ObjectiveTo predict the in-hospital mortality risk among patients with ischemic stroke combined by dysphagia using interpretable machine learning methods, so as to provide more evidence-based support for the prognosis prediction of patients with ischemic stroke combined by dysphagia. MethodsMedical record of 308 patients diagnosed with ischemic stroke combined by dysphagia in the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) (2.0) in the United States were retrospectively analyzed. Features of the research data were screened based on the least absolute shrinkage and selection operator, and which were randomly divided into a training set and a test set at a ratio of 7∶3. Then ten models, including logistic regression, random forest, K-nearest neighbor, linear discriminant analysis, naive bayes (NB), neural network, quadratic discriminant analysis, recursive partitioning tree, extreme gradient boosting tree, and support vector machine, etc. were constructed. The predictive effect was measured by calculating the area under the curve (AUC) of receiver operating characteristics. In addition, the calibration curve and Brier score were used to evaluate the calibration degree of the model, and the decision curve was drawn to reflect the clinical net benefit. The Shapley additive explanation method was used to analyze the interpretability of the black box model and explore the important decision-making factors. ResultsThe NB model in the test set showed better predictive ability compared with other models (AUC=0.85, 95%CI: 0.83‒0.88). After interpretability analysis, it was found that blood urea nitrogen (BUN), age, sequential organ failure assessment, bicarbonate, chloride, and hypertension were important risk factors for in-hospital mortality in patients with ischemic stroke combined by dysphagia. ConclusionThe comprehensive performance of the NB model is better than that of the other nine models in predicting the risk of in-hospital mortality in patients with ischemic stroke combined by dysphagia. The interpretability of the model can help clinicians better understand the reasons behind the results and take further reasonable intervention measures for risk factors to improve the survival probability of patients.

Objective:To explore distribution characteristics of PD-1 on surface of peripheral blood T cells in non-small cell lung cancer(NSCLC)and its relationship with efficacy of interventional therapy.Methods:A total of 100 NSCLC patients who under-went interventional treatment in Rugao People's Hospital from February 2018 to October 2022 were selected as study subjects and set as case group,and 100 healthy individuals who underwent physical examinations at Rugao People's Hospital during same period as control group 1,another 100 patients with benign lung disease were set as control group 2.Hierarchical regression model was used to analyze relationship between surface PD-1 expression rate of peripheral blood T lymphocytes and clinical pathological characteristics.Generalized linear mixed model(GLMM)was constructed to determine relationship between PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Restricted cubic splines(RCS)was used to analyze dose-response relationship be-tween PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Cox regression analysis was used to identify risk factors.Results:Compared with control group,case group had higher expression rate of PD-1 on surface of CD4+T and CD8+T cells in peripheral blood(P<0.05).PD-1 expression rate of on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients were significantly correlated with TNM staging,lymph node metastasis and distant metastasis(P<0.05).Stratified regression model analysis showed that TNM staging,lymph node metastasis and distant metastasis had significant impact on PD-1+CD4+T and PD-1+CD8+T cells(P<0.05).Interventional therapy showed good clinical efficacy,with total effective rate of 76.00%.As therapeutic effect decreased,expression rate of PD-1 on surface of CD4+T and CD8+T lymphocytes in patients with different therapeutic effects showed an increasing trend before and after treatment(P<0.05).After adjusting for confounding factors(Model 2),PD-1+CD4+T value of 15.82～19.43,and≥19.44 clinical ineffectiveness risk were 1.164 and 1.330 times higher than those of control group(<12.20%),respectively(P<0.05);risk of clinical ineffectiveness with PD-1+CD8+T ranging from 17.06～20.69,and≥20.70 was 1.162 and 1.313 times higher than control group(<13.42%),respectively(P<0.05).RCS analysis showed a non-linear relationship between continuous changes in PD-1+CD4+T and PD-1+CD8+T and clinical failure risk(all P<0.001).Cox regression analysis showed that distant metastasis,PD-1+CD4+T and PD-1+CD8+T were all independent influencing factors for postoperative OS(P<0.05);TNM staging,distant metastasis and number of interventions were all independent influencing factors for postoperative PFS(P<0.05).Conclusion:PD-1 expression rate on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients is significantly correlated with TNM staging,lymph node metastasis,distant metastasis,clinical efficacy of interventional treatment and postoperative OS;PD-1+CD4+T and PD-1+CD8+T levels in TNM stages Ⅲ～Ⅳ are significantly higher than stage Ⅰ～Ⅱ patients.PD-1 expression rate can provide assistance for early diagnosis and auxiliary staging of NSCLC patients and guide clinical treatment.

