Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

Pre-hospital application of REBOA for life-threatening hemorrhage

Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Objective: To investigate the occurrence of PTSD in pre-hospital emergency nurses and its related factors, and to compare the differences of neurotransmitter and immune-related factors between pre-hospital emergency nurses who experienced traumatic events and those who did not develop PTSD and healthy people. How: Post-traumatic Stress Disorder Self-Rating Scale (PCL-C) tests were performed on pre-hospital emergency nurses in PTSD group, non-PTSD group and healthy control group, and the plasma monoamine neurotransmitters and serum cytokines were determined by double-antibody sandwich ABC-ELISA assay using enzyme-linked adsorption kit provided by Shanghai Xitang Biotechnology Co., Ltd. Results: 1) There were statistically significant differences in PCL-C scores between PTSD group, non-PTSD group and healthy group (p α between PTSD group, non-PTSD group and healthy group (p Conclusion: Pre-hospital emergency nurses should have early psychological intervention and guidance to reduce the occurrence of PTSD in emergency and emergency nurses.

Parental Knowledge of Pre-Hospital Management of Avulsed Permanent Tooth in Children at Kath

BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered as the treatment of choice. OBJECTIVE: The study was undertaken to assess the knowledge of parents who accompany their children to the pediatric dental clinic, KATH on the pre-hospital management of avulsed permanent tooth in children. METHODS: A researcher administered structured questionnaire was used to collect data on the knowledge of pre-hospital management of avulsed permanent tooth from 83 parents who accompanied their wards to the pediatric dental clinic at KATH. RESULTS: A total of 83 parents were involved in the study. 30 (36%) were males while 53 (64%) were females. The majority of the parents (57%) were either university trained or had attended college of education. Only 32 parents (39%) were aware of the possibility of replantation. Majority of the parents chose non-physiologic media as the transport media of choice and only 10% would attempt self-replantation before seeking professional help. 76 parents (92%) had no previous education on pre-hospital management of avulsed tooth. CONCLUSION: The results obtained from this study indicate that parental knowledge on pre-hospital management of avulsed permanent tooth is low hence the need for massive public educational campaigns.

Analysis of the Effect of Humanistic Care in the Process of Pre-Hospital Emergency Care

Objective:To explore the effectiveness of humanistic care in pre-hospital emergency care.Methods:From April 2020 to January 2021,80 pre-hospital emergency patients were studied.The patients were randomly divided into two groups:a control group(n=40),which received conventional care,and an experimental group(n=40),which received humanistic care.The effects of nursing care and psychological state were compared between the two groups.Results:The experimental group showed better nursing outcomes and a more positive psychological state compared to the control group(P<0.05).Conclusion:Humanistic care in pre-hospital emergency settings is more effective in reducing patients’anxiety and depression,enhancing the operational abilities and service attitudes of nursing staff,and increasing the emergency success rate.

快速脱装CPR在武警特战队员训练中的应用

目的 探讨快速脱装心肺复苏(CPR)在武警特战队员训练中的应用及效果。方法 全装武警特战队员84名,随机平均分成14个救护小组,每小组6人,每组分别对a岗位、b岗位、c岗位、d岗位、e岗位特战实装伤员进行快速脱装CPR、常规CPR训练,并分别记录每组救护员快速脱装CPR、常规CPR从伤员倒地到接受胸外按压所需时间。结果 每组队员均顺利完成快速脱装CPR、常规CPR互救训练,接受快速脱装CPR用时短于常规CPR,两组差别均有统计学意义(P<0.01);d岗位伤员接受快速脱装CPR用时长于a、b、c、e岗位伤员,差别均有统计学意义(P<0.05)。a、b、c、e岗位伤员接受快速脱装CPR用时差异均无统计学意义(P>0.05)。结论 快速脱装CPR可在全装武警特战队员互救训练中顺利运用,并缩短互救时间。

