Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.

Objective:To summarize the experience in the treatment of giant neurofibromas.Methods:A retrospective analysis was performed on the clinical information of patients with giant neurofibromas who were admitted to the Department of Burn and Plastic Surgery, Yichang Central People’s Hospital from January 2019 to December 2022. Preoperative endovascular embolization was performed by interventional technique. Intraoperatively, the tumor was stripped while hemostasis was performed, and the tumor was completely removed radically. Depending on the type of wound, the wound was closed directly, or with the meshed full-thickness skin taken from the surface of the tumor. The vacuum sealing drainage dressing with a stable suction pressure of -150 - -250 mmHg(1 mmHg=0.133 kPa) was used. Then tumor recurrence, defect repair, and associated complications were observed and followed up.Results:A total of 4 patients were included, 2 males and 2 females, aged 43-56 years with an average age of 49.3 years. Two patients had previous resection surgery at other hospitals. The tumors in the four patients were situated in the left thigh, buttocks, left waist and left leg respectively, with volumes of 20 cm×10 cm×10 cm, 50 cm×20 cm×15 cm, 20 cm×15 cm×10 cm and 15 cm×10 cm×8 cm correspondingly. After resection of the tumor from the left thigh and leg, the wounds were closed directly. The mesh skin graft from the tumor on the buttock and left waist was used for wound after tumor resection. Following the surgery, the patient with a neurofibroma on the buttock was transferred to the intensive care unit due to excessive blood loss. The sinus tract was formed, but healed after several dressing changes. The vacuum sealing dressing and sutures were removed two weeks after the operation for other cases. The wounds healed well and during the six months to three years follow-up, no tumor recurrence, impairment of motor or sensory function was found.Conclusion:Surgical resection and plastic surgery techniques are effective in treating giant neurofibromas. Preoperative tumor embolization and complete removal of the tumor during surgery can significantly reduce the risk of bleeding. The wounds resulted from tumor resection can be directly closed or with meshed from skin grafts on the tumor surface. Vacuum sealing drainage can also promote wound healing.

Objective:To summarize the experience in the treatment of giant neurofibromas.Methods:A retrospective analysis was performed on the clinical information of patients with giant neurofibromas who were admitted to the Department of Burn and Plastic Surgery, Yichang Central People’s Hospital from January 2019 to December 2022. Preoperative endovascular embolization was performed by interventional technique. Intraoperatively, the tumor was stripped while hemostasis was performed, and the tumor was completely removed radically. Depending on the type of wound, the wound was closed directly, or with the meshed full-thickness skin taken from the surface of the tumor. The vacuum sealing drainage dressing with a stable suction pressure of -150 - -250 mmHg(1 mmHg=0.133 kPa) was used. Then tumor recurrence, defect repair, and associated complications were observed and followed up.Results:A total of 4 patients were included, 2 males and 2 females, aged 43-56 years with an average age of 49.3 years. Two patients had previous resection surgery at other hospitals. The tumors in the four patients were situated in the left thigh, buttocks, left waist and left leg respectively, with volumes of 20 cm×10 cm×10 cm, 50 cm×20 cm×15 cm, 20 cm×15 cm×10 cm and 15 cm×10 cm×8 cm correspondingly. After resection of the tumor from the left thigh and leg, the wounds were closed directly. The mesh skin graft from the tumor on the buttock and left waist was used for wound after tumor resection. Following the surgery, the patient with a neurofibroma on the buttock was transferred to the intensive care unit due to excessive blood loss. The sinus tract was formed, but healed after several dressing changes. The vacuum sealing dressing and sutures were removed two weeks after the operation for other cases. The wounds healed well and during the six months to three years follow-up, no tumor recurrence, impairment of motor or sensory function was found.Conclusion:Surgical resection and plastic surgery techniques are effective in treating giant neurofibromas. Preoperative tumor embolization and complete removal of the tumor during surgery can significantly reduce the risk of bleeding. The wounds resulted from tumor resection can be directly closed or with meshed from skin grafts on the tumor surface. Vacuum sealing drainage can also promote wound healing.

Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.