Objective:To explore distribution characteristics of PD-1 on surface of peripheral blood T cells in non-small cell lung cancer(NSCLC)and its relationship with efficacy of interventional therapy.Methods:A total of 100 NSCLC patients who under-went interventional treatment in Rugao People's Hospital from February 2018 to October 2022 were selected as study subjects and set as case group,and 100 healthy individuals who underwent physical examinations at Rugao People's Hospital during same period as control group 1,another 100 patients with benign lung disease were set as control group 2.Hierarchical regression model was used to analyze relationship between surface PD-1 expression rate of peripheral blood T lymphocytes and clinical pathological characteristics.Generalized linear mixed model(GLMM)was constructed to determine relationship between PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Restricted cubic splines(RCS)was used to analyze dose-response relationship be-tween PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Cox regression analysis was used to identify risk factors.Results:Compared with control group,case group had higher expression rate of PD-1 on surface of CD4+T and CD8+T cells in peripheral blood(P<0.05).PD-1 expression rate of on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients were significantly correlated with TNM staging,lymph node metastasis and distant metastasis(P<0.05).Stratified regression model analysis showed that TNM staging,lymph node metastasis and distant metastasis had significant impact on PD-1+CD4+T and PD-1+CD8+T cells(P<0.05).Interventional therapy showed good clinical efficacy,with total effective rate of 76.00%.As therapeutic effect decreased,expression rate of PD-1 on surface of CD4+T and CD8+T lymphocytes in patients with different therapeutic effects showed an increasing trend before and after treatment(P<0.05).After adjusting for confounding factors(Model 2),PD-1+CD4+T value of 15.82～19.43,and≥19.44 clinical ineffectiveness risk were 1.164 and 1.330 times higher than those of control group(<12.20%),respectively(P<0.05);risk of clinical ineffectiveness with PD-1+CD8+T ranging from 17.06～20.69,and≥20.70 was 1.162 and 1.313 times higher than control group(<13.42%),respectively(P<0.05).RCS analysis showed a non-linear relationship between continuous changes in PD-1+CD4+T and PD-1+CD8+T and clinical failure risk(all P<0.001).Cox regression analysis showed that distant metastasis,PD-1+CD4+T and PD-1+CD8+T were all independent influencing factors for postoperative OS(P<0.05);TNM staging,distant metastasis and number of interventions were all independent influencing factors for postoperative PFS(P<0.05).Conclusion:PD-1 expression rate on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients is significantly correlated with TNM staging,lymph node metastasis,distant metastasis,clinical efficacy of interventional treatment and postoperative OS;PD-1+CD4+T and PD-1+CD8+T levels in TNM stages Ⅲ～Ⅳ are significantly higher than stage Ⅰ～Ⅱ patients.PD-1 expression rate can provide assistance for early diagnosis and auxiliary staging of NSCLC patients and guide clinical treatment.

Objective:To survey treatment and prognosis of hyperkalemia patients in the emergency department and to analyze factors associated with all-cause in-hospital mortality.Methods:We implemented electronic hospital information system, extracted demographic characteristics, underlying diseases, laboratory findings, potassium lowering therapy and prognosis of hyperkalemia patients [age ≥ 18 years, serum potassium (K +) concentration ≥ 5.5 mmol/L] in the emergency department of Peking Union hospital in Beijing between June 1st 2019 to May 31st 2020. The enrolled subjects were divided into the non-survival group and the survival group according to their prognosis. Univariate analysis and Cox regression model were adopted to analyze factors affecting all-cause in-hospital mortality of hyperkalemia patients. Results:A total of 579 patients [median age 64 (22) years; 310 men (53.5%) and 269 women (46.5%)] with hyperkalemia were enrolled, among which, 317 (54.7%), 143 (24.7%) and 119 (20.6%) were mild, moderate, and severe hyperkalemia, respectively. 499 (86.20%) patients received potassium-lowering therapy, forty-four treatment regimens were administered. Insulin and glucose (I+G, 61.3%), diuretics (Diu, 57.2%), sodium bicarbonate (SB, 41.9%) and calcium gluconate/chloride (CA, 44.4%) were commonly used for the treatment of hyperkalemiain the emergency department. The combination of insulin and glucose, calcium gluconate/chloride, diuretics and sodium bicarbonate (I+G+CA+Diu+SB) was the most favored combined treatment regimen of hyperkalemia in the emergency department. The higher serum potassium concentration, the higher proportion of administrating combined treatment regimen and/or hemodialysis (HD) (the proportion of administrating combined treatment regimen in mild, moderate, and severe hyperkalemia patients were 58.4%, 82.5% and 94.8%; the proportion of administrating HD in mild, moderate, and severe hyperkalemia patients were 9.7%, 13.3% and 16.0%, respectively). The proportion of achievement of normokalaemia elevated as the kinds of potassium lowering treatment included in the combined treatment regimen increased. The proportion of achievement of normokalaemia was 100% in the combined treatment regimen including 6 kinds of potassium lowering therapy. Among various potassium lowering treatments, HD contributed to the highest rate of achievement of normokalaemia (93.8%). 111 of 579 (19.20%) hyperkalemia patients died in hospital. Cox regression model revealed that complicated with cardiac dysfunction predicted higher mortality [hazard ratio ( HR) = 1.757, 95% confidence interval (95% CI) was 1.155-2.672, P = 0.009]. Achievement of normokalaemia and administration of diuretics attributed to lower mortality ( HR = 0.248, 95% CI was 0.155-0.398, P = 0.000; HR = 0.335, 95% CI was 0.211-0.531, P = 0.000, respectively). Conclusions:Treatment of hyperkalemia in the emergency department were various. Complicated with cardiac dysfunction were associated with higher mortality. Achieving normokalaemia was associated with decreased mortality.