2-CPR/RPU并联机构的构型设计及工作性能分析

针对当前物流领域中货件品类多、人工耗用高等问题,为满足产线快速分拣的需求,提出一种全周自由度的2-CPR/RPU并联机构,以提高物流货件的分拣效率,减少人力时间成本。绘制2-CPR/RPU机构的三维模型,采用螺旋理论对2-CPR/RPU机构自由度进行求解,并根据修正的Grübler-Kutzbach公式进行验证,通过封闭矢量对机构支链进行位置逆解分析,基于逆解表达式求得机构速度Jacobian矩阵,利用代数法分析奇异位形是否存在,编程MATLAB语言求解其符合工作范围的点并绘制出工作空间,最后对机构的承重量进行有限元仿真分析。结果表明:2-CPR/RPU并联机构具有共3个自由度,可实现2T1R型的运动(沿x、z轴的平移和绕x轴的转动);结构尺寸符合要求没有奇异位形,工作空间较大,均匀分布且呈扇形对称,执行平台转动可达60°;2-CPR/RPU并联机构结构简单且运动稳定,工作精度高、载重性能良好,适用于大部分物流包装产线的分拣装箱工作。

CPRS阻垢技术在工作面乳化液供液系统的应用

针对采煤工作面乳化液供液系统易结水垢进而堵塞工作面用液设备导致液压支架初撑力不足的问题,提出将CPRS阻垢设备串联于井下乳化液供液系统中,在宁夏煤业双马煤矿进行应用。结果表明:安装CPRS装置于供液箱和乳化泵吸液管路的管道泵之后可节约乳化油及生产用水用量,提升滤芯及水处理设备使用寿命,且原管线和设备内壁的旧垢逐步被溶解、软化并脱落,直接经济效益较为明显,为提升煤矿乳化液系统清洁度具有重要现实意义。

CPR1000机组冷凝器钛管氦气查漏条件分析

通过对CPR1000机组冷凝器钛管氦气查漏条件分析,可以更好的确保机组的运行安全以及机组的运行效率。本文介绍了冷凝器钛管氦气检漏系统的组成及查漏原理,通过理论分析与实际工程应用中的数据对比,分析机组在停机状态和半列运行状态下氦气检漏系统灵敏度差别的原因。结果表明由于不同机组状态下空气分压的差别导致停机状态下氦气查漏系统的灵敏度比机组半列运行下的灵敏度低70倍。

一种CPR1000机组水压试验期间一回路压力控制方法优化与实践

CPR1000机组在一回路水压试验期间,一回路始终处于单相状态,稳压器顶部不建立汽腔,与正常运行期间稳压器顶部存在汽腔的工况不同。压力控制是机组控制难点,如何有效控制退出化学和容积控制系统中的下泄孔板操作期间一回路压力波动是关系水压试验能否顺利实施的关键步骤。笔者通过对化学和容积控制系统的下泄孔板隔离阀结构及节流特性研究,给出了一种可以快速可控调节化学和容积控制系统下泄孔板隔离阀同时优化化学和容积控制系统上充回路调节阀性能的方法,实现对机组升压过程中一回路压力的有效控制,避免下泄孔板退出操作时一回路压力产生大幅波动产生系统应力瞬变的风险。经过机组大修的应用验证,这种方法可以大幅减少现场操作控制阀门的时间,减少现场人员的辐射照射剂量,同时可以保证一回路水压试验期间退出化学和容积控制系统下泄孔板的过程实现一回路压力平稳过渡。

CPR1000型核电机组换料水箱底板焊缝修复实践

介绍了某CPR1000型核电机组换料水箱的结构,底板缺陷处理方案、处理过程及结果;对缺陷产生原因进行了分析;针对核电机组出现的此类问题,提出了改进建议。

CPR:生死时刻的救命法宝

在紧急医疗救援中,时间就是生命。心脏是人体血液与氧气的传送中枢,当一个人的心脏骤停,血液循环和氧气供应立即中断,几分钟内就可能造成不可逆的脑损伤甚至死亡。这时,CPR(心肺复苏术)便成为挽救生命的关键手段。CPR的原理是通过人工方式维持血液循环和氧气供应,为后续的专业医疗救治赢得宝贵时间。本文将详细介绍CPR的重要性、基本步骤、特殊情况下的应用以及公众普及的重要性,帮助大家掌握这一生死时刻的救命法宝。

CPR和P450基因在昆虫抗药性中的作用研究进展

P450酶系在昆虫代谢农药中有重要作用,NADPH-细胞色素P450还原酶(NADPH-cytochrome P450 reductase,CPR)和细胞色素P450(P450)在该酶系起核心作用。昆虫具有P450超基因家族,但只有一个单一的CPR基因,CPR是昆虫所有参与农药代谢的P450酶的唯一电子供体,其影响P450活性。P450基因的高水平表达在害虫抗药性中具有重要作用,P450基因介导的昆虫抗药性是最重要的代谢抗性类型。不同P450基因的高表达的调控机制不同,引起P450基因过量表达的原因可能有P450基因的编码区突变、顺式作用元件和反式作用因子变化、基因扩增等。细胞色素P450介导的抗药性存在一定程度的进化可塑性,即同种昆虫不同种群对相同的农药产生抗药性时,导致抗性产生的P450基因不同;同一昆虫品系在某种农药的抗性选择压力下,影响抗性的P450基因的种类和表达特性会随着持续的农药选择而发生变化。最近的研究显示,CPR的变异和昆虫抗药性相关,但是昆虫CPR基因介导抗药性的机制还缺乏深入研究。全面阐释P450酶系介导昆虫抗药性的机制、建立基于P450基因表达量变化与CPR突变的抗性分子标记,对于害虫抗药性治理具有重要意义。

Current pre-hospital traumatic brain injury management in China

BACKGROUND: Traumatic brain injury(TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, prehospital service can signifi cantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China.DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure(CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identifi ed articles.RESULTS: Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions.CONCLUSION: Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China.

Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9305687 from 2007 to 2016 in Zhengzhou, of which 418882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups:emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

French pre-hospital trauma triage criteria:Does the “prehospital resuscitation” criterion provide additional benefit in triage?

AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.

俯卧位心肺复苏(反式CPR)实施技术要点及成功率的影响因素分析

目的总结俯卧位心肺复苏操作技术要点,分析与俯卧位心肺复苏成功有关的因素,为临床实践提供参考。方法通过检索国内外文献数据库,对符合纳入与排除标准的文献进行收集,对病例基本信息、主要诊断、主要治疗/手术部位(类型)、心脏骤停发生前及发生时情况(包括引起心脏骤停的始动原因和直接原因)、抢救经过(包括技术关键点)及是否成功(即自主循环是否恢复)等信息进行提取分析,并根据复苏是否成功进行分组,尝试寻找与复苏成功有关的因素。结果最终纳入39篇文献,共50个病例用于数据资料的提取与分析。俯卧位心肺复苏实施中,如背部正中具备按压条件,则主要按压部位为胸椎中段(T4~T8),如不具备按压条件(如存在手术切口),则可考虑按压左右肩胛区,同时也有在患者胸骨体中下段与俯卧平面之间放置对抗物的报道。室颤患者可采用俯卧位体外电除颤,除颤电极板的安放位置应根据是否存在背部手术切口,可将电极板A放置于左侧第五肋间腋中线处或略向前,电极板S放置于尽量靠近心脏右上,即靠近心底的位置。全部50例病例,复苏成功35例,复苏失败15例,成功率为70%。在心脏骤停的直接原因方面,快速型室性心律失常病例(均为室颤)的复苏成功率为100%,而其他病例的复苏成功率仅为53.13%,差异有统计学意义(P<0.05)。进一步分析心脏骤停的始动原因与复苏成功率的关系,发现急性呼吸道梗阻所致心脏骤停更容易复苏成功,而空气栓塞所致者成功率较低(P<0.05)。结论在不允许患者迅速翻转为仰卧的情况下,俯卧位心肺复苏应该果断实施,而各种相关经验都需要在临床实践与基础研究中进一步积累。

Clinical Research of Pre-Hospital Emergency Care, Nursing, Infection Prevention and Control for Senile Osteoporotic Vertebral Compression Fracture during Epidemic Period

Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.

一种分裂形式CPR格式在欠解析流动中的稳定性研究

基于重构的修正过程(correction procedure via reconstruction,CPR)方法是一种适用于非结构网格、紧致高效的高阶方法,但在离散非线性对流项时容易因为混淆误差的累积而出现数值不稳定。本文研究了基于LG(Legendre-Gauss)点分裂形式的CPR方法在欠解析流动中的稳定性,并将其与子单元限制技术结合,求解含激波的欠解析流动问题。结果表明:经过边界通量修正的LG点分裂形式CPR格式能够满足离散守恒律,且与子单元限制相结合后守恒律依然成立;在无激波的欠解析流动问题中,相比于散度形式CPR格式,分裂形式明显提高了计算的稳定性,而且比使用LGL(Legendre-Gauss-Lobatto)点的分裂形式CPR格式具有更小的数值误差;在含激波的欠解析流动求解中,相比基于LGL点的间断伽辽金谱元法子单元限制策略,基于LG点的分裂形式CPR格式子单元限制策略具有更高的分辨率和更小的振荡。