Objective:To establish and evaluate a new real-time quality control method that can identify the random errors by using the backpropagation neural network (BPNN) algorithm and taking blood glucose test as an example.Methods:A total of 219 000 blood glucose results measured by Siemens advia 2 400 analytical system from January 2019 to July 2020 and derived from Laboratory Information System of Beijing Chaoyang Hospital Laboratory Department was regarded as the unbiased data of our study. Six deviations with different sizes were introduced to generate the corresponding biased data. With each biased data, BPNN and MovSD algorithms were used and tested, and then evaluated by traceability method and clinical method.Results:For BPNN algorithm, the block size was pre-set to 10 and the false-positive rate in all biases was within 0.1%. For MovSD, however, the optimal block size and exclusive limit were 150 and 10% separately and its false-positive rate in all biases was 0.38%, which was 0.28% higher than BPNN. Especially, for the least two error factors of 0.5 and 1, all the random errors were not detected by MovSD; for the error factor larger than 1, random errors could be detected by MovSD but the MNPed was higher than that of BPNN under all deviations. The difference was up to 91.67 times. 460 000 reference data were produced by traceability procedure. The uncertainty of BPNN algorithm evaluated by these reference data was only 0.078%.Conclusion:A real-time quality control method based on BPNN algorithm was successfully established to identify random errors in analytical phase, which was more efficient than MovSD method and provided a new idea and method for the identification of random errors in clinical practice.

Objective:To investigate the application value of establishing the differential diagnosis model of pulmonary tuberculosis using routine laboratory data.Methods:The retrospective study was conducted. The routine laboratory data of newly diagnosed patients with pulmonary tuberculosis and other pulmonary diseases in Beijng Jishuitan Hospital and Beijing Hepingli Hospital from May 2015 to November 2021were collected. According to the random numbers showed in the computer, all the 11516 patients were divided into training dataset and test dataset with a ratio of 9∶1. Four machine learning algorithms, Support Vector Machine, Random Forest, K-Nearest Neighbor and Logistic Regression, were used to build models and select features. The diagnostic accuracy of each model was verified by using the 10-fold cross-validation method and the performance of each model was evaluated by using the receptor operator of characteristic (ROC) curve.Results:Random Forest was selected as the optimal machine learning algorithm to build the best feature model in the study. According to importance scale of factors, the differential diagnosis model of pulmonary tuberculosis consisting of 37 non-specific test indexes. In the validation set and test set the accuracy and area under curve (AUC) of the models were 0.747 and 0.736, the sensitivity, specificity and accuracy were 68.03% and 68.75%, 70.91% and 67.90%, 70.30% and 68.12%, respectively.Conclusion:A key tool in the differential diagnosis model of pulmonary tuberculosis was established by routine laboratory data in combination with machine learning. The results of this study need to be further verified by more data from medical institutions.

Objective:To explore the clinical effect of R-MAD (rituximab, methotrexate, cytarabine, dexamethasone) regimen in the treatment of primary ocular adnexal double-expression diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of an elderly patient with primary ocular adnexal double-expression DLBCL who was treated with R-MAD regimen in June 2019 in Fujian Medical University Union Hospital was retrospectively analyzed. The clinical manifestations, diagnosis and treatment, prognosis were also analyzed, and the related literature was reviewed.Results:The patients was a 71-year-old male. After initial treatment of R-CHOP chemotherapy, the patient's eye mass did not shrink, the swelling and pain became worse, the curative effect was not good, and the disease progression continued. After the patient was given R-MAD chemotherapy for 3 courses, the eye swelling subsided and pain symptoms were significantly improved, satisfactory results were obtained, and no obvious adverse reactions occurred.Conclusions:R-MAD regimen has an ideal effect on the patient with primary ocular adnexal double-expression DLBCL, which can significantly improve symptoms, delay disease progression, and improve the quality of life of patients, but the prognosis still needs to be followed up in the long-term.