ObjectiveTo design and evaluate the ideological and political teaching in the Medical Statistics as a public basic course for postgraduates in a medical school. MethodsThrough expert consultation， literature review， investigation， we designed the main points in the ideological and political teaching for the Medical Statistics. Students' satisfaction and demand of ideological and political teaching were investigated by a questionnaire. Furthermore， effect of ideological and political teaching was evaluated. ResultsA total of 178 out of 201 graduate students in Grade 2020 in a medical university completed the survey， accounting for 88.56%， with a response rate of 100%. Among them， 84.27% of the students believed it was necessary to implement ideological and political teaching for the Medical Statistics， and 90.45% expected that ideological and political teaching could be combined with case studies. The comparison before and after class showed that the students’ correct understanding of data acquisition has been greatly improved from 78.65% to 100%. In addition， the proportion of those who were dedicated to studying increased from 89.88% to 97.75%. ConclusionThe ideological and political teaching for Medical Statistics can be implemented in combination with case studies. Ideological and political teaching may improve the courses with practical operation of knowledge and skills.

Objective:To study the influence of time-dependent acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on 14-day death risk in patients with severe stroke, and to provide reference for clinical diagnosis and treatment.Methods:Data of 3 229 patients with severe stroke were enrolled from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ). According to the main types of stroke, the patients were divided into subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS) and other groups. According to age, patients were divided into > 60 years old and ≤ 60 years old subgroups. According to the baseline of sequential organ failure assessment (SOFA) score, they were divided into subgroups of > 3 and ≤ 3. The daily measured values of APACHE Ⅱ scores in each patient were recorded. And all-cause death within 14 days after admission to intensive care unit (ICU) was used as the outcome index to obtain the survival status and survival time of patients. Joint models for longitudinal and time-to-event data were established to evaluate the effect of APACHE Ⅱ score measured at multiple time points on the death risk of patients, and a subgroup analysis was performed.Results:Among the joint models, the one which include APACHE Ⅱ score, and the interaction items between APACHE Ⅱ and age showed the better fitting. Further analysis showed that APACHE Ⅱ score was affected by age, gender, hospital admission, baseline SOFA score and smoking history. After controlling for these confounding factors, APACHE Ⅱ score was significantly associated with 14-day all-cause death in patients with severe stroke [hazard ratio ( HR) = 1.48, 95% confidence interval (95% CI) was 1.31-1.66, P < 0.001], which indicated that the risk of death increased by 48% (95% CI was 31%-66%) for each 1-point increase in APACHE Ⅱ score. Subgroup analysis showed that for different types of severe stroke patients, APACHE Ⅱ score had a greater impact on the risk of 14-day death in SAH patients ( HR = 1.43, 95% CI was 1.10-1.85), but had a smaller impact on ICH and IS groups [HR (95% CI) was 1.37 (1.15-1.64) and 1.35 (1.06-1.71), respectively]. There was no significant difference in APACHE Ⅱ score on the risk of 14-day death between the patients aged > 60 years old and those aged ≤ 60 years old [ HR (95% CI): 1.37 (1.08-1.72) vs. 1.35 (1.07-1.70), respectively]. Compared with patients with SOFA score > 3, APACHE Ⅱ score had a greater impact on the risk of 14-day death in patients with SOFA score ≤ 3 [ HR (95% CI): 1.40 (1.16-1.70) vs. 1.34 (1.16-1.55)]. Conclusion:Time-dependent APACHE Ⅱ score is an important indicator to evaluate the risk of death in patients with severe stroke.

