant drugs.This article discusses guidelines and recent studies for the prevention and treatment of VTE in patients with gastric cancer to help clinicians make individualized decisions for their patients and maximize clinical outcomes for their patients.

Patients with primary membranous nephropathy(PMN)tend to develop thrombosis,especially in the early phase of the disease.The pathogenesis of thrombosis is multifactorial,with hypoalbuminemia being widely regarded as an inde-pendent risk factor.Other factors include proteinuria,M-type phospholipase A2 receptor antibody,and D-dimer.Although prophy-lactic anticoagulation therapy is frequently used in clinical practice to prevent thrombosis in PMN patients,there are still many un-resolved issues regarding the optimal prevention of thrombosis in this condition.The timing of prophylactic anticoagulation,the threshold of serum albumin level,and the choice of treatment regimen are still lacking consensus.This article reviewed the relevant literature on these topics,aiming to establish a standard for thrombosis prevention and treatment for this population in the future and provide guidance for clinical practice.

Objective To deeply analyze the problems of public hospitals in medical service satisfaction,construct a more applicable and explanatory service satisfaction evaluation model,and provide reference for the improvement path of patients'medical service satisfaction.Methods Based on the ESCI model,this paper puts forward a research hypothesis,compiles the"Medical Service Satisfaction Evaluation Scale of Public Hospitals in S City",selects S public hospitals as the research object,and evaluates medical service satisfaction from the perspective of patients.Results At present,the main problems affecting the improvement of patients'satisfaction with medical service management in public hospitals in S city are as follows:it is urgent to improve the diagnosis and treatment technology in terms of hardware quality and optimize the environmental hygiene of public hos-pitals,and it is an urgent task to shorten the waiting time for medical treatment in software quality.The score of medical service satisfaction evaluation of S public hospitals was 3.76,and the satisfaction of patients in S public hospitals with their medical serv-ices was at a moderately low level.Conclusion In view of the above problems,it is recommended to strengthen the construction of key specialties,strengthen the construction of talent team,optimize the medical process,open digital linkage services,and strengthen service management,so as to promote the improvement of patients'satisfaction with medical services.

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.

ObjectiveTo investigate a foodborne disease outbreak and identify the pathogenic factors in order to prevent the occurrence of similar incidents. MethodsEpidemiological study， on-site food hygiene investigation， and laboratory testing were used to analyze the cause of outbreak in Company A. ResultsA total of 24 confirmed cases were screened out. The major clinical symptoms were diarrhea （100.0%）， stomachache （100.0%）， and vomiting （41.7%）. Samples from 24 patients were tested positive for Vibrio parahaemolyticus， and were homologous by Pulsed field gel electrophoresis （PFGE） phylogenetic study. According to the result of case-control study， eating glass noodles salad at the dinner and supper on July 16th， 2019 was the risk factor （OR=15.71，95%CI：1.90‒129.71）. ConclusionThis foodborne disease outbreak was caused by glass noodles salad cross contaminated with Vibrio parahaemolyticus.

OBJECTIVE：To provide reference for the development and application of pharmacy popular-science video courseware. METHODS ：Combined with the problems existing in the medication of patients with chronic diseases at the present stage and the key points of medication management ，the theme ，content and form of this popular-science were determined ；the video shooting and production were completed ，and publicity and promotion were carried out. Questionnaire survey was conducted ， and the reception of pharmacy outpatient service in our hospital was counted ；the broadcasting effects of popular-science video were analyzed. RESULTS ：The theme of popular-science video courseware was determined to be self-medication management of patients with chronic diseases at home assisted by pharmacists. Combined with the “five moments ”of medication safety proposed by WHO ， the content included six units as knowing pharmacists ，understanding drugs ，taking drugs ，adding drugs ，checking drugs ，and discontinuing drugs. PPT video was used to explain the contents of each unit ，with an average duration of about 25 min. After the first unit was launched ，a total of 39 327 hits were received within two months. A total of 100 questionnaires were sent out ，97 questionnaires were collected （recovery rate of 97.0％）. Among them ，80（82.5％）thought it helpful to watch the video. Within two months after the broadcast of unit 1 video，the reception volume of pharmacy outpatient department of our hospital （1 160 person times ）increased by 104.2％ compared with the two months in the same period last year （568 person times ），and increased by 18.7％ compared with the two months before the broadcast （977 person times ）；99 patients came to the pharmacy outpatient department to consult because of watching the video ，and 55.6％ of the registered patients consulted the demonstration of video courseware and repeatedly mentioned related problems. CONCLUSIONS ：It is a beneficial exploration for pharmacists to develop popular-science video courseware with the theme of safe and rational drug use. It is the direction for future work to increase the scope of disease types ，target different groups of people or focus on different types of drugs and promot them in various forms.

BACKGROUND:Three dimensional finite element analysis is widely used in orthopedics, but research in the knee flexion movement is not much. OBJECTIVE:To analyze biomechanical properties of knee flexion using finite element analysis.METHODS:Three dimensional finite element models and models of knee flexion at 30 degrees, 60 degrees and 120 degrees were established. Femoral forward movement, femur inward movement, tibia internal rotation and tibia vara were analyzed at different flexion angles. RESULTS AND CONCLUSION:(1) When knee flexion was at 30 degrees, 60 degrees and 120 degrees, the femur had backward movement. The backward movement value was larger at 60 degrees than at 30 and 120 degrees (P<0.05). The backward movement value was larger at 120 degrees than at 30 degrees (P>0.05). (2) The femur had outward movement at 30 degrees, and inward movement at 120 degrees. The inward movement value was significantly larger at 120 degrees than at 30 and 60 degrees (P<0.05). No significant difference in outward movement was determined between the 30 and 60 degrees (P>0.05). (3) Tibia internal rotation was not significantly different at 30, 60 and 120 degrees of flexion (P>0.05). (4) Tibia vara was found at 30, 60 and 120 degrees of flexion, but the tibia vara was not obvious at 120 degrees. The tibia vara was maximum at 60 degrees, and significantly higher than that at 120 degrees (P<0.05). The tibia vara was larger at 30 degrees than at 120 degrees (P>0.05). (5) These findings verify that backward movement was most obvious at 60 degrees. Femur inward movement was most large at 120 degrees. Tibia internal rotation was noticeable at 30 and 120 degrees. Tibia vara was remarkable at 60 degrees.

BACKGROUND:There are studies on three-dimensional finite element analysis of total knee replacement, but few research concerns contact pressure and contact area inside and outside polyethylene liner of fixed prosthesis and rotating platform prosthesis in total knee replacement. OBJECTIVE:To explore the contact pressure and contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement. METHODS:We established three-dimensional finite element models of fixed platform prosthesis and rotating platform prosthesis in total knee replacement and compared contact pressure and contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement. RESULTS AND CONCLUSION:The peak contact pressure inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement was minimum at 0° of genuflex. The peak contact pressure inside polyethylene liner was higher than that outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement at 0°-90° of genuflex (P<0.05). The peak contact pressure inside and outside polyethylene liner of fixed platform prosthesis was higher than that of rotating platform prosthesis in total knee replacement at 60°-120° of genuflex (P<0.05). The contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement was maximum at 0° of genuflex. The contact area inside polyethylene liner of fixed platform prosthesis in total knee replacement was lower than that of outside at 0°-30° of genuflex (P<0.05). The contact area inside polyethylene liner of fixed platform prosthesis in total knee replacement was lower than that of outside at 0°-90° of genuflex (P<0.05). The contact area inside and outside polyethylene liner of fixed platform prosthesis was lower than that of rotating platform prosthesis in total knee replacement at 30°-120° of genuflex (P<0.05). These results suggested that peak contact pressure inside polyethylene liner of fixed and rotating platform prostheses was higher than that outside in total knee replacement, and the inside contact area was lower than that of outside. Inside and outside contact pressure of the rotating platform prosthesis was lower than that of fixed platform prosthesis. Inside and outside contact area of the rotating platform prosthesis was higher than that of fixed platform prosthesis.