Objective To investigate the expression of paired box 2 (Pax2) and E-cadherin in human renal cell carcinoma (RCC) and their correlation with clinicopathologic parameters.Methods The RCC tissue microarrays containing 85 renal cell carcinoma specimens and 35 normal kidney tissue specimens were used to detect Pax2 and E-cadherin expressions by immunohistochemistry.Results The positive expression rate of Pax2 was 77.6％ (66/85) in RCC specimens,which was significantly higher than that in 35 normal kidney tissue specimens (P ＜ 0.01).The positive expression rate of E-cadherin was 30.6％ (26/85) in RCC specimens,which was significantly lower than that in 35 normal kidney tissue specimens (P ＜ 0.01).The expression of Pax2 in RCC was significantly related to histological classification and pathological grade (P ＜ 0.05),while it was not related to the size of tumor and clinical stage (P ＞ 0.05).The expression of E-cadherin in RCC was significantly related to the size of tumor,histological classification,pathological grade and clinical stage (P ＜ 0.05).The positive expression rate of E-cadherin in survival group was significantly higher than that in death group (P ＜ 0.05).Conclusions The abnormal expressions of Pax2 and E-cadherin may play a crucial stage in development of human RCC.Detection of the expressions of Pax2 and E-cadherin can be used in the evaluation of malignant degree and prognosis of RCC.

Objective To apply Nutritional Risk Screening-2002(NRS-2002) to perform primary screening for nutritional risk in patients with esophageal cancer who undergo radiotherapy, and assess their nutritional status, and to investigate the value of NRS-2002 in such patients.Methods A total of 97 patients who were diagnosed with esophageal cancer and underwent radiotherapy in Zhejiang Cancer Hospital from January 2010 to April 2014 were analyzed retrospectively.The Kaplan-Meier method was applied to analyze the difference in survival, and the chi-square test and the Pearson correlation analysis were applied to analyze the correlation between NRS-2002 score and blood parameters.Results Of all patients, 26.8%had nutritional risk before radiotherapy, which gradually increased with the progress of radiotherapy.The 1-year overall survival rates of the patients with NRS-2002scores of ≤3 and ≥4 on admission were 91.1%and 61.9%, respectively (P=0.010).As for the patients with the highest NRS-2002 scores of ≤2 and ≥3 during treatment, the 1-year overall survival rates were 94.2% and 77.5%, respectively (P=0.012).As for the patients with the lowest NRS-2002 scores of ≤3 and ≥4 during treatment, the 1-year overall survival rates were 91.3% and 54.5%, respectively ( P=0.018).The NRS-2002 score was correlated with prealbumin on admission and at week 1 of radiotherapy (P=0.000 and 0.002), and the NRS-2002 score was correlated with albumin at week 3 of radiotherapy (P=0.036).The multivariate analysis showed that the TNM stage of esophageal cancer and the highest NRS-2002 score during treatment were the independent prognostic factors in esophageal cancer (P=0.001 and 0.005).Conclusions The patients with esophageal cancer undergoing radiotherapy have high nutritional risk, and NRS-2002 score is the independent prognostic factor in these patients and can be used as a tool for primary screening for nutritional risk.

Objective To investigate the value of glycated hemoglobin(HbA1c)and urine trace albumin (u -ALB)content in early diagnosis of type 2 diabetic nephropathy.Methods 200 patients with type 2 diabetes were selected as diabetes group,and 30 cases of healthy people as control group.According to the content of HbA1c, the diabetes patients were re -divided into low group (HbA1c <7%),the median group(7.1%≤HbA1c≤10%) and high value group (HbA1c >10.1%).The levels of HbA1c and u -ALB were detected and the correlation between them was calculated.Results The values of HbA1c (8.85 ±1.22)% and u -ALB (88.3 ±12.4)mg/L in the diabetes group were significantly higher than those of the control group (t =10.88,54.25,all P <0.05);The level of HbA1c in the high,medium and low group[(11.02 ±1.37)%,(8.45 ±2.01)%,(6.88 ±1.23)%]were consistent with the levels of the respective levels of fasting glucose[(13.22 ±2.05)mmol/L,(9.25 ±1.28)mmol/L, (6.27 ±0.63)mmol/L].HbA1c and constituting the u -ALB levels were positively correlated in the high,medium and low group(r =0.452,0.512,0.452,all P <0.05).Conclusion The combined detection of HbA1c and u -ALB levels has important value for early diagnosis of type 2 diabetic nephropathy.