Objective:To investigate the relationship between abdominal visceral adipose tissue (VAT) and cardiometabolic risk (CMR) through quantitative computed tomography (QCT).Methods:The present study included 76226 participants. Abdominal fat areas were measured using the QCT Pro Model 4 system. Cardiometabolic indices were collected, including systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, triglyceride, and low-density and high-density lipoprotein cholesterols CMR score was the sum of abnormal blood pressure, fasting glucose, triglyceride, and high-density lipoprotein cholesterol. Restricted cubic spline and ordered logistic regression models were applied.Results:The mean age was 50±13 years and the percentage of men was 58.8%. The level of VAT area was higher in men than in women (191.7±77.1 cm 2 vs 116.4±56.2 cm 2, P<0.0001 for all). After adjustment for age, the cardiometabolic indices except high-density lipoprotein cholesterol increased with increasing VAT area. When VAT area was 300 cm 2, age-adjusted odds ratios and 95% confidence intervals of a CMR score ≥ 1 were 14.61 (13.31, 16.04) for men and 5.46 (4.06, 7.36) for women, and the age-adjusted probability of a CMR score ≥ 3 was 31.7% for men and 31.3% for women. Conclusions:QCT-derived VAT is closely related to CMR. The findings suggest that measurement of visceral fat is recommended for the management of abdominal obesity in subjects who agree to undergo lung cancer screening via low-dose CT without additional radiation exposure.

Objective: To compare the clinical application of three-dimensional laparoscopic pancreatoduodenectomy (3D-LPD) with that of two-dimensional laparoscopic pancreatoduodenectomy (2D-LPD), and to explore the safety and feasibility of 3D-LPD. Methods: A retrospective analysis was made from the data of 45 patients with 3D-LPD and 45 patients with 2D-LPD who underwent total laparoscopic pancreatoduodenectomy from March 2017 to August 2018 at Department of Hepato-Pancreato-Biliary Surgery, the First People′s Hospital of Changzhou.The differences of intraoperative conditions, postoperative complications and postoperative pathological findings between the two methods were compared.Measurement data were compared with independent sample t-test, enumeration data were statistically analyzed with Chi-square test or Fisher exact probability. Results: The operation time of 3D-LPD group was shorter than that of 2D-LPD group ((335±95) min vs. (419±113) min, t=-3.817, P=0.000), which mainly showed that the time of digestive tract reconstruction was reduced ((92±26) min vs. (131±46) min, t=-4.951, P=0.000). The intraoperative blood loss in the 3D-LPD group was significantly less than that in the 2D-LPD group ((242±124) ml vs. (350±176) ml, t=-3.365, P=0.001), and the perioperative blood transfusion in the 3D-LPD group was significantly less than that in the 2D-LPD group (χ²=4.444, P=0.035). Postoperative hospitalization days and ICU stay time were not significantly different between the two groups(both P>0.05). Postoperative complications such as pancreatic fistula, biliary fistula, postoperative bleeding, gastric emptying disorders, abdominal infection, were not significantly different between the two groups(all P>0.05). Conclusions The operation time of 3D-LPD is shorter than that of 2D-LPD, and the amount of bleeding is less. Short-term clinical data showed that, 3D-LPD is effective, safe and worth popularizing.

Objective:to apply Fuzhengkangai AIDS particles combined therapy with effective antiretroviral therapy (HAART) at the beginning of the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) patients,observe its clinical curative effect and improve the related adverse reactions.Methods:a multicenter,randomized,double-blind,placebo-controlled clinical research method,divided into experimental group and the control group (n =57),experimental group to "Fuzhengkangai particles" joint efficient antiretroviral therapy (HAART) antiviral treatment,control group to "Fuzhengkangai particles" placebo (5％ low dose) joint efficient antiretroviral therapy (HAART) antiviral treatment,treatment for 3 months.Two groups of patients with simultaneous liver and kidney function,blood routine,CD4 + T lymphocyte count,the observation of TCM symptoms and signs,survival quality of integral.Results:after 12 weeks of treatment,the control group and experimental group,the experimental group significantly elevated levels of peripheral blood RBC,lower levels of CR,reduce the signs and symptoms (total score,fatigue,stay,and spontaneous perspiration)integral,higher levels of CD4 + T lymphocyte count and survival quality score,the difference had statistical significance (p ＜ 0.05).Conclusion:Fuzhengkangai particles joint efficient antiretroviral therapy (HAART) antiviral treatment,can improve HAART after initial treatment of the patient's clinical symptoms,blood toxicity,the quality of survival,reduce the antiviral treatment of adverse reactions,combination drug alone can significantly increase the CD4 + T lymphocytes,so as to improve clinical curative